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September 25, 2018 Circulation. 2018;138:e272–e391. DOI: 10.1161/CIR.0000000000000549 e300

CLINICAL STATEMENTS AND GUIDELINES

at 24 hours.S6-26 For patients with recurrent, stable VT not in the setting of an AMI, intravenous procainamide has been shown to be superior to lidocaine for terminating the arrhythmia.S6-11 One RCT in 62 patients found procainamide superior to amiodarone for termination of stable VT.S6-13 Adverse events, including hypotension, were more common with amiodarone, but the difference was not statistically signficant. Procainamide and its metabolite n-acetylprocainamide have potassium channel blocking properties that may prolong the QT interval. In patients who already have QT prolongation, administration of procainamide may further prolong the QT interval and lead to torsades de pointes.S6-11 A single RCT of 33 patients comparing sotalol with lidocaine for treating patients with hemodynamically stable VT showed that VT was terminated in 69% of patients using sotalol and 18% using lidocaine.S6-25 Intravenous sotalol has been approved for use in the United States. Sotalol has potassium channel blocking properties that may prolong the QT interval. In patients who already have QT interval prolongation, administration of sotalol may further prolong the QT interval and lead to torsades de pointes.S6-25

Figure 2. Management of sustained monomorphic VT. Colors correspond to Class of Recommendation in Table 1. See Sections 7, 8.1.3, 8.2.3, and 10 for discussion. *Known history of verapamil sensitive or classical electrocardiographic presentation. ACLS indicates advanced cardiovascular life support; ECG, electrocardiogram; VA, ventricular arrhythmia; and VT, ventricular tachycardia.

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