Ventricular tachycardia medical therapy: Difference between revisions

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* [[Procainamide]] is preferred to use in the setting of recurrent stable hemodynamic [[VT]], without evidence of acute[[ MI]], and absence of [[Long QTC]] in the [[ECG]].
* [[Procainamide]] is preferred to use in the setting of recurrent stable hemodynamic [[VT]], without evidence of acute[[ MI]], and absence of [[Long QTC]] in the [[ECG]].
* [[lidocaine]] was less effective than [[amiodarone]] to improve [[hospital]] admission after [[out-of-hospital cardiac arrest]] due to shock-refractory [[VF]] or polymorphic [[VT]], but there were no differences between the two [[medications]] in [[survival]] to [[hospital]] discharge.
* [[lidocaine]] was less effective than [[amiodarone]] to improve [[hospital]] admission after [[out-of-hospital cardiac arrest]] due to shock-refractory [[VF]] or polymorphic [[VT]], but there were no differences between the two [[medications]] in [[survival]] to [[hospital]] discharge.
*[[Lidociane]]  improved [[survival]] to [[hospital]] discharge in witnessed [[SCA]] due to initial shock-refractory [[VF]] or pulseless [[VT]].


==References==
==References==

Revision as of 05:23, 12 May 2021

Ventricular tachycardia Microchapters

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Overview

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Differentiating Ventricular Tachycardia from other Disorders

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sara Zand, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3], Avirup Guha, M.B.B.S.[4]

Overview

Medical Therapy

Common medications for treatment of VT include:[1]

Sodium channel blocker

Ranolazine

  • NO efficacy in reduction the fist VT, VF in high risk patients, but significant reduction of recurrent VT, VF requiring ICD implantation.[6]

Beta blocker

Amiodarone, sotalol

Calcium channel blocker

Electrolytes

Fatty acids, Lipids

Specific recommendation





Antiarrhythmic medications

[37]


Arrhythmiac medication, class, dose Indication Receptor target Electrophysiologic effect Pharmacological characteristics Common advers effects
Acebutolol

PO 200–1200 mg daily, up to 600 mg bid

VT, PVC B1, mild internistic sympathetic activity Slowing sinus rate, increasing AV nodal refractoriness Prolonged haft life in renal impairment, metabolism: hepatic Bradycardia, hypotension, HF, AV block, Dizziness, fatigue, anxiety, impotence, hyperesthesia,hypoesthesia
Amiodarone (III)

IV:VF/pulseless VT arrest: 300 mg bolus, stable VT: 150-mg bolus then 1 mg/min x 6 h, then 0.5 mg/min x 18 h PO: 400 mg q 8 to 12 h for 1–2 wk, then 300–400 mg daily; reduce dose to 200 mg daily if possible

VT, VF, PVC INa, ICa, IKr, IK1, IKs, Ito, Beta receptor, Alpha receptor, nuclear T3

recepto

Slowed sinus rate, QRS prolongation, QTc prolongation, increased AV nodal refractoriness ,increased defibrilation threshold Metabolism: hepatic, half life: 26-107 days Hypotension, bradycardia, AV block, TdP, slowing VT below programmed ICD detection rate, increased defibrillation threshold, corneal microdeposits, thyroid abnormalities, ataxia, nausea, emesis, constipation, photosensitivity, skin discoloration, ataxia, dizziness, peripheral neuropathy, tremor, hepatitis, cirrhosis, pulmonary fibrosis, pneumonitis
Atenolol (II)

PO: 25–100 mg qd or bid

VT, PVC, ARVC, LQTS Beta 1 Slowed sinus rate ,
increased AV nodal refractoriness
Metabolism: hepatic Bradycardia, hypotension, heart failure, AV block, dizziness, fatigue, depression, impotence
Bisoprolol (II)

PO: 2.5–10 mg once daily

VT, PVC Beta 1 receptor Slowed sinus rate, increased AV nodal refractoriness Metabolism: hepatic Chest pain, bradycardia, AV block, Fatigue, insomnia, diarrhea
Carvedilol (II)

PO: 3.125–25 mg q 12 h

VT, PVC Beta 1, Beta 2, Alpha Slowed sinus rate, increased AV nodal refractoriness Metabolism: hepatic Bradycardia, hypotension, AV block, edema, syncope, Hyperglycemia, dizziness, fatigue, diarrhea
Carvedilol (II)

PO: 3.125–25 mg q 12 h

VT, PVC Beta 1, Beta 2, Alpha Slowed sinus rate, increased AV nodal refractoriness Metabolism: hepatic Bradycardia, hypotension, AV block, edema, syncope, Hyperglycemia, dizziness, fatigue, diarrhea
Diltiazem (IV)

IV: 5–10 mg,qd: 15–30 min, Extended release: PO: 120–360 mg/da, PO: 3.125–25 mg q 12 h

RVOT VT, ideopathic left VT ICa-L Slowed sinus rate, slowed AV node conduction, PR prolongation Metabolism: hepatic Bradycardia, hypotension, AV block, edema, exacerbation of HF reduced EF, Headache, rash, constipation
Esmolol (II)

IV: 0.5 mg/kg bolus, 0.05 mg/kg/min

VT B1 Slowed sinus rate, increased AV node refractoriness Metabolism: RBC Bradycardia, hypotension, AV block, HF, dizziness, neusea
Flecainide (IC) PO: 50–200 mg q 12 h VT, PVC (in the absence of structural heart disease), CPVT INa, IKr, IKur Prolonged PR interval, prolonged QRS duration, increased defibrillation threshold Metabolism: RBC Sinus node dysfunction, AV block, drug-induced Brugada syndrome, monomorphic VT in patients with a myocardial scar, exacerbation of HFrEF
Lidocaine (IB)

IV: 1 mg/kg bolus, 1–3 mg/min, 1–1.5 mg/kg. Repeat 0.5–0.75 mg/kg bolus every 5–10 min (max cumulative dose 3 mg/kg), maintenance infusion: 1–4 mg/min or starting 0.5 mg/min

VT, VF INa Slightly shortening of QTc interval Metabolism: hepatic, prolonged half life in HF, liver disease, shock, severe renal disease Bradycardia, hemodynamic collapse, AV block, sinus arrest, delirium, psychosis, seizure, nausea, tinnitus, dyspnea, bronchospasm
Metoprolol (II) IV: 5 mg q 5 min up to 3 doses, PO: 25–100 mg Extended release qd or q 12 h VT, PVC B1 Slowed sinus rate, increased AV nodal refractoriness Metabolism: None, Excretion: urine Bradycardia, hypotension, AV block, dizziness, fatigue, diarrhea, depression, dyspnea
Metoprolol (II) IV: 5 mg q 5 min up to 3 doses, PO: 25–100 mg Extended release qd or q 12 h VT, PVC B1 Slowed sinus rate, increased AV nodal refractoriness Metabolism: None, Excretion: urine Bradycardia, hypotension, AV block, dizziness, fatigue, diarrhea, depression, dyspnea
Mexiletine (IB), PO: 150–300 mg q 8 h or q 12 h VT, PVC, VF, Long QT3 INa Slightly shortening of QTc interval Metabolism: hepatic HF, AV block, lightheaded, tremor, ataxia, paresthesias, nausea, blood dyscrasias
Nadolol (II)

PO: 40–320 mg daily

VT, PVC, LQTS, CPVT B1, B2 Slowed sinus rate, increased AV nodal refractoriness Metabolism: none, excretion: urine Bradycardia, hypotension, HF, AV block, edema, dizziness, cold extremities, bronchospasm
Procainamide (IA), IV: loading dose 10–17 mg/kg at 20–50 mg/min, maintenance dose: 1–4 mg/min, PO (SR preparation): 500–1250 mg q 6 h VT, PVC, LQTS, CPVT B1, B2 Slowed sinus rate, increased AV nodal refractoriness Metabolism: none, excretion: urine Bradycardia, hypotension, HF, AV block, edema, dizziness, cold extremities, bronchospasm
Propafenone (IC), PO: Immediate release 150–300 mg q 8 h, Extended release 225–425 mg q 12 h VT, PVC (in the absence of structural heart disease]] INa, IKr, IKur, Beta receptor, Alpha recept Prolonged PR interval, prolonged QRS duration, increased defibrillation threshold Metabolism: hepatic HF, AV block, drug-induced Brugada syndrome, dizziness, fatigue, nausea, diarrhea, xerostomia, tremor, blurred vision
Propranolol (II), IV: 1–3 mg q 5 min to a total of 5 mg, PO: Immediate release 10–40 mg q 6 h; Extended release 60–160 mg q 12 h VT, PVC, Long QT syndrome Beta 1 , B2 , INa Slowed sinus rate, increased AV nodal refractoriness Metabolism: hepatic Bradycardia, hypotension, HF, AV block, sleep disorder, dizziness, nightmares, hyperglycemia, diarrhea, bronchospasm
Quinidine (IA), PO: sulfate salt 200–600 mg q 6 h to q 12 h, gluconate salt 324–648 mg q 8 h to q 12 h, IV: loading dose: 800 mg in 50 mL infused at 50 mg/min VT, VF, short QT syndrome, brugada INa, Ito, IKr, M, Alpha receptor QRS prolongation, QTc prolongation, increased defibrillation threshold Metabolism: hepatic [[Syncope], torsades de pointes, AV block, dizziness, diarrhea, nausea, esophagitis, emesis, tinnitus, blurred vision, rash, weakness, tremor, blood dyscrasias
Ranolazine (not classified), PO: 500–1000 mg q 12 h VT INa, IKr Slowed sinus rate, QTc prolongation Metabolism: hepatic Bradycardia, hypotension, headache, dizziness, syncope, nausea, dyspnea
Sotalol (III), IV: 75 mg q 12 h, PO: 80–120 mg q 12 h, may increase dose every 3 d; max 320 mg/d VT, VF, PVC B1, B2 IKr Slowed sinus rate, QTc prolongation, increased AV nodal refractoriness, decreased defibrillation threshold Metabolism: none Bradycardia, hypotension, HF, syncope, TdP, fatigue, dizziness, weakness, dyspnea, bronchitis, depression, nausea, diarrhea
Verapamil, IV: 2.5–5 mg q 15–30 min, sustained release PO: 240–480 mg/d RVOT VT, verapamil-sensitive idiopathic Left VT ICa-L Slowed sinus rate,PR prolongation, slowed AV nodal conduction Metabolism: hepatic Hypotension, edema, HF, AV block, bradycardia, exacerbation of HF reduced EF, headache, rash, gingival hyperplasia, constipation, dyspepsia

Specific recommendation

References

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