Treatment of Ventricular Tachycardia in Idiopathic Fascicular VT — Haemodynamically Stable Presentation

This protocol addresses the acute management of idiopathic fascicular ventricular tachycardia in patients who are haemodynamically tolerated — presenting without signs of haemodynamic instability.

Clinical scenario: Idiopathic fascicular ventricular tachycardia, haemodynamically tolerated. The absence of haemodynamic compromise permits a pharmacological approach to acute termination rather than immediate electrical intervention.

Acute Approach

In this haemodynamically stable setting, an intravenous calcium channel blocker is the recommended agent for acute conversion of fascicular VT — the complete regimen, repeat dosing guidance, and sequencing are detailed in the full protocol.

Clinical goal: termination of ventricular tachycardia with restoration of sinus rhythm.

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References

DOI: 10.1093/eurheartj/ehac262

In patients presenting with a haemodynamically tolerated idiopathic VT, treatment with intravenous beta-blocker (RVOT VT) or verapamil (fascicular VT) is recommended.

In case of a known idiopathic VT (Figure 4), treatment with beta-blockers (for RVOT VT) or verapamil (for fascicular VT) is recommended for acute conversion.

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