EMedHome's Clinical Pearl
Lidocaine is one of the least effective agents for converting ventricular tachycardia (VT) outside of the acute myocardial infarction setting. (Am J Emerg Med. 2019;37:1340.)
Contrary to widespread belief, IV procainamide is more effective and safer than IV amiodarone for the acute conversion of VT. (Am J Emerg Med. 2019;37:1340; Acad Emerg Med. 2019;26:1099, http://bit.ly/2p6hz7Y; Eur Heart J. 2017;38:1329, http://bit.ly/2Vx0Nuw; Emerg Med J. 2015;32:161.)
IV procainamide is the only agent that carries a class IIA indication for the pharmacologic conversion of VT, and it is listed ahead of IV amiodarone (class IIB) in the ACLS guidelines. (Am J Emerg Med. 2019;37:1340; Acad Emerg Med. 2019;26:1099, http://bit.ly/2p6hz7Y; Eur Heart J. 2017;38:1329, http://bit.ly/2Vx0Nuw; Emerg Med J. 2015;32:161; Circulation. 2010;122[16 Suppl 2]:S345; http://bit.ly/2nEfks4.)
On the other hand, IV amiodarone is the most effective agent in preventing recurrences of VT, making its use in repetitive VT appropriate. Frequently, IV procainamide is used for terminating VT, followed by IV amiodarone for preventing recurrence. (Am J Emerg Med. 2019;37:1340.) The safety of administering procainamide and amiodarone in sequence, however, has not been clearly established.
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This Month's Video
Nilesh Patel, DO: Current Evaluation and Management of Complications of Cirrhosis: http://bit.ly/EMN-EMedHomeVideos. Dr. Patel is an assistant professor of clinical emergency medicine at New York Medical College and the emergency medicine residency program director at St. Joseph's Regional Medical Center in Paterson, NJ.
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Amal Mattu, MD, and Colleagues: Cardiac Transplant Patients in the ED, Cardiac Syncope, and Penicillin Allergy: http://bit.ly/MattuEMN. Dr. Mattu is one of the premier speakers in emergency medicine, and a professor of emergency medicine and the vice chair of emergency medicine at the University of Maryland School of Medicine in Baltimore.