Template:ACLS Wide Regular Tachycardia

Wide Regular Tachycardia

Pulseless: see Adult pulseless arrest

• Unstable: Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure
  • Synchronized cardioversion 100-200J
• Stable:
  1. Medications
     • Procainamide
       • 20-50mg/min; then maintenance infusion of 1-4mg/min x6hr
       • Treat until arrhythmia suppressed, QRS duration increases >50%, hypotension, Max 17mg/kg or 1 gram
       • Avoid if prolonged QT or CHF
     • Procainamide 100 mg q5min at max rate of 25-50 mg/min
       • Until termination of arrhythmia, then start 2-6 mg/min (or 1-2 mg/min for renal/cardiac failure) OR
       • Max 17 mg/kg total dose given (12 mg/kg if renal failure) OR
       • If QRS widens > 50%
       • Favored over Amiodarone in PROCAMIO trial; termination of tachycardia in 67% of procainamide group vs 38% of amiodarone group, adverse cardiac events 9% vs 41%, respectively
     • Amiodarone
       • 150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr
     • Adenosine
       • May be considered for diagnosis and treatment only if rhythm is regular and monomorphic
  2. Synchronized Cardioversion (100J)