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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Sara Zand, M.D.[2] Edzel Lorraine Co, DMD, MD[3]


The mainstay of therapy for patients with cardiac arrest is starting cardiopulmonary resuscitation (CPR) with minimizing interruption in chest compression. The rhythm should be reassessed. If the rhythm is ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), the shock should be delivered immediately. If the rhythm is asystole or pulseless electrical activity (PEA), CPR should be resumed. Advanced life support (ALS) should be kept with minimizing interruption in chest compression including: advanced airway, continuous chest compressions, capnography, intravenous (IV) intraosseous/ (IO) access, vasopressors, and antiarrhythmic therapy. This can address reversible causes such as hypoxia, hypovolemia,hypothermia, hyperkalemia, hypokalemia,acidosis, tension pneumothorax, tamponade, toxins (benzodiazepines, alcohol, opiates, tricyclics, barbiturates, betablockers, calcium channel blockers), thrombosis ST elevation myocardial infarction (STEMI, and massive pulmonary thromboembolism). The following should be considered immediately in post cardiac arrest patients: 12–lead electrocardiogram (ECG) ,perfusion/reperfusion in patients with acute myocardial infarction,(AMI), oxygenation and ventilation, temperature controlling, and treatment of reversible causes. Management of patients in post-cardiac arrest status include treatment of the underlying disorder, hemodynamic stability, respiratory support, and control of neurologic complications.

Urgent Treatment

Medical Therapy

2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death [12]

Recommendations for public basic life support and access to automated external defibrillators
Class I (Level of Evidence: B)
Class I (Level of Evidence: B)
  • Prompt CPR by bystanders is recommended at out-of-hospital cardiac arrest.
Class I (Level of Evidence: B)
Class IIa (Level of Evidence: B)
  • Mobile phone-based alerting of basic life support-trained bystander volunteers to assist nearby out-of-hospital cardiac arrest victims should be considered.
Recommendations for treatment of sudden cardiac death in patients with coronary anomalies
Class I (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Recommendations for the management of patients with idiopathic premature ventricular complexes/ ventricular tachycardia
Class I (Level of Evidence: B)
Class I (Level of Evidence: C)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: C)
Class IIb (Level of Evidence: B)
Class III (Level of Evidence: C)
Class III (Level of Evidence: C)
Class III (Level of Evidence: C)
Recommendations for the management of patients with premature ventricular complex-induced or premature ventricular complex-aggravated cardiomyopathy
Class I (Level of Evidence: C)
Class IIa (Level of Evidence: C)
Class IIa (Level of Evidence: B)
Class IIa (Level of Evidence: C)
Recommendations for diagnosis of ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy
Class IIb (Level of Evidence: C)

2017AHA/ACC/HRS Guideline for management of sudden cardiac arrest and ventricular arrhythmia


Recommendations for management of cardiac arrest
CPR (Class I, Level of Evidence A):

CPR should be done according to basic and advanced cardiovascular life support algorithms

Amiodarone (Class I, Level of Evidence A) :

❑ In the recurrence of ventricular arrhythmia after maximum energy shock delivery and unstable hemodynamic, amiodarone should de infused

Direct current cardioversion : (Class I, Level of Evidence A)

❑ In ventricular arrhythmia and unstable hemodynamic, direct current cardioversion should be delivered

Revascularization:(Class I, Level of Evidence B)

❑ In patients with polymorphic VT and VF and evidence of acute STEMI in ECG, coronary angiography and emergency revascularization is advised

Wide QRS tachycardia: (Class I, Level of Evidence C)

Wide QRS tachycardia should be considered as VT if the diagnosis is unclear

Intravenous procainamide (Class 2a, Level of Evidence A):

❑ In hemodynamically stable VT, intravenous procainamide is recommended

Intravenous lidocaine : (Class 2a, Level of Evidence B)

Lidocaine is recommended in witness cardiac arrest due to polymorphic VT, VF unresponsed to CPR, defibrillation or vasopressor therapy

Intravenous betablocker : (Class 2a, Level of Evidence B)

❑ In polymorphic VT due to myocardial ischemia, intravenous betablocker maybe helpful

Intravenous Epinephrine : (Class 2b, Level of Evidence A)

❑ In cardiac arrest administration of 1 mg epinephrine every 3-5 minutes during CPR is recommended

Intravenous amiodarone : (Class 2b, Level of Evidence B)

❑ In hemodynamic stable VT, infusion of amiodarone or sotalole maybe considered

High dose of intravenous epinephrine : (Class III , Level of Evidence A)

❑ In cardiac arrest, administration of high dose epinephrine>1 mg bolouses is not beneficial
❑ In refractory VF not related to torsades de pointes, administration of intravenous magnesium is not beneficial

Intravenous amiodarone : (Class III , Level of Evidence B)

