View source for Template:ACLS Narrow Irregular Tachycardia

===[[Narrow complex tachycardia|Narrow ''Irregular'' Tachycardia]]===
*Multi-focal atrial tachycardia (MAT)
**Treat underlying cause (hypokalemia, hypomagnesemia)
**Consider [[diltiazem]]
**Avoid beta blockers unless they are already known to be tolerated, as airway disease often co-morbid
**If not symptomatic and rate < 110/120 bpm, may not require treatment (e.g., patient with MAT secondary to COPD)
*Sinus Tachycardia with frequent PACs
**Treat underlying cause
*[[A fib]] / A Flutter with variable conduction (see also [[Atrial Fibrillation with RVR]])
**Check if patient has taken usual rate-control meds
***If missed dose, may provide dose of home medication and observe for resolution
**Determine whether patient is better candidate for rate control or rhythm control <ref>Frankel, G. et al. (2013) Rate versus rhythm control in atrial fibrillation. Canadian Family Physician 59(2), 161 - 168</ref>
***Rate control preferred with:
****Persistent A fib
****Less symptomatic patients
****Age 65 or older
****Hypertension
****No heart failure
****Previous failure to cardiovert
****Patient preference
***Rhythm control preferred with:
****Paroxismal or new A fib
****More symptomatic patients
****Age < 65 years
****Heart failure clearly exacerbated by A fib
****No history of rhythm control failure
****Patient preference
**Rate control with:
***[[Diltiazem]]
***[[Metoprolol]]
***[[Amiodarone]] (good in setting of hypotension, CHF)
***[[Digoxin]] (good in setting of CHF)
**Rhythm conversion with:
***Synchronized [[Cardioversion]] (120-200 J)
****Best performed on patients with new onset A fib or patients fully therapeutically anti-coagulated for > 3 weeks
***[[Procainamide]] per [[EBQ:Ottawa Aggressive ED Cardioversion Protocol|Ottawa Aggressive ED Cardioversion Protocol]]