Treatment of Ventricular Tachycardia

Initial Assessment and Management

• The European Society of Cardiology recommends first determining if the patient has a pulse and assessing hemodynamic stability, checking for adverse signs such as low blood pressure, chest pain, heart failure, or high heart rate 1, 2
• Immediate synchronized DC cardioversion is recommended for unstable VT, with sedation prior to cardioversion if the patient is conscious 1, 2

Pharmacological Management

• The American Heart Association recommends lidocaine as the first-choice antiarrhythmic for VT, with a dosing regimen of 50 mg IV over 2 minutes, repeated every 5 minutes to a total dose of 200 mg, and maintenance with infusion at 2-4 mg/min 1
• Amiodarone is indicated for VT refractory to lidocaine, with a dosing regimen of 5 mg/kg over one hour for stable patients, and maintenance with further loading dose of 15 mg/kg over 24 hours 1

Long-Term Management

• The European Heart Society recommends catheter ablation for patients with scar-related heart disease presenting with incessant VT, patients with recurrent ICD shocks due to sustained VT, and consideration after first episode of sustained VT in patients with ischemic heart disease and ICD 2
• The British Journal of Sports Medicine suggests always administering IV drugs with a 20 ml saline bolus to aid delivery to central circulation, and monitoring for hypotension with antiarrhythmic drugs, especially in already compromised patients 1