ACLS review: Wide Complex Tachycardia (WCT) Part 8

Polymorphic VT

Polymorphic VT

·         varying QRS morphology

·         irregular rhythm

·         hemodynamically unstable

·         should be treated immediately because of the frequent transition to unstable VT

·         often associated with ischemic heart events or electrolyte or toxic conditions

Treatment

·         Assess QT baseline

·         If normal use:

o   Procainamide

o   Amiodarone

o   Sotalol

o   Unsynchronized Cardioversion

Note:  Adenosine should not be given for unstable or for irregular or polymorphic wide complex tachycardias, as it may cause degeneration of the Arrhythmia to VF (Class III, LOE C).

If a patient has polymorphic VT, treat the rhythm as VF and deliver high-energy unsynchronized shocks (ie, defibrillation dose)

 

Unsynchronized shocks

·         It is difficult to competely synchronize on a polymorphic rhythm

·         If there is any doubt whether monomorphic or polymorphic VT is present in the unstable patient, do not delay shock delivery to perform detailed rhythm analysis: provide high-energy unsynchronized shocks (ie, defibrillation doses).



Failure to completely synchronize on a polymorphic rhythm

Reviewed 2/28/16