Ventricular tachycardia electrical cardioversion: Difference between revisions

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==Overview==
==Overview==
Therapy may be directed at either terminating an episode of the [[arrhythmia]] or for suppressing a future episode from occurring. The treatment is tailored to the specific [[patient]], with regard to how well the individual tolerates episodes of ventricular tachycardia, how frequently episodes occur, their [[comorbidities]], and their wishes. It is usually possible to terminate a [[VT]] episode with a direct current shock across the [[heart]]. This is ideally synchronised to the patient's [[heartbeat]]. As it is quite uncomfortable, shocks should be delivered only to an unconscious or [[sedation|sedated patient]].
For treatment of unstable [[tachyarrhythmia]] (with [[chest pain]], [[dyspnea]], [[pulmonary edema]], [[altered mental status]]), other than [[VF]] or [[pulselessVT]], [[synchronized cardioversion]] should be warranted.In [[Synchronized cardioversion]]  the amount of energy delivered is less than defibrillation and also the shock is delivered in different parts of the [[cardiac cycle]]. R-on -T phenomena may happen if the electrical defibrillated shock is delivered during the [[refractory period]] (on the latter part of T wave) which is vulnerable to induce [[VF]]. For prevention of this phenomena and monitoring R wave for each [[QRS]] complex for delivery of shock in [[cardiac cycle]], the defibrillator is placed on [[synchronize]] mode. The recommendation energy for synchronized cardioversion is 50-200 jouls.


