Sustained monomorphic ventricular tachycardia (SMVT) presenting with haemodynamic instability is a time-critical clinical emergency. Rapid deterioration can occur even when the arrhythmia initially appears tolerated, making immediate intervention the priority.
Haemodynamic instability at presentation defines this scenario. DC cardioversion is the recommended first-line treatment — prompt termination is essential, as haemodynamic deterioration may occur rapidly even in initially tolerated SMVT.
Management centres on immediate electrical intervention to terminate the arrhythmia. The protocol also specifies the approach when the primary method cannot be applied as intended, and addresses when advanced life support should be instituted.
The full sequence, contingency steps, and all clinical conditions are available in the complete structured protocol.
Termination of ventricular tachycardia with restoration of haemodynamically stable sinus rhythm.
DOI: 10.1093/eurheartj/ehac262
Patients presenting with haemodynamic instability require immediate synchronized cardioversion.
DC cardioversion is recommended as the first-line treatment for patients with haemodynamically not-tolerated SMVT.
If synchronization is not possible, an unsynchronized shock should be used.
In case of haemodynamic instability at initial evaluation, institution of advanced life support (ALS) is recommended.
Prompt termination of SMVT is recommended even for tolerated SMVT, as rapid haemodynamical deterioration may occur.
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