Ventricular tachycardia electrical cardioversion: Difference between revisions
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*[[Epinephrine ]] IV/IO Dose: 1 mg every 3–5 minutes | *[[Epinephrine ]] IV/IO Dose: 1 mg every 3–5 minutes | ||
*[[Amiodarone]] IV/IO Dose: First dose: 300 mg bolus, second dose: 150 mg | *[[Amiodarone]] IV/IO Dose: First dose: 300 mg bolus, second dose: 150 mg | ||
*[[Lidocaine]]: 1–1.5 mg/kg|B02= | *[[Lidocaine]]: 1–1.5 mg/kg|B02='''Advanced [[Airway]]''' | ||
*[[Supraglottic]] advanced [[airway]] or [[endotracheal intubation]] | |||
*10 breaths per minute with maintaining [[chest compressions]]}} | |||
{{familytree | | | | | | C01 |-|-|-|-|-| C02 |-|-|-|-|-| C03 | | | |C01=C01|C02=[[Cardiac arrest]] algorithm|C03=C03}} | {{familytree | | | | | | C01 |-|-|-|-|-| C02 |-|-|-|-|-| C03 | | | |C01=C01|C02=[[Cardiac arrest]] algorithm|C03=C03}} | ||
{{familytree | | | | | | | | | | D01 |-|'|!|`|-| D02 | | | | | | | |D01=D01|D02=D02}} | {{familytree | | | | | | | | | | D01 |-|'|!|`|-| D02 | | | | | | | |D01=D01|D02=D02}} | ||
Revision as of 05:00, 23 May 2021
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Ventricular tachycardia Microchapters |
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Differentiating Ventricular Tachycardia from other Disorders |
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Diagnosis |
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Treatment |
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Case Studies |
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Ventricular tachycardia electrical cardioversion On the Web |
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Ventricular tachycardia electrical cardioversion in the news |
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to Hospitals Treating Ventricular tachycardia electrical cardioversion |
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Risk calculators and risk factors for Ventricular tachycardia electrical cardioversion |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in Chief: Sara Zand, M.D.[2] Avirup Guha, M.B.B.S.[3]
Overview
Therapy may be directed at either terminating an episode of the arrhythmia or for suppressing a future episode from occurring. The treatment is tailored to the specific patient, with regard to how well the individual tolerates episodes of ventricular tachycardia, how frequently episodes occur, their comorbidities, and their wishes. It is usually possible to terminate a VT episode with a direct current shock across the heart. This is ideally synchronised to the patient's heartbeat. As it is quite uncomfortable, shocks should be delivered only to an unconscious or sedated patient.
Electrical Cardioversion
CPR quality
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Medication
| Advanced Airway
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| C01 | Cardiac arrest algorithm | C03 | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| D01 | D02 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| E01 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
- Electrical Cardioversion is usually possible to terminate a VT episode with a direct current shock across the heart.
- Electrical Cardioversion is ideally synchronised to the patient's heartbeat. As it is quite uncomfortable, shocks should be delivered only to an unconscious or sedated patient.
- A patient with pulseless VT will be unconscious and treated as an emergency on a cardiac arrest protocol.
- Elective cardioversion is usually performed in controlled circumstances with anaesthetic and airway support.
- The shock may be delivered to the outside of the chest using an external defibrillator, or internally to the heart by an implantable cardioverter-defibrillator (ICD) if one has previously been inserted.
- An ICD may also be set to attempt to overdrive pace the ventricle. Pacing the ventricle at a rate faster than the underlying tachycardia can sometimes be effective in terminating the rhythm.
- If this fails after a short trial, the ICD will usually stop pacing, charge up and deliver a defibrillation grade shock.
ACLS Cardiac Arrest Algorithm
| Adult Cardiac Arrest | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Start CPR Give oxygen Attach monitor/defibrillator | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rhythm shockable? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| VF/VT | Asystole/PEA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Shock | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Box A: CPR 2 min IV/IO access | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rhythm shockable? | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Shock | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Box B: CPR 2 min Epinephrine every 3-5 min Consider advanced airway and capnography | Box C: CPR 2 min IV/IO access Epinephrine every 3-5 min Consider advanced airway and capnography | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rhythm shockable? | No | Rhythm shockable? | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Shock | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| CPR 2 min Amiodarone Treat reversible causes | Box D: CPR 2 min Treat reversible causes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Go back to box A | No | Rhythm shockable? | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Shock Then, go to box A or box B | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| If no signs of return of spontaneous circulation: Go to box C or box D If return of spontaneous circulation: Start post cardiac arrest care | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 8.[1]
| ICD with recurrent VT, VF | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Polymorphic VT/VF | Sustained monomorphic VT | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Correction of reversible causes | Catheter ablation as first line therapy (class2b) | Amiodarone, sotalol (class1) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ischemia= revascularization (class1) | Drug, electrolytes: Treating QT prolongation, discontinuation offending drugs, correction electrolytes abnormality (class1) | NO reversible causes | Arrhythmia not controlled | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Amiodarone (class1) | Betablocker (class2a) | Non ischemic cardiomyopathy | IHD with frequent VT or VT storm | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Arrhythmia not controlled | Catheter ablation (class2a) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Considering PVC triggers | Yes: Catheter ablation (class1) | NO: Catheter ablation (class2a) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes: Catheter ablation | NO: Autotomic modulation (class2b) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| The above algorithm adopted from 2017 AHA/ACC/HRS Guideline |
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References
- ↑ Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW; et al. (2010). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S729–67. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224.
- ↑ Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.