title: Best Clinical Practice: Emergency Medicine Management of Stable Monomorphic Ventricular Tachycardia.
abstract: BACKGROUND
  Ventricular tachycardia (VT) and ventricular fibrillation are the causes of approximately 300,000 deaths per year in the United States. VT is classified based on hemodynamic status and appearance. Stable, monomorphic VT treatment is controversial.
  
  
  OBJECTIVE
  Our aim was to provide emergency physicians with an evidence-based review of the medical management of stable, monomorphic VT.
  
  
  CONCLUSIONS
  Stable, monomorphic VT is part of a larger class of ventricular dysrhythmias defined by a rate of at least 120 beats/min with QRS > 120 ms without regularly occurring P:QRS association. Little controversy exists for the treatment of hemodynamically unstable VT. The medical management of hemodynamically stable monomorphic VT is surrounded by controversy. Direct current cardioversion is most efficacious. Guidelines for the treatment of stable VT from the American Heart Association provide a IIa recommendation for procainamide, compared with a IIb recommendation for both amiodarone and sotalol. Studies evaluating procainamide, lidocaine, amiodarone, and sotalol suffer from poor design, difference in inclusion and exclusion criteria, small sample size, and outcome determination. Procainamide demonstrates the greatest efficacy. If procainamide is selected, a maximum dose of 10 mg/kg at 50-100 mg/min intravenous (IV) over 10-20 min should be provided with monitoring of blood pressure and electrocardiogram. Monomorphic VT with acute myocardial ischemia requires further study.
  
  
  CONCLUSIONS
  Optimal management of stable, monomorphic VT includes direct current cardioversion. If medical management is chosen, procainamide is most efficacious, though current literature suffers from poor design.
authors.affiliation: Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas.
authors.forename: Brit
authors.initials: B
authors.lastname: Long
authors.affiliation: Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Alex
authors.initials: A
authors.lastname: Koyfman
mesh_terms: D000638:Amiodarone / Q000494:pharmacology / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004554:Electric Countershock / Q000379:methods / Q000592:standards*; D004562:Electrocardiography / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D008012:Lidocaine / Q000494:pharmacology / Q000627:therapeutic use; D011342:Procainamide / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D011744:Pyrimidinones / Q000494:pharmacology / Q000627:therapeutic use; D012196:Review Literature as Topic; D013015:Sotalol / Q000494:pharmacology / Q000627:therapeutic use; D017180:Tachycardia, Ventricular / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000889:Anti-Arrhythmia Agents; D011744:Pyrimidinones; C076259:nifekalant; D008012:Lidocaine; D013015:Sotalol; D011342:Procainamide; D000638:Amiodarone
keywords: amiodarone; dysrhythmia; electrocardiogram; procainamide; ventricular tachycardia; wide complex tachycardia