==[[Electrical Cardioversion]]==
==[[Electrical Cardioversion]]==
*[[CPR]] is the hallmark of [[cardiac arrest]] management.
*[[Chest compression]] should be done to a depth of at least 2 inches, or 5 cm, for an average [[adult]] while avoiding excessive [[chest compression]] depths (greater than 2.4 inches, or 6 cm) (Class 1, LOE B), with the rate of 100 to 120/min (Class 2a, LOE B).
*Early defibrillation is critical  for survival of [[cardiac arrest]] presented with [[VF]] or [[pulseless VT]]. However, there was not established benefit of double sequential defibrillation—shock delivery by 2 defibrillators nearly simultaneously for refractory shockable rhythm.<ref name="BeckOstermayer2019">{{cite journal|last1=Beck|first1=Lauren R.|last2=Ostermayer|first2=Daniel G.|last3=Ponce|first3=Joseph N.|last4=Srinivasan|first4=Saranya|last5=Wang|first5=Henry E.|title=Effectiveness of Prehospital Dual Sequential Defibrillation for Refractory Ventricular Fibrillation and Ventricular Tachycardia Cardiac Arrest|journal=Prehospital Emergency Care|volume=23|issue=5|year=2019|pages=597–602|issn=1090-3127|doi=10.1080/10903127.2019.1584256}}</ref>
* There are some uncertainty evidence about the [[IO]] rout. [[IV]] access is preferred rout and  if attempts for IV access are unsuccessful or not feasible,  IO route is recommended.<ref name="GranfeldtAvis2020">{{cite journal|last1=Granfeldt|first1=Asger|last2=Avis|first2=Suzanne R.|last3=Lind|first3=Peter Carøe|last4=Holmberg|first4=Mathias J.|last5=Kleinman|first5=Monica|last6=Maconochie|first6=Ian|last7=Hsu|first7=Cindy H.|last8=Fernanda de Almeida|first8=Maria|last9=Wang|first9=Tzong-Luen|last10=Neumar|first10=Robert W.|last11=Andersen|first11=Lars W.|title=Intravenous vs. intraosseous administration of drugs during cardiac arrest: A systematic review|journal=Resuscitation|volume=149|year=2020|pages=150–157|issn=03009572|doi=10.1016/j.resuscitation.2020.02.025}}</ref>
* [[Epinephrine]] is recommended as soon as feasible for [[cardiac arrest]] with a non-shockable [[rhythm]].
* In shockable rhythm with the failed first attempt to defibrillation, [[epinephrine]] should be administrated.
*Early administration of [[epinephrine]] for non-shockable [[rhythm]] is emphasized in the new guideline.
* In [[pulseless VT]] or [[VF]], emergency tachycardia rhythm should be treated under the [[ACLS]] [[cardiac arrest]] algorithm.
* In stable [[wide complex tachycardia]], [[antiarrhythmic]] medications can be used.
* For treatment of unstable [[tachyarrhythmia]] (with [[chest pain]], [[dyspnea]], [[pulmonary edema]], [[altered mental status]]), other than [[VF]] or [[pulselessVT]], [[synchronized cardioversion]] may be warranted under [[sedation]] or [[anesthesia]].
* In [[Synchronized cardioversion]]  the amount of energy delivered is less than defibrillation and also the shock is delivered in different parts of the [[cardiac cycle]].
* R-on -T phenomena may happen if the electrical defibrillated shock is delivered during the [[refractory period]] (on the latter part of T wave) which is vulnerable to induce [[VF]].
* For prevention of this phenomena and monitoring R wave for each [[QRS]] complex for delivery of shock in [[cardiac cycle]], the defibrillator is placed on [[synchronize]] mode.
*The recommendation energy for synchronized cardioversion is 50-200 jouls.
===[[Cardiac arrest ]] algorithm===
{{familytree/start |summary=Sample 8}}{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | A01 | | |A01='''[[CPR]] quality'''
*Chest compression (100–120/min) and allow complete [[chest]] recoil
* Minimizing interruptions in [[chest ]]compressions
* Avoidance excessive [[ventilation]]
* Changing compressor every 2 minutes
* If no advanced [[airway]], 30:2 [[compression-ventilation]] ratio
* Quantitative waveform [[capnography]]}}
{{familytree | | | | | | | | | | B01 |-|.|!|,|-| B02 | | | | | | | |B01= '''[[Medication]]'''
*[[Epinephrine ]] IV/IO Dose: 1 mg every 3–5 minutes
*[[Amiodarone]] IV/IO Dose: First dose: 300 mg bolus, second dose: 150 mg
*[[Lidocaine]]: 1–1.5 mg/kg|B02='''Advanced [[Airway]]'''
*[[Supraglottic]] advanced [[airway]] or [[endotracheal intubation]]
*10 breaths per minute with maintaining [[chest compressions]]}}
{{familytree | | | | | | C01 |-|-|-|-|-| C02 |-|-|-|-|-| C03 | | | |C01='''Shock energy'''
*Biphasic: Manufacturer recommendation ( initial dose of 120–200 J): if unknown, use maximum available
*Second and subsequent doses should be equivalent
*Higher doses may be considered|C02='''[[Cardiac arrest]] algorithm'''|C03='''[[Return of Spontaneous Circulation]]([[ROSC]])'''
*[[Pulse]] and [[blood pressure]]
*Checking [[perfusion]] status when exhaled CO2 > 25 mm Hg, the amount > 40 mm Hg is equal to [[ROSC]]
*Spontaneous [[arterial pressure ]] waves with [[intra-arterial]] monitoring}}
{{familytree | | | | | | | | | | | | | | |!| | | | | | | | | | |}}
{{familytree | | | | | | | | | | | | | | E01 | | | | | | | | | | | |E01='''Correction of reversible causes'''
*[[Hypovolemia]]
*[[Hypoxia]]
*[[Hydrogen ion]] ([[acidosis]])
*[[Hypokalemia]]/[[Hyperkalemia]]
*[[Hypothermia]]
*[[Tension pneumothorax]]
*[[Tamponade]]
*[[Toxins]]
*[[Thrombosis]], [[pulmonary]]
*[[Thrombosis]], [[coronary]]}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree/end}}


{|
! colspan="2" style="background: PapayaWhip;" align="center" + |The above  adopted from 2020 AHA/ECC Guideline for CPR
|-
|}<ref name="MerchantTopjian2020">{{cite journal|last1=Merchant|first1=Raina M.|last2=Topjian|first2=Alexis A.|last3=Panchal|first3=Ashish R.|last4=Cheng|first4=Adam|last5=Aziz|first5=Khalid|last6=Berg|first6=Katherine M.|last7=Lavonas|first7=Eric J.|last8=Magid|first8=David J.|title=Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care|journal=Circulation|volume=142|issue=16_suppl_2|year=2020|issn=0009-7322|doi=10.1161/CIR.0000000000000918}}</ref>


