What are the treatment options for hemodynamically stable monomorphic ventricular tachycardia (VT)?

Updated: Dec 05, 2017
  • Author: Steven J Compton, MD, FACC, FACP, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

In stable patients with monomorphic VT and normal LV function, restoration of sinus rhythm is typically achieved with intravenous (IV) procainamide, amiodarone, or sotalol. Lidocaine may also be used, but this agent may have common and limiting side effects and, consequently, increase the overall mortality risk. A 12-lead electrocardiogram (ECG) is obtained before conversion.

If LV function is impaired, amiodarone (or lidocaine) is preferred to procainamide for pharmacologic conversion because of the latter drug’s potential for exacerbating heart failure. However, mounting evidence indicates that amiodarone should not be the first-line antiarrhythmic for stable VT, because its effects on myocardial conduction and refractoriness are gradual in onset. [52, 53, 54, 55] If medical therapy is unsuccessful, synchronized cardioversion (50-200 J monophasic) following sedation is appropriate.


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