monomorphic ventricular tachycardia

Introduction

Ventricular tachycardia in which the QRS complexes maintain a single morphology throughout the tachycardia.

Etiology

• generally from re-entry in patients with structural heart disease
• in the absence of heart disease, may arise from triggered activity, often originating in the ouflow tract of the right ventricle

* also see ventricular tachycardia

Management

(also see ventricular tachycardia)

• hemodynamic instability
  • immediate DC synchronized cardioversion
• stable patient, chemical cardioversion
  • preserved heart function
    • procainamide*
    • sotalol or other beta-blocker
    • amiodarone 150 mg IV over 10 minutes
      • initial bolus followed by continuous infusion
    • lidocaine 0.5-0.75 mg/kg IV push
  • poor LV ejection fraction
    • amiodarone 150 mg IV over 10 minutes
      • initial bolus followed by continuous infusion
    • lidocaine 0.5-0.75 mg/kg IV push
    • then DC synchronized cardioversion
  • coronary revascularization alone in patients with coronary artery disease is unsufficient to prevent recurrent ventricular tachycardia

* procainamide is the agent of choice for chemical cardioversion except in the settings of:

• acute MI
• digoxin toxicity
• poor LV ejection fraction
  • in these cases, lidocaine remains the agent of choice

More general terms

• ventricular tachycardia (VT)