 
=== [[Advanced Cardiovascular Life Support]] ([[ACLS]]) Algorithm===
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
*[[Electrical Cardioversion / Defibrillation|Electrical Cardioversion]] is usually possible to terminate a VT episode with a direct current shock across the [[heart]].
*[[Electrical Cardioversion / Defibrillation|Electrical Cardioversion]] is ideally synchronised to the patient's [[heartbeat]]. As it is quite uncomfortable, shocks should be delivered only to an [[unconscious]] or [[sedation|sedated patient]].
* A patient with [[pulseless VT]] will be [[unconscious]] and treated as an [[emergency]] on a [[cardiac arrest]] protocol.
* Elective [[cardioversion]] is usually performed in controlled circumstances with [[anaesthetic]] and [[airway]] support.
* The shock may be delivered to the outside of the chest using an external defibrillator, or internally to the heart by an [[implantable cardioverter-defibrillator]] (ICD) if one has previously been inserted.
* An [[ICD]] may also be set to attempt to overdrive pace the [[ventricle]]. Pacing the [[ventricle]] at a rate faster than the underlying [[tachycardia]] can sometimes be effective in terminating the [[rhythm]].
* If this fails after a short trial, the [[ICD]] will usually stop pacing, charge up and deliver a [[defibrillation]] grade shock.
 
===[[ACLS]] [[Cardiac Arrest]] Algorithm===
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | | | | | | A01 | | | | | A01='''Adult Cardiac Arrest'''}}
{{familytree | | | | | | | | | | | | | A01 | | | | | A01='''Adult [[Cardiac Arrest]]'''}}
{{familytree | | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | | | | A02 | | | | | | A02='''Start [[CPR]]'''<br>Give oxygen<br>Attach monitor/defibrillator}}
{{familytree | | | | | | | | | | | | | A02 | | | | | | A02='''Start [[CPR]]'''<br>Give [[oxygen]]<br>Attach monitor/[[defibrillator]]}}
{{familytree | | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | | | | A03 | | | | | | A03='''Rhythm shockable?'''}}
{{familytree | | | | | | | | | | | | | A03 | | | | | | A03='''Rhythm shockable?'''}}
Line 52: Line 80:
{{familytree | | | | E01 | | | | | | | | | | | | | | | |!| | E01=<u>'''''Box A:'''''</u><br><br>'''[[CPR]] 2 min'''<br>IV/IO access}}
{{familytree | | | | E01 | | | | | | | | | | | | | | | |!| | E01=<u>'''''Box A:'''''</u><br><br>'''[[CPR]] 2 min'''<br>IV/IO access}}
{{familytree | | | | |!| | | | | | | | | | | | | | | | |!| | }}
{{familytree | | | | |!| | | | | | | | | | | | | | | | |!| | }}
{{familytree | | | | F01 |-| F02 |~|7| | | | | | | | | |!| | F01='''Rhythm shockable?'''| F02=No}}
{{familytree | | | | F01 |-| F02 |~|7| | | | | | | | | |!| | F01='''[[Rhythm]] [[shockable]]?'''| F02=No}}
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | }}
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | }}
{{familytree | | | | G01 | | | | | |:| | | | | | | | | |!| | G01=Yes}}
{{familytree | | | | G01 | | | | | |:| | | | | | | | | |!| | G01=Yes}}
Line 66: Line 94:
{{familytree | | | | L01 | | | | | |:| | | | | | | | | |!| | | |:| | L01=Shock}}
{{familytree | | | | L01 | | | | | |:| | | | | | | | | |!| | | |:| | L01=Shock}}
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }}
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }}
{{familytree | | | | M01 | | | | | |:| | | | | | | | | M02 | | |:| | M01='''[[CPR]] 2 min'''<br>[[Amiodarone]]<br>Treat reversible causes| M02=<u>'''''Box D:'''''</u><br><br>'''[[CPR]] 2 min'''<br>Treat reversible causes}}
{{familytree | | | | M01 | | | | | |:| | | | | | | | | M02 | | |:| | M01='''[[CPR]] 2 min'''<br>[[Amiodarone]] or [[lidocaine]]<br>Treat reversible causes| M02=<u>'''''Box D:'''''</u><br><br>'''[[CPR]] 2 min'''<br>Treat reversible causes}}
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }}
{{familytree | | | | |!| | | | | | |:| | | | | | | | | |!| | | |:| | }}
{{familytree | | | | N00 | | | | | |D|~|~|~|~| N01 |-| N02 | | |:| | N00= Go back to box A| N01=No| N02='''Rhythm shockable?'''}}
{{familytree | | | | N00 | | | | | |D|~|~|~|~| N01 |-| N02 | | |:| | N00= Go back to box A| N01=No| N02='''Rhythm shockable?'''}}
Line 75: Line 103:
{{familytree | | | | | | | | | | | Q01 | | | | | | | | | | | Q01='''If no signs of return of spontaneous circulation:'''<br>Go to box C or box D<br><br>'''If return of spontaneous circulation:'''<br> Start post cardiac arrest care}}
{{familytree | | | | | | | | | | | Q01 | | | | | | | | | | | Q01='''If no signs of return of spontaneous circulation:'''<br>Go to box C or box D<br><br>'''If return of spontaneous circulation:'''<br> Start post cardiac arrest care}}
{{familytree/end}}
{{familytree/end}}
''Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 8.''<ref name="pmid20956224">{{cite journal| author=Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW et al.| title=Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S729-67 | pmid=20956224 | doi=10.1161/CIRCULATIONAHA.110.970988 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956224  }} </ref>
{|
! colspan="2" style="background: PapayaWhip;" align="center" + |The above  adopted from 2020 AHA/ECC Guideline for CPR
|-
|}<ref name="MerchantTopjian2020">{{cite journal|last1=Merchant|first1=Raina M.|last2=Topjian|first2=Alexis A.|last3=Panchal|first3=Ashish R.|last4=Cheng|first4=Adam|last5=Aziz|first5=Khalid|last6=Berg|first6=Katherine M.|last7=Lavonas|first7=Eric J.|last8=Magid|first8=David J.|title=Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care|journal=Circulation|volume=142|issue=16_suppl_2|year=2020|issn=0009-7322|doi=10.1161/CIR.0000000000000918}}</ref>
 
