Stable ventricular tachycardia

FIGURE 6-11. Decision algorithm for termination of hemody-namically stable ventricular tachycardia. 

For the treatment of hemodynamically stable ventricular tachycardia in children, procainamide (loading dose of 15 mg/kg IV infused over 30 to 60 minutes) may be considered as an alternative agent to amiodarone. 

Parham WA, Mehdirad AA, Biermaim KM, Fredman CS. Case report adenosine induced ventricular fibrillation in a patient with stable ventricular tachycardia. J Interv Card Electrophysiol 2001 5(1) 71. ... 

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Bocker, D., et al.. Benefits of treatment with implantable cardioverter-defibrillators in patients with stable ventricular tachycardia without cardiac arrest. Br Heart J,... 

Cardioversion is an appropriate, immediate treatment for stable ventricular tachycardia (VT). Alternatives to this treatment depend on the type of VT, the patient s cardiac function, and the configuration of the QT interval. In monomorphic VT, QRS complexes keep the same form or appearance. In polymorphic VT, QRS complexes occur in more than one form, varying in appearance. 

SOTALOL DIURETICS-CARBONIC ANHYDRASE INHIBITORS, LOOP DIURETICS, THIAZIDES t risk of ventricular arrhythmias, particularly torsades de pointes ventricular tachycardia, caused by sotalol Hypokalaemia, a side-effect of these diuretics, predisposes to arrhythmias during sotalol therapy Normalize potassium levels before starting sotalol in patients already taking these diuretics. When starting these diuretics in patients already taking sotalol, monitor potassium levels eveiy 4-6 weeks until stable... 

A 66-year-old developed a ventricular tachycardia after kidney transplantation and was given amiodarone. Maintenance immunosuppression included prednisone, azathioprine, and ciclosporin. Ciclosporin concentrations before amiodarone initiation were stable (range 100-150 ng/ml). During amiodarone therapy, the ciclosporin concentration increased more than two-fold. 

Sustained ventricular tachycardia is defined as consecutive premature ventricular contractions lasting more than 30 seconds. Nonsustained ventricular tachycardia (VT) usually self-terminates and lasts for less than 30 seconds. The acute treatment of SuVT depends on the hemodynamic stability and symptoms of the patient. Unstable patients should receive immediate cardioversion. If patients are stable with mild symptoms, they can be treated with IV antiarrhythmics. 

Acute treatment of TdP is different from treatment for the more common acute monomorphic ventricular tachycardia (or polymorphic VT with a normal QT interval). For an acute episode of TdP, most patients will require and respond to DCC. However, TdP tends to the paroxysmal in nature and often will recur rapidly after countershock. Therefore, after the initial restoration of a stable rhythm, therapy designed to prevent recurrences of TdP should be instituted. Drugs that further prolong repolarization such as intravenous procainamide are absolutely contraindicated. Lidocaine usually is inef-... 

Once the patient is resuscitated successfuUy, antiarrhythmics should be continued until the patient s rhythm and overaU status is stable. If the episode of ventricular flbriUation was associated with acute ischemia, long-term antiarrhythmic drugs probably are uimec-essary, but the patient should be monitored closely for recurrence of ventricular tachycardia and/or ventricular flbriUation. If, on the other hand, ventricular flbriUation was not associated with acute MI (or a known precipitating factor), the patient should undergo invasive elec-trophysiologic studies and (depending on the results) probably ICD implantation (Fig. 17-16). 

Stable Strontium. Cardiovascular effects of strontium have been investigated by intravenous infusion studies in dogs. Infusions of strontium (as chloride or gluconate) averaging 172 mg strontium/kg under conditions of lowered potassium induced accelerated ventricular escape beats, ventricular tachycardia, or atrial fibrillation (Foster et al. 1977). High levels of strontium also induced oscillatory potentials and... 

Stable monomorphic or polymorphic ventricular tachycardia algorithm... 

Verapamil (80 mg p.o. q. 6 to 8 hours) is indicated in the management of Prinzmetal s or variant angina or unstable or chronic, stable angina pectoris verapamil (0.075 to 0.15 mg/kg rv pnsh over a 2-minnte period) is indicated in the treatment of supraventricnlar tachyarrhythmias verapamil (240 to 480 mg p.o. daily) is indicated in the prevention of recurrent paroxysmal supraventricular tachycardia verapamil (240 to 320 mg p.o. daily) is indicated in the control of the ventricular rate in digitalized patients with chronic atrial flatter and/or fibrillation and verapamil (80 mg p.o. t.i.d.) is indicated in the management of hypertension. 

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