❑In acute myocardial infarction, prophylactic administration of lidocaine or amiodarone for prevention of VT is harmful

Intravenous verapamil, diltiazem : (Class III , Level of Evidence C)

❑ In a wide QRS tachycardia with unknown origin, administration of verapamil and diltiazem is harmful

Sustained monomorphic VT
Hemodynamic stability
12-Lead ECG, history, physical exam
Dirrect current cardioversion,ACLS
Notifying disease causing VT
VT termination
Structural heart disease
Intravenous procainamide (class2a)
Yes, therapy of underlying heart disease
NO, cardioversion (class1)
NO, Ideopathic VT
Intravenous amiodarone or sotalole (class2b)
VT termination
Verapamil sensitive VT: Verapamil outflow tract VT: betablocker (class2a)
Non effective: cardioversion
Yes,therapy of underlying heart disease
NO, Sedation ,anesthesia, reassessing antiarrhythmic therapy, repeating cardioversion
Therapy to prevent recurrence of VT
No VT termination
Catheter ablation (class1)
Catheter ablation (class1)
Verapamil , betablocker (class2a)


Catheter ablation can only be performed for patients with sustained monomorphic ventricular tachycardia based on these characteristics:


  1. Priori, Silvia G.; Blomström-Lundqvist, Carina; Mazzanti, Andrea; Blom, Nico; Borggrefe, Martin; Camm, John; Elliott, Perry Mark; Fitzsimons, Donna; Hatala, Robert; Hindricks, Gerhard; Kirchhof, Paulus; Kjeldsen, Keld; Kuck, Karl-Heinz; Hernandez-Madrid, Antonio; Nikolaou, Nikolaos; Norekvål, Tone M.; Spaulding, Christian; Van Veldhuisen, Dirk J. (2015). "2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". European Heart Journal. 36 (41): 2793–2867. doi:10.1093/eurheartj/ehv316. ISSN 0195-668X.
  2. 2.0 2.1 Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.
  3. Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z; et al. (2020). "The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis". Crit Care. 24 (1): 61. doi:10.1186/s13054-020-2773-2. PMC 7036236 Check |pmc= value (help). PMID 32087741 Check |pmid= value (help).
  4. Hallstrom AP, Ornato JP, Weisfeldt M, Travers A, Christenson J, McBurnie MA; et al. (2004). "Public-access defibrillation and survival after out-of-hospital cardiac arrest". N Engl J Med. 351 (7): 637–46. doi:10.1056/NEJMoa040566. PMID 15306665. Review in: ACP J Club. 2005 Jan-Feb;142(1):2 Review in: Evid Based Nurs. 2005 Apr;8(2):50
  5. Nakashima T, Noguchi T, Tahara Y, Nishimura K, Yasuda S, Onozuka D; et al. (2019). "Public-access defibrillation and neurological outcomes in patients with out-of-hospital cardiac arrest in Japan: a population-based cohort study". Lancet. 394 (10216): 2255–2262. doi:10.1016/S0140-6736(19)32488-2. PMID 31862250.
  6. Pollack RA, Brown SP, Rea T, Aufderheide T, Barbic D, Buick JE; et al. (2018). "Impact of Bystander Automated External Defibrillator Use on Survival and Functional Outcomes in Shockable Observed Public Cardiac Arrests". Circulation. 137 (20): 2104–2113. doi:10.1161/CIRCULATIONAHA.117.030700. PMC 5953778. PMID 29483086.
  7. Kragholm K, Wissenberg M, Mortensen RN, Hansen SM, Malta Hansen C, Thorsteinsson K; et al. (2017). "Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest". N Engl J Med. 376 (18): 1737–1747. doi:10.1056/NEJMoa1601891. PMID 28467879.
  8. Kitamura T, Kiyohara K, Sakai T, Matsuyama T, Hatakeyama T, Shimamoto T; et al. (2016). "Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan". N Engl J Med. 375 (17): 1649–1659. doi:10.1056/NEJMsa1600011. PMID 27783922.
  9. Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P; et al. (2015). "Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest". N Engl J Med. 372 (24): 2307–15. doi:10.1056/NEJMoa1405796. PMID 26061835.
  10. Kalarus Z, Svendsen JH, Capodanno D, Dan GA, De Maria E, Gorenek B; et al. (2019). "Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA)". Europace. 21 (10): 1603–1604. doi:10.1093/europace/euz163. PMID 31353412.
  11. Rankin AC, Rae AP, Cobbe SM (1987). "Misuse of intravenous verapamil in patients with ventricular tachycardia". Lancet. 2 (8557): 472–4. doi:10.1016/s0140-6736(87)91790-9. PMID 2887775.
  12. Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA; et al. (2022). "2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". Eur Heart J. 43 (40): 3997–4126. doi:10.1093/eurheartj/ehac262. PMID 36017572 Check |pmid= value (help).

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