 





Latest revision as of 05:21, 30 May 2021

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

Overview

For treatment of unstable tachyarrhythmia (with chest pain, dyspnea, pulmonary edema, altered mental status), other than VF or pulselessVT, synchronized cardioversion should be warranted.In Synchronized cardioversion the amount of energy delivered is less than defibrillation and also the shock is delivered in different parts of the cardiac cycle. R-on -T phenomena may happen if the electrical defibrillated shock is delivered during the refractory period (on the latter part of T wave) which is vulnerable to induce VF. For prevention of this phenomena and monitoring R wave for each QRS complex for delivery of shock in cardiac cycle, the defibrillator is placed on synchronize mode. The recommendation energy for synchronized cardioversion is 50-200 jouls.

Electrical Cardioversion

Cardiac arrest algorithm

 
 
 
 
 
 
 
 
 
 
 
 
 
CPR quality
 
 
 
 
 
 
 
 
 
 
 
Medication
 
 
 
 
 
 
 
 
Advanced Airway
  • Supraglottic advanced airway or endotracheal intubation
  • 10 breaths per minute with maintaining chest compressions
  •  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Shock energy
    • Biphasic: Manufacturer recommendation ( initial dose of 120–200 J): if unknown, use maximum available
    • Second and subsequent doses should be equivalent
    • Higher doses may be considered
     
     
     
     
     
    Cardiac arrest algorithm
     
     
     
     
     
    Return of Spontaneous Circulation(ROSC)
  • Pulse and blood pressure
  • Checking perfusion status when exhaled CO2 > 25 mm Hg, the amount > 40 mm Hg is equal to ROSC
  • Spontaneous arterial pressure waves with intra-arterial monitoring
  •  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Correction of reversible causes
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    The above adopted from 2020 AHA/ECC Guideline for CPR

    [3]

    Advanced Cardiovascular Life Support (ACLS) Algorithm

     
     
     
     
     
     
     
     
     
     
     
     
    Adult Cardiac Arrest
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Start CPR
    Give oxygen
    Attach monitor/defibrillator
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Rhythm shockable?
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Yes
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    No
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    VF/VT
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Asystole/PEA
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Shock
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Box A:

    CPR 2 min
    IV/IO access
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Rhythm shockable?
     
    No
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Yes
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Shock
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Box B:

    CPR 2 min
    Epinephrine every 3-5 min
    Consider advanced airway
    and capnography
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Box C:

    CPR 2 min
    IV/IO access
    Epinephrine every 3-5 min
    Consider advanced airway
    and capnography
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Rhythm shockable?
     
    No
     
     
     
     
     
     
     
     
     
     
     
    Rhythm shockable?
     
    Yes
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Yes
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    No
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Shock
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    CPR 2 min
    Amiodarone or lidocaine
    Treat reversible causes
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Box D:

    CPR 2 min
    Treat reversible causes
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Go back to box A
     
     
     
     
     
     
     
     
     
     
     
    No
     
    Rhythm shockable?
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Yes
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Shock
    Then, go to box A or box B
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    If no signs of return of spontaneous circulation:
    Go to box C or box D

    If return of spontaneous circulation:
    Start post cardiac arrest care
     
     
     
     
     
     
     
     
     
     
    The above adopted from 2020 AHA/ECC Guideline for CPR

    [3]




     
     
     
     
     
     
     
    ICD with recurrent VT, VF
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Polymorphic VT/VF
     
     
     
     
     
     
     
    Sustained monomorphic VT
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Correction of reversible causes
     
     
     
     
     
     
    Catheter ablation as first line therapy (class2b)
     
    Amiodarone, sotalol (class1)
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Ischemia= revascularization (class1)
     
    Drug, electrolytes: Treating QT prolongation, discontinuation offending drugs, correction electrolytes abnormality (class1)
     
    NO reversible causes
     
     
     
     
    Arrhythmia not controlled
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Amiodarone (class1)
     
    Betablocker (class2a)
     
    Non ischemic cardiomyopathy
     
    IHD with frequent VT or VT storm
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Arrhythmia not controlled
     
     
     
     
    Catheter ablation (class2a)
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Considering PVC triggers
     
     
     
     
     
    Yes: Catheter ablation (class1)
     
    NO: Catheter ablation (class2a)
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Yes: Catheter ablation
     
    NO: Autotomic modulation (class2b)
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    The above algorithm adopted from 2017 AHA/ACC/HRS Guideline

    [4]

    References

    1. Beck, Lauren R.; Ostermayer, Daniel G.; Ponce, Joseph N.; Srinivasan, Saranya; Wang, Henry E. (2019). "Effectiveness of Prehospital Dual Sequential Defibrillation for Refractory Ventricular Fibrillation and Ventricular Tachycardia Cardiac Arrest". Prehospital Emergency Care. 23 (5): 597–602. doi:10.1080/10903127.2019.1584256. ISSN 1090-3127.
    2. Granfeldt, Asger; Avis, Suzanne R.; Lind, Peter Carøe; Holmberg, Mathias J.; Kleinman, Monica; Maconochie, Ian; Hsu, Cindy H.; Fernanda de Almeida, Maria; Wang, Tzong-Luen; Neumar, Robert W.; Andersen, Lars W. (2020). "Intravenous vs. intraosseous administration of drugs during cardiac arrest: A systematic review". Resuscitation. 149: 150–157. doi:10.1016/j.resuscitation.2020.02.025. ISSN 0300-9572.
    3. 3.0 3.1 Merchant, Raina M.; Topjian, Alexis A.; Panchal, Ashish R.; Cheng, Adam; Aziz, Khalid; Berg, Katherine M.; Lavonas, Eric J.; Magid, David J. (2020). "Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 142 (16_suppl_2). doi:10.1161/CIR.0000000000000918. ISSN 0009-7322.
    4. Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.


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