Sustained Monomorphic Ventricular Tachycardia with Structural Heart Disease: What to Do When Procainamide or Amiodarone Has Not Converted the Arrhythmia
Clinical Scenario
The patient presents with sustained monomorphic ventricular tachycardia (SMVT) in the context of known or suspected structural heart disease. The arrhythmia is haemodynamically tolerated — no signs of haemodynamic instability are present.
Previous Treatment Did Not Reach the Goal
Initial antiarrhythmic therapy with intravenous procainamide or intravenous amiodarone was attempted. The target — termination of ventricular tachycardia with conversion to sinus rhythm — was not achieved. This protocol defines the recommended next step.
Next-Step Approach (Partial Overview)
When intravenous antiarrhythmic medication has not terminated the arrhythmia, a direct electrical intervention becomes the preferred strategy — particularly when the risk associated with sedation is judged to be acceptable. The specific eligibility criteria, preparatory requirements, and the complete step-by-step management algorithm are in the full protocol…
Treatment Goal
Termination of ventricular tachycardia with restoration of sinus rhythm.
References
DOI: 10.1093/eurheartj/ehac262
- In patients presenting with a haemodynamically tolerated SMVT and known or suspected SHD, intravenous procainamide should be considered.
- DC cardioversion is recommended as the first-line treatment for patients presenting with tolerated SMVT provided that the anaesthetic/sedation risk is low.
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