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ERCAST


Welcome to ERCast, a focused discussion on the questions, quagmires and known unknowns we face everyday in the emergency department.

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Dec 10, 2010

What do you do when you get to the end of the ventricular tachycardia algorithm your patient is still in V-Tach. You are now off the map of ACLS and in the middle of a V Tach Storm.

We go step by step through a case of incessant ventricular tachycardia with pearls, pitfalls and things to think about when the fecus is hitting the fan.


Mike Sherriff EMT-P
almost seven years ago

I really enjoyed the podcast on VT. One point that may be worth mentioning is that overdrive pacing need not necessarily be faster than the underlying tachycardia. Others can explain it better, but from what I understand the paced impulse interrupts and breaks the cyclical nature of the dysrhythmia.

Amal Mattu discusses that overdrive pacing between 90 and 140 (if I recall correctly) may be effective.

Also from:
http://drsvenkatesan.wordpress.com/2009/11/07/forgotten-concepts-in-cardiology-over-drive-pacing/

The rate of pacing is generally between 50- 150 /mt
Technically we call it as over drive pacing , in reality most of the time pacing is domne at a lesser heart rate than the tachycardia itself. This should be recognised because, the term overdrive pacing connotes a meaning of pacing at more than the tachycardia rate.

Re Torsades:
From "Termination of drug-induced torsades de pointes with overdrive pacing" The American Journal of Emergency Medicine
Volume 28, Issue 1, January 2010, Pages 95-102

An asynchronous (fixed rate) mode must be used to overcome the patient's intrinsic rhythm. Although ventricular rates of 90 to 110 bpm are usually sufficient to eliminate ventricular ectopy, rates of up to 140 may be needed in some patients [4], [8] and [12]. Once control of the dysrhythmia has been obtained, the pacing rate can be gradually diminished to the lowest paced rate that adequately suppresses further ectopy and dysrhythmia.

Mike