Tachydysrhythmias are defined as any abnormal cardiac rhythm with a rate greater than 100 beats per minute. The tachydysrhythmias include a large number of diagnoses including atrial (atrial fibrillation/flutter, supraventricular tachycardia (SVT), multifocal atrial tachycardia (MFAT)) and ventricular dysrhythmias (ventricular tachycardia (VT), ventricular fibrillation (VF) and Torsades de Pointes). These disorders are common and patients can present in extremis making it critical for emergency providers to be able to rapidly distinguish between tachydysrhythmias and initiate management.
This post will be the first in a series. Here, we set out to create simple yet comprehensive algorithms for identification and management of tachydysrhythmias. In future posts, we will take each diagnosis individually and delve into management.
Thanks to Salim Rezaie and Haney Mallemat for peer review on this post.
Hi! Thanks for this nice chart! Just one question, how does Accelerated Idioventricular Rhythm play into all of this, if anyhow? Is there room for nuance regarding differentiating between VTach vs high-rate AIVR? Since it also has therapeutic implications.
Jan – Interesting question. We’ll actually have a post in a couple of weeks on VTach and we touch on this point. In general, AIVR tends to be < 110 beats per minute but can mimic VT (Hyperkalemia and Na channel blockade similarly can mimic and have rates around 110 bpm). Beyond the rate, I think the only other thing to look at is clinical context. This can be difficult as well as patients can have VT after an MI or AIVR if they've reperfused.
Thank you! This is wonderful information. How do I get the information you will post in the future? Thank you!
D’neen – sorry, we don’t have a system in place for that yet. I’ll have to consult with the other editors and see if we can make something like that happen.
Glad you’re enjoying the blog!
Actually D’neen we do have a few great ways to stay informed of new content:
In the second algorithm, it lists amiodarone as an option for Afib with aberrancy, but there’s no differentiation between bizarre multifocal Afib with aberrancy (possible WPW/Afib) versus ‘plain old’ irregular wide complex A fib. I’m in the camp of not using amiodarone if I’m worried about WPW/Afib–what are your thoughts on this? Curious.
Gita – I agree with your thoughts on amiodarone. I’m not a fan of the drug for any tachydysrhythmia. I think there’s always a better option. However, amiodarone is listed as a second line drug for AF w/ WPW and this is why we listed it. I would prefer to go with electricity or, if you had to use a chemical, procainamide.
Thanks! Love the new site. Using it in our Asynchrony course this week and wanted to clarify–thanks again!
Wouldn’t amiodarone be