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Circulation. 2025;152(suppl 2):S538–S577. DOI: 10.1161/CIR.0000000000001376 October 21, 2025 S565 Wigginton et al Advanced Life Support: 2025 AHA Guidelines for CPR and ECC polymorphic VT. Treatment of causative myocardial ischemia (eg, β-adrenergic blockers or emergent coronary intervention) as well as lidocaine and amiodarone,16–22 in concert with defibrillation, may be synergetic when the arrhythmia is sustained. β-Adrenergic blockers have also been shown to reduce the incidence of ventricular arrhythmias in acute coronary syndromes.23,24 Expert consultation is advisable when alternative causes of polymorphic VT are suspected, for which β-adrenergic blockers and antiarrhythmics may also have efficacy.6,25 Since the 2018 AHA Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest,26 no new evidence has been identified. 4. In the absence of long QT, magnesium has not been shown to be effective in the treatment of polymorphic VT10 or other ventricular tachyarrhythmias.12 A single case series with 5 patients showed no benefit of magnesium administration for polymorphic VT with normal QT. Since the 2018 AHA focused update on antiarrhythmic drugs during and immediately after cardiac arrest no new evidence has been identified. REFERENCES 1 Chan A, Isbister GK, Kirkpatrick CM, Dufful SB. Drug-induced QT pro- longation and torsades de pointes: evaluation of a QT nomogram. QJM. 2007;100:609–615. doi: 10.1093/qjmed/hcm072 2. Saprungruang A, Khongphatthanayothin A, Mauleekoonphairoj J, Wandee P, Kanjanauthai S, Bhuiyan ZA, Wilde AAM, Poovorawan Y. Genotype and clinical characteristics of congenital long QT syndrome in Thailand. Indian Pacing Electrophysiol J. 2018;18:165–171. doi: 10.1016/j.ipej.2018.07.007 3. Drew BJ, Ackerman MJ, Funk M, Gibler WB, Kligfield P, Menon V, Philippides GJ, Roden DM, Zareba W; American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol. 2010;55:934–947. doi: 10.1016/j.jacc.2010.01.001 4. Wolfe CL, Nibley C, Bhandari A, Chatterjee K, Scheinman M. Polymorphous ventricular tachycardia associated with acute myocardial infarction. Circulation. 1991;84:1543–1551. doi: 10.1161/01.cir.84.4.1543 5. Pogwizd SM, Corr PB. Electrophysiologic mechanisms underlying arrhythmias due to reperfusion of ischemic myocardium. Circulation. 1987;76:404– 426. doi: 10.1161/01.cir.76.2.404 6. Liu N, Ruan Y, Priori SG. Catecholaminergic polymorphic ventricular tachycardia. Prog Cardiovasc Dis. 2008;51:23–30. doi: 10.1016/j.pcad.2007.10.005 7. Gollob MH, Redpath CJ, Roberts JD. The short QT syndrome: proposed diagnostic criteria. J Am Coll Cardiol. 2011;57:802–812. doi: 10.1016/j.jacc.2010.09.048 8. Cross B, Homoud M, Link M, Foote C, Garlitski AC, Weinstock J, Estes NA 3rd. The short QT syndrome. J Interv Card Electrophysiol. 2011;31:25–31. doi: 10.1007/s10840-011-9566-0 9. Chapman M, Hargreaves M, Schneider H, Royle M. Bidirectional ventricular tachycardia associated with digoxin toxicity and with normal digoxin levels. Heart Rhythm. 2014;11:1222–1225. doi: 10.1016/j.hrthm.2014.03.050 10. Tzivoni D, Keren A, Cohen AM, Loebel H, Zahavi I, Chenzbraun A, Stern S. Magnesium therapy for torsades de pointes. Am J Cardiol. 1984;53:528– 530. doi: 10.1016/0002-9149(84)90025-0 11. Tzivoni D, Banai S, Schuger C, Benhorin J, Keren A, Gottlieb S, Stern S. Treatment of torsade de pointes with magnesium sulfate. Circulation. 1988;77:392–397. doi: 10.1161/01.cir.77.2.392 12. Manz M, Jung W, Luderitz B. [Effect of magnesium on sustained ventricular tachycardia]. Herz. 1997;22:51–55. doi: 10.1007/BF03042655 13 Hoshino K, Ogawa K, Hishitani T, Isobe T, Etoh Y. Successful uses of mag- nesium sulfate for torsades de pointes in children with long QT syndrome. Pediatr Int. 2006;48:112–117. doi: 10.1111/j.1442-200X.2006.02177.x 14. Baker WL. Treating arrhythmias with adjunctive magnesium: identifying future research directions. Eur Heart J Cardiovasc Pharmacother. 2017;3:108–117. doi: 10.1093/ehjcvp/pvw028 15. DiSegni E, Klein HO, David D, Libhaber C, Kaplinsky E. Overdrive pacing in quinidine syncope and other long QT-interval syndromes. Arch Intern Med. 1980;140:1036–1040. 16. Vrana M, Pokorny J, Marcian P, Fejfar Z. Class I and III antiarrhythmic drugs for prevention of sudden cardiac death and management of postmyocardial infarction arrhythmias. A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013;157:114–124. doi: 10.5507/bp.2013.030 17. Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, et al.; Task Force on the management of STseamiotESoC. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569–2619. doi: 10.1093/eurheartj/ehs215 18. Nalliah CJ, Zaman S, Narayan A, Sullivan J, Kovoor P. Coronary artery reperfusion for ST elevation myocardial infarction is associated with shorter cycle length ventricular tachycardia and fewer spontaneous arrhythmias. Europace. 2014;16:1053–1060. doi: 10.1093/europace/eut307 19. Brady W, Meldon S, DeBehnke D. Comparison of prehospital monomorphic and polymorphic ventricular tachycardia: prevalence, response to therapy, and outcome. Ann Emerg Med. 1995;25:64–70. doi: 10.1016/s0196-0644(95)70357-8 20. Brady WJ, DeBehnke DJ, Laundrie D. 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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, et al. 2017 AHA/ACC/ HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2018;15:e73– e189. doi: 10.1016/j.hrthm.2017.10.036 24. Chatterjee S, Chaudhuri D, Vedanthan R, Fuster V, Ibanez B, Bangalore S, Mukherjee D. Early intravenous beta-blockers in patients with acute coronary syndrome--a meta-analysis of randomized trials. Int J Cardiol. 2013;168:915–921. doi: 10.1016/j.ijcard.2012.10.050 25. Van Houzen NE, Alsheikh-Ali AA, Garlitski AC, Homoud MK, Weinstock J, Link MS, Estes NA 3rd. Short QT syndrome review. J Interv Card Electrophysiol. 2008;23:1–5. doi: 10.1007/s10840-008-9201-x 26. Panchal AR, Berg KM, Kudenchuk PJ, Del Rios M, Hirsch KG, Link MS, Kurz MC, Chan PS, Cabañas JG, Morley PT, et al. 2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018;138:e740– e749. doi: 10.1161/CIR.0000000000000613 REGULAR NARROW-COMPLEX TACHYCARDIA Recommendations for the Treatment of Regular Narrow-Complex Tachycardia in Adults COR LOE Recommendations 1 B-R 1. Vagal maneuvers are recommended for acute treatment of adult patients with regular narrowcomplex tachycardias. Downloaded from http://ahajournals.org by on October 7, 2026