II. Indications: Wide Complex Tachycardia in Children

  1. Tachycardia AND
  2. Wide QRS Complex (duration > 0.08 sec)
    1. Note adult wide complex is defined as (at least 0.12 sec)

III. Approach

  1. No pulse
    1. Treat as Pulseless Ventricular Tachycardia
  2. Unstable (shock or ALOC)
    1. Treat as Unstable Ventricular Tachycardia
    2. Administer Synchronized Cardioversion
  3. Stable
    1. Treat per protocol below

IV. Protocol: Stable Wide Complex Tachycardia (presumed Ventricular Tachycardia) Management

  1. Electrical Cardioversion if unstable or refractory to below measures
    1. Sedation and analgesia if no delay
    2. Synchronized Cardioversion Dose
      1. First: 0.5-1.0 Joules/kg
      2. Next: 2.0 Joules/kg
  2. Step 1: Adenosine
    1. AVOID if polymorphic or irregular Wide Complex Tachycardia (can degenerate to VF)
    2. Dose
      1. First: 0.1 mg/kg (max 6 mg) rapid IV push
      2. Next: 0.2 mg/kg (max 12 mg) rapid IV push
    3. Effect
      1. SVT: converts or at least slows rhythm for interpretation
      2. VT: no effect (unless irregular, in which case could degenerate into VF)
  3. Step 2: Choose one Antiarrhythmic (do not use both)
    1. Consultation with pediatric cardiology recommended
    2. Amiodarone 5 mg/kg (max 150 mg) IV over 20 to 60 minutes OR
    3. Procainamide 15 mg/kg IV over 30 to 60 minutes

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Tachycardia, Ventricular (C0042514)

Definition (NCI) A disorder characterized by an electrocardiographic finding of three or more consecutive complexes of ventricular origin with a rate greater than a certain threshold (100 or 120 beats per minute are commonly used). The QRS complexes are wide and have an abnormal morphology. (CDISC)
Definition (NCI_CTCAE) A disorder characterized by a dysrhythmia with a heart rate greater than 100 beats per minute that originates distal to the bundle of His.
Definition (NCI_FDA) An abnormally rapid ventricular rhythm with aberrant ventricular excitation, usually in excess of 150 beats per minute.
Definition (MSH) An abnormally rapid ventricular rhythm usually in excess of 150 beats per minute. It is generated within the ventricle below the BUNDLE OF HIS, either as autonomic impulse formation or reentrant impulse conduction. Depending on the etiology, onset of ventricular tachycardia can be paroxysmal (sudden) or nonparoxysmal, its wide QRS complexes can be uniform or polymorphic, and the ventricular beating may be independent of the atrial beating (AV dissociation).
Concepts Pathologic Function (T046)
MSH D017180
ICD10 I47.2
SnomedCT 195075005, 6624005, 155370003, 25569003
English Tachycardia, Ventricular, TACHYCARDIA VENTRICULAR, Tachycardias, Ventricular, Ventricular Tachycardias, Ventricular Tachycardia, ventricular tachycardia (diagnosis), ventricular tachycardia, V.tach, Tachycardia ventricular, Tachycardia, ventricular, Tachycardia, Ventricular [Disease/Finding], v tach, vt, ventricular tachyarrhythmia, ventricular tachycardia (V-tach), Ventricular tachycardia (Vtach), Tachycardia - ventric., Ventricular tachyarrhythmia (disorder), Ventricular techycardia, VENTRICULAR TACHYCARDIA, Ventricular tachycardia, VT - Ventricular tachycardia, Ventricular tachycardia (disorder), Ventricular tachyarrhythmia, tachycardia; ventricular, ventricular; tachycardia, Ventricular tachycardia, NOS, Tachycardia;ventricular
French TACHYCARDIE VENTRICULAIRE, Tachyarythmie ventriculaire, V.tach, Tachycardie ventriculaire
Portuguese TAQUICARDIA VENTRICULAR, Taquiarritmia ventricular, Taquicardia ventricular, Taquicardia Ventricular
Spanish TAQUICARDIA VENTRICULAR, Taquiarritmia ventricular, Taquicardia V, taquiarritmia ventricular, taquiarritmia ventricular (trastorno), taquicardia ventricular (trastorno), taquicardia ventricular, Taquicardia ventricular, Taquicardia Ventricular
Dutch ventriculaire tachyaritmie, ventrikeltachycardie, tachycardie; ventriculair, ventriculair; tachycardie, ventriculaire tachycardie, Ritmestoornis, Tachycardie, ventriculaire, Ventriculaire tachycardie
German Kammer-Tachyarrhythmie, V.tach, TACHYKARDIE VENTRIKULAER, Ventrikulaere Tachykardie, Tachykardie ventrikulaer, Tachykardie, ventrikuläre
Italian Tachiaritmia ventricolare, Tachicardia ventricolare
Japanese 心室性頻脈性不整脈, シンシツセイヒンミャク, シンシツセイヒンミャクセイフセイミャク, 心室性頻拍, 頻拍-心室性, 心室性頻拍症, 心室性頻脈, 心室頻拍, 心室頻拍症, 心室頻脈, 発作性心室性頻拍, 発作性心室性頻拍症, 発作性心室頻拍, 発作性心室頻拍症
Swedish Kammartakykardi
Finnish Kammiotakykardia
Russian TAKHIKARDIIA VENTRIKULIARNAIA, TAKHIKARDIIA ZHELUDOCHKOVAIA PAROKSIZMAL'NAIA, ТАХИКАРДИЯ ВЕНТРИКУЛЯРНАЯ, ТАХИКАРДИЯ ЖЕЛУДОЧКОВАЯ ПАРОКСИЗМАЛЬНАЯ
Czech Ventrikulární tachyarytmie, Tachykardie komorová, Komorová tachykardie, KT, VT, komorová tachykardie, tachykardie komorová
Korean 심실성 빠른맥
Croatian TAHIKARDIJA, VENTRIKULARNA
Polish VT, Tachykardia komorowa, Częstoskurcz komorowy
Hungarian Ventricularis tachyarrhythmia, Tachycardia,ventricularis, V . Tach., Ventricularis tachycardia
Norwegian Ventrikkeltakykardi, Takykardi, ventrikkel-, Ventrikulær takykardi