AHA/ACC/HRS VA 2018 — Guideline for Management of Patients With Ventricular Arrhythmias and Prevention of Sudden Cardiac Death

Unstable wide-complex tachycardia with hypoperfusion mandates immediate synchronized direct-current cardioversion. Hemodynamically stable sustained monomorphic VT may be treated with IV procainamide or IV amiodarone. Calcium channel blockers (verapamil, diltiazem) are strictly contraindicated in wide-complex tachycardia of uncertain mechanism. Polymorphic VT / Torsades de Pointes associated with QT prolongation is treated with IV magnesium sulfate (2 g bolus) and temporary overdrive transvenous or isoproterenol pacing.