Author: Aaron Lessen, MD

Educational Pearls:

• Defined as QRS over 120 ms and rate over 120
• Two major rhythms = Vetricular tachycardia (VT) or SVT with aberrancy
• Safest approach is to assume it is VT
• Synchronized Cardioversion is preferred even for stable VT for multiple reasons including safety and efficacy
• Procainamide is preferred pharmacologic option
• Amiodarone is less preferred third option
• Calcium channel blockers (i.e. diltiazem) can worsen certain rhythms and should be avoided

References:

Long B, Koyfman A. Best Clinical Practice: Emergency Medicine Management of Stable Monomorphic Ventricular Tachycardia. J Emerg Med. 2017 Apr;52(4):484-492. doi: 10.1016/j.jemermed.2016.09.010. Epub 2016 Oct 15. Review. PubMed PMID: 27751700.

Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD