Wide-complex tachycardia

Stable wide-complex tachycardia with a regular rhythm... 

Stable wide-complex tachycardia with an irregular rhythm o If atrial fibrillation with aberrancy (see Table 1.7)... 

Perfusing stable VT, wide complex tachycardia or ectopy ... 

Unlabeled Uses Control of hemodynamicallystableventriculartachycardia, control of rapid ventricular rate due to accessory pathway conduction in preexcited atrial arrhythmias, conversion of atrial fibrillation to normal sinus rhythm, in cardiac arrest with persistent ventricular tachycardia or ventricular fibrillation, paroxysmal supraventricular tachycardia, polymorphic ventricular tachycardia or wide complex tachycardia of uncertain origin, prevention of postoperative atrial fibrillation... 

Contraindications are hypotension, cardiogenic shock, marked bradycardia, second or third degree AV-block, Wolff-Parkinson-White (WPW) syndrome, wide complex tachycardia, VT and uncompensated heart failure. 

Francis J, Hamzeh RK, Cantin-Hermoso MR. Lithium toxicity-induced wide-complex tachycardia in a pediatric patient. J Pediatr 2004 145 235 10. 

A 43-year-old man injected a large dose of cocaine in a suicide attempt and had a seizure and cardiopulmonary arrest, from which he was resuscitated. His arterial blood pH was 6.72 and his electrocardiogram showed a wide complex tachycardia. An infusion of sodium bicarbonate maintained the blood pH at 7.50 and the electrocardiogram became normal. The bicarbonate infusion was discontinued after 12 hours. 

A 75-year-old man who had had coronary bypass surgery was given an intravenous infusion of adenosine for stress testing (25). After 1 minute he developed a three-beat run of wide-complex tachycardia, followed by a 20-second run of a regular wide-complex tachycardia at a rate of 115/minute. There was left bundle branch block, and the tachycardia ended spontaneously. Adenosine infusion was continued and some ventricular extra beats with the same configuration occurred. In this case there was impaired perfusion of the left ventricle. 

A 52-year-old woman with a wide-complex tachycardia was given adenosine 6,12, and another 12 mg as intravenous bolus doses immediately after the third dose she developed ventricular fibrillation (27). She recovered with cardioversion. 

A 57-year-old man with a wide-complex tachycardia was given lidocaine 100 mg intravenously and immediately became asystolic. Resuscitation was unsuccessful. 

A 31-year-old woman had a cardiac arrest and was resuscitated to a wide-complex tachycardia, which was treated with intravenous lidocaine 100 mg. She immediately became asystohc but responded to calcium chloride. 

A 79-year-old man took about 19 g of procainamide and developed lethargy, vomiting, a wide-complex tachycardia, hypotension, and coma (60). His serum procainamide concentration was 77 pg/ml at 3 hours. He was treated with vasopressors and peritoneal dialysis. 

Wide-complex tachycardias occurred in two elderly patients (a 74-year-old man and an 80-year-old woman) who had taken propafenone for atrial fibrillation (23). In the first case the dysrhythmia was due to atrial flutter with 1 1 conduction. 

Amiodarone is indicated for the suppression and prevention of documented life-threatening, recurrent, ventricular tachycardia or fibrillation when other agents have failed. Amiodarone is also used in the management of supraventricular tachyarrhythmias including paroxysmal atrial fibrillation and atrial flutter, ectopic or multifocal atrial tachycardia, junctional tachycardia, and paroxysmal reentrant supraventricular tachycardia when other agents have failed to suppress or prevent their recurrence. Amiodarone has also been used to treat wide-complex tachycardia of uncertain mechanism. 

C. CardiotDxic ( membrane-stabilizing ) drug intoxication. Give 1-2 mEq/kg IV bolus over 1-2 minutes repeat as needed to improve cardiotoxic manifestations (eg, prolonged QRS interval, wide-complex tachycardia, hypotension) and to maintain serum pH at 7.45-7.55. There is no evidence that constant infusions are as effective as boluses given as needed. 

A 36-year-old woman with a history of hypothyroidism became lethargic after taking an overdose of diphenhydramine. Her serum concentration was 1200 ng/ml. She developed generalized seizures, which continued for 30 minutes despite intravenous lorazepam 8 mg. A propofol infusion terminated the seizures. An electrocardiogram showed a wide complex tachycardia with a QRS duration of 12 ms, which narrowed after administration of intravenous sodium bicarbonate 200 mmol. She recovered within 2 days. 

Jang DH, Manini AF, Trueger NS, Duque D, Nestor NB, Nelson LS, Hoffman RS. Status epilepticus and wide-complex tachycardia secondary to diphenhydramine overdose. Clin Toxicol 2010 48 (9) 945-8. 

Drug overdose Life-threatening flecainide intoxication in a 2-year-old toddler occurred when syringes used for oral administration were accidentally reversed, producing a fivefold flecainide overdose 3 hours after drug administration he developed a bradycardia of 50/minute and had a cardiopulmonary arrest, requiring resuscitation and adrenaline, after which the bradycardia recurred, followed by a wide-complex tachycardia that converted rapidly to a narrow-complex tachycardia after bolus intravenous adrninistration of sodium bicarbonate [60 ]. He then remained hemo-dynamicaUy stable and in sinus rhjflhm. The serum flecainide concentration was 0.7 mg/1. 

The electrophysiology test may be useful for specific clinical situations. The electrophysiology test may be useful for patients with wide complex tachycardia of unclear mechanism (76) and for patients with syncope and impaired left ventricular function or structural heart disease (76). Examples include a patient with left ventricular dysfunction and a recent non-Q-wave myocardial infarction who has suffered a sustained arrhythmia near the time of the acute myocardial infarction and a patient who has a cardiac arrest after cardiac surgery, in the throes of acute congestive heart failure, or during infusion of an inotropic drug. 

Cardiovascular Amiodarone-induced torsade de pointes has been reported in a patient with Wolff-Parkinson-White syndrome who had been given intravenous amiodarone for a wide-complex tachycardia [24 ]. Aas sinus rhythm was restored, QT interval prolongation and T wave alter-nans occurred, followed by symptomatic torsade de pointes. The dysrhythmia spontaneously terminated after discontinuation of intravenous amiodarone. 

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