Management of Ventricular and Supraventricular Tachycardia

Ventricular Tachycardia (VTach) Management

The American Heart Association recommends immediate synchronized DC cardioversion as the definitive treatment for pulseless VT or VT with adverse signs, with escalating energy levels: 100 J, then 200 J, then 360 J if initial attempts fail 1, 2
For pulseless VT, the American Heart Association advises following the VF protocol with immediate defibrillation, as pharmacologic treatment is secondary to early defibrillation 1, 2
The use of magnesium may be effective for VF/VT, particularly when associated with acute myocardial infarction, with a recommended dose of 8 mmol bolus followed by 2.5 mmol/h infusion 1, 2
Lidocaine has a significantly lower efficacy than amiodarone for VT termination, with a 27% vs 78% termination rate, and should not be used for supraventricular arrhythmias 1, 2

The American College of Cardiology recommends immediate synchronized cardioversion as the treatment of choice for decompensated patients with SVTach (hypotensive, heart failure, angina, or HR >150 bpm) 1, 3
Vagal maneuvers, such as the modified Valsalva maneuver, carotid sinus massage, or ice-cold wet towel to the face, are first-line interventions for hemodynamically stable SVTach, with a success rate of approximately 43% 1, 4
Adenosine is a second-line treatment for SVTach, with a 90-95% success rate for orthodromic AVRT and approximately 95% for AVNRT, and serves both therapeutic and diagnostic purposes 3, 4
The American Heart Association advises against using calcium channel blockers (diltiazem, verapamil) or beta-blockers in patients with pre-excitation on ECG, as they may enhance conduction over the accessory pathway and potentially lead to ventricular fibrillation and death 3, 4