II. Causes
- Ventricular Dysrhythmias (common post-MI)
- Bradyarrhythmia
- Atrioventricular Block
III. Approach: Ventricular Tachycardia
- Non-Sustained Monomorphic Ventricular Tachycardia (duration <30 seconds)
- Avoid Antiarrhythmic medications
- Suppression of Non-Sustained Ventricular Tachycardia does not decrease morbidity or mortality
- Risk of adverse effects
- Evaluate for underlying causes
- Electrolyte abnormalities
- Ongoing coronary ischemia
- Avoid Antiarrhythmic medications
- Sustained Monomorphic Ventricular Tachycardia (duration >30 seconds) or causing hemodynamic instability
- Typically caused by Myocardial Infarction scar
- Cardioversion for Unstable Patients
- Start Antiarrhythmic (choose one)
- Amiodarone (preferred, beta blocking activity)
- Lidocaine
- Procainamide
- Polymorphic Ventricular Tachycardia (Normal QTc, non-Torsades)
- Typically caused by ongoing coronary ischemia
- Cardioversion for Unstable Patients
- Start Antiarrhythmic if persists and not cardioverted (choose one)
- Amiodarone (preferred, beta blocking activity)
- Lidocaine
- Prevention following resolution
- Consider Beta Blocker
IV. Approach: Ventricular Fibrillation
- Defibrillate immediately
- Following Return of Spontaneous Circulation (ROSC)
- Antiarrhythmic medications are not typically recommended for prophylaxis
- Consider Beta Blockers to dampen adrenergic surge
V. Approach: Accelerated Idioventricular Rhythm (AIVR)
- Similar appearance to Ventricular Tachycardia, but slower (<130 bpm)
- May be associated with reperfusion (e.g. following Thrombolytics, but inconsistent association)
- Avoid Antiarrhythmic medications
- Evaluate for ongoing Myocardial Ischemia
- Consult Cath Lab for possible activation
VI. References
- Mattu and Swaminathan in Swadron (2022) EM:Rap 22(1): 9-10