APRIL 2001 37:4 ANNALS OF EMERGENCY MEDICINE S91 TREATMENT OF TACHYARRHYTHMIAS Panel Members: Dianne L. Atkins, MD * Paul Dorian, MD ‡ Edgar R. Gonzalez, PharmD § Anton P. M. Gorgels, MD II Peter J. Kudenchuk, MD ¶ Keith G. Lurie, MD # Peter T. Morley, MD ** Colin Robertson, MD ‡‡ Ricardo A. Samson, MD §§ Michael J. Silka, MD II II Bramah N. Singh, MD ¶¶ From the University of Iowa, Iowa City, IA * ; St. Michael’s Hospital, Toronto, Ontario, Canada ‡ ; Medical College of Virginia, Richmond, VA § ; Amsterdam, Netherlands II ; University of Washington Medical Center, Seattle, WA ¶ ; University of Minnesota Medical School, Minneapolis, MN # ; Royal Melbourne Hospital, Victoria, Australia ** ; The Royal Infirmary of Edinburgh, Edinburgh, UK ‡‡ ; University of Arizona, Tucson, AZ §§ ; University of Southern California, Los Angeles, CA II II ; and University of California, Los Angeles, CA. ¶¶ Dr Kudenchuk is with the speakers’ bureau for Wyeth Ayerst and Pfizer and received research grants from Wyeth Ayerst and Medtronic. Reprints of single articles are available online at www.mosby.com/AnnEmergMed for $35 per article. Address for correspondence: Peter J. Kudenchuk, MD, Division of Cardi- ology, Box 356422, University of Washington, Seattle, WA 98195-6422. Joint copyright © 2001 by the American Heart Association and the American College of Emergency Physicians. 0196-0644/2001/$35.00 + 0 47/0/114125 doi:10.1067/mem.2001.114125 [Atkins DL, Dorian P, Gonzalez ER, Gorgels APM, Kudenchuk PJ, Lurie KG, Morley PT, Robertson C, Samson RA, Silka MJ, Singh BN. Treatment of tachyarrhythmias. Ann Emerg Med. April 2001;37:S91-S109.] INTRODUCTION New information published since 1992 prompted a criti- cal reevaluation of recommendations for treatment of arrhythmias with 2 goals: (1) to develop new recommen- dations for treatment of common tachyarrhythmias based on clinical evidence of efficacy and (2) to develop common algorithms for treatment of such arrhythmias in children and adults insofar as available evidence and pathophysi- ologic considerations allow. Because of the emergent nature of treatment, evidence evaluation was restricted to parenteral antiarrhythmic medications, including drugs not yet approved for use in the United States (NAUS) but available elsewhere. Topic 1: Hemodynamically Stable Wide (Broad)-Complex Tachycardia OVERVIEW “Hemodynamically stable wide (broad)-complex tachy- cardia” implies the presence of a regular tachycardia (ex- ceeding the expected limits of sinus tachycardia at rest, ie, more than 120 beats/min in adults) with uniform (monomorphic) QRS configuration of 120 ms or greater duration without signs or symptoms of impaired con- sciousness or tissue hypoperfusion. Also implied is the presence of clinical stability sufficient to allow diagnosis of the rhythm (or transport to a facility where such a diag- nosis can be made) and a blood pressure reserve suffi- cient to permit pharmacologic intervention and the absence of symptoms suggesting the need for immediate termination using electrical cardioversion. Treatment of Tachyarrhythmias