TABLE 1

Recommendations for Acute Management of Hemodynamically Stable and Regular Tachycardia

ECGRecommendationClassificationLevel of EvidenceReferences
Narrow QRS-complex tachycardia (SVT)Vagal maneuversIB
AdenosineIA15,17,18
Verapamil, diltiazemIA19
Beta blockersIIbC20,21
AmiodaroneIIbC22
DigoxinIIbC
Wide QRS-complex tachycardia
 •SVT + BBBSee above
 •Pre-excited SVT/AFFlecainideIB23
IbutilideIB24
ProcainamideIB
DC cardioversionIC
 •Wide QRS-complex tachycardia of unknownProcainamideIB25,26
originSotalolIB27
AmiodaroneIB29,30
DC cardioversionIB28
LidocaineIIbB26,27
Adenosine§IIbC31
Beta blockersIIIC28
Verapamil∗∗IIIB32
Wide QRS-complex tachycardia of unknownAmiodaroneIB29,30
origin in patients with poor LV functionDC cardioversion, lidocaineIB28

The order in which treatment recommendations appear in this table within each class of recommendation does not necessarily reflect a preferred sequence of administration. Please refer to text for details. For pertinent drug dosing information please refer to the ACC/AHA/ESC Guidelines on the Management of Patients With Atrial Fibrillation.

AF indicates atrial fibrillation; BBB, bundle-branch block; DC, direct current; ECG, electrocardiogram; LV, left ventricular; QRS, ventricular activation on ECG; SVT, supraventricular tachycardia; VT, ventricular tachycardia.

  • All listed drugs are administered intravenously.

  • See Section V-D.

  • Should not be taken by patients with reduced LV function.

  • § Adenosine should be used with caution in patients with severe coronary artery disease because vasodilation of normal coronary vessels may produce ischemia in vulnerable territory. It should be used only with full resuscitative equipment available.

  • Beta blockers may be used as first-line therapy for those with catecholamine-sensitive tachycardias, such as right ventricular outflow tachycardia.

  • ∗∗ Verapamil may be used as first-line therapy for those with LV fascicular VT.