PMID- 27751700
DCOM- 20171116
LR  - 20171128
IS  - 0736-4679 (Print)
IS  - 0736-4679 (Linking)
VI  - 52
IP  - 4
DP  - 2017 Apr
TI  - Best Clinical Practice: Emergency Medicine Management of Stable Monomorphic
      Ventricular Tachycardia.
PG  - 484-492
LID - S0736-4679(16)30721-1 [pii]
LID - 10.1016/j.jemermed.2016.09.010 [doi]
AB  - BACKGROUND: Ventricular tachycardia (VT) and ventricular fibrillation are the
      causes of approximately 300,000 deaths per year in the United States. VT is
      classified based on hemodynamic status and appearance. Stable, monomorphic VT
      treatment is controversial. OBJECTIVE: Our aim was to provide emergency
      physicians with an evidence-based review of the medical management of stable,
      monomorphic VT. DISCUSSION: Stable, monomorphic VT is part of a larger class of
      ventricular dysrhythmias defined by a rate of at least 120 beats/min with QRS >
      120 ms without regularly occurring P:QRS association. Little controversy exists
      for the treatment of hemodynamically unstable VT. The medical management of
      hemodynamically stable monomorphic VT is surrounded by controversy. Direct
      current cardioversion is most efficacious. Guidelines for the treatment of stable
      VT from the American Heart Association provide a IIa recommendation for
      procainamide, compared with a IIb recommendation for both amiodarone and sotalol.
      Studies evaluating procainamide, lidocaine, amiodarone, and sotalol suffer from
      poor design, difference in inclusion and exclusion criteria, small sample size,
      and outcome determination. Procainamide demonstrates the greatest efficacy. If
      procainamide is selected, a maximum dose of 10 mg/kg at 50-100 mg/min intravenous
      (IV) over 10-20 min should be provided with monitoring of blood pressure and
      electrocardiogram. Monomorphic VT with acute myocardial ischemia requires further
      study. CONCLUSIONS: Optimal management of stable, monomorphic VT includes direct 
      current cardioversion. If medical management is chosen, procainamide is most
      efficacious, though current literature suffers from poor design.
CI  - Published by Elsevier Inc.
FAU - Long, Brit
AU  - Long B
AD  - Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam
      Houston, Texas.
FAU - Koyfman, Alex
AU  - Koyfman A
AD  - Department of Emergency Medicine, The University of Texas Southwestern Medical
      Center, Dallas, Texas.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20161015
PL  - United States
TA  - J Emerg Med
JT  - The Journal of emergency medicine
JID - 8412174
RN  - 0 (Anti-Arrhythmia Agents)
RN  - 0 (Pyrimidinones)
RN  - 5VZ7GZM43E (nifekalant)
RN  - 98PI200987 (Lidocaine)
RN  - A6D97U294I (Sotalol)
RN  - L39WTC366D (Procainamide)
RN  - N3RQ532IUT (Amiodarone)
SB  - IM
MH  - Amiodarone/pharmacology/therapeutic use
MH  - Anti-Arrhythmia Agents/pharmacology/*therapeutic use
MH  - Electric Countershock/methods/*standards
MH  - Electrocardiography/methods
MH  - Emergency Service, Hospital/organization & administration
MH  - Evidence-Based Medicine/methods
MH  - Humans
MH  - Lidocaine/pharmacology/therapeutic use
MH  - Procainamide/administration & dosage/pharmacology/therapeutic use
MH  - Pyrimidinones/pharmacology/therapeutic use
MH  - *Review Literature as Topic
MH  - Sotalol/pharmacology/therapeutic use
MH  - Tachycardia, Ventricular/*drug therapy/mortality
OT  - amiodarone
OT  - dysrhythmia
OT  - electrocardiogram
OT  - procainamide
OT  - ventricular tachycardia
OT  - wide complex tachycardia
EDAT- 2016/10/19 06:00
MHDA- 2017/11/29 06:00
CRDT- 2016/10/19 06:00
PHST- 2016/06/08 00:00 [received]
PHST- 2016/07/26 00:00 [revised]
PHST- 2016/09/05 00:00 [accepted]
PHST- 2016/10/19 06:00 [pubmed]
PHST- 2017/11/29 06:00 [medline]
PHST- 2016/10/19 06:00 [entrez]
AID - S0736-4679(16)30721-1 [pii]
AID - 10.1016/j.jemermed.2016.09.010 [doi]
PST - ppublish
SO  - J Emerg Med. 2017 Apr;52(4):484-492. doi: 10.1016/j.jemermed.2016.09.010. Epub
      2016 Oct 15.