Treatment for Patients Who Tolerate Arrhythmia

In patients who are tolerating their arrhythmia, intravenous amiodarone (in a dose of 5 mg/kg up to a maximum of 300 mg) administered over 20-60 minutes is the treatment recommended by the UK Resuscitation Council [1].

Lignocaine is no longer recommended as several studies have confirmed poor efficacy only terminating VT in around 20% of cases. Intravenous procainamide and sotalol, may be superior but the evidence for any treatment is limited currently [2].

Interestingly the AHA/ACC/HRS 2017 practice guidelines have preferentially recommended intravenous procainamide over amiodarone for termination of stable VT [3]. If unsuccessful, DC cardioversion should be considered.

Correction of any underlying abnormalities that might be precipitating the arrhythmia (e.g. hypo/hyperkalaemia and hypomagnesaemia) is also required.