Analysis of the Treatment of Spontaneous Sustained Stable Ventricular Tachycardia

• Published in: Academic emergency medicine Vol. 4; no. 12; pp. 1122 - 1128
• Main Authors: Marill, Keith A., Greenberg, Gary M., Kay, Darren, Nelson, Brian K.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.1997
• Subjects: adenosine; Anti-Arrhythmia Agents - therapeutic use; Electrocardiography; Female; Heart Failure - complications; Humans; Injections, Intravenous; lidocaine; Lidocaine - therapeutic use; Male; Middle Aged; myocardial infarction; Myocardial Infarction - complications; Retrospective Studies; Risk Factors; tachycardia; Tachycardia, Ventricular - complications; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - drug therapy; Time Factors; Treatment Outcome; ventricular
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/j.1553-2712.1997.tb03694.x

ABSTRACT Objectives: To determine the termination rate of spontaneous sustained stable ventricular tachycardia (SSSVT) as a function of the first and second therapeutic interventions used, and to determine factors associated with successful termination. Methods: A multihospital, retrospective analysis of the treatment of patients with SSSVT was performed. The setting included 2 urban county hospitals, 2 urban private hospitals, and a Veterans Affairs hospital. Cases were identified by discharge diagnosis and ECG characteristics, and confirmed by electrophysiology study or ECG criteria. Results: There were 40 cases of SSSVT identified. Excluding adenosine, 35 patients were treated with lidocaine as a first intervention. The rate of termination with lidocaine bolus was 17% (6 of 35) (95% CI 7–34%). Regarding the 35 patients initially treated with lidocaine, the odds of termination of SSSVT were 11 times greater in those without a history of previous myocardial infarction (MI) than in those with a history of MI (95% CI 0.96–551). Of the 29 patients who failed initial lidocaine treatment, 23 were treated with a second lidocaine bolus, with a termination rate of 18% (4 of 22) (95% CI 5–40%). Only 2 patients with sustained ventricular tachycardia had a concurrent MI, and the tachycardia was unresponsive to initial lidocaine bolus in both cases. Fifteen patients received adenosine with no tachycardia terminations and no significant adverse effects. Conclusions: The rate of SSSVT termination with lidocaine was low, particularly in patients with a history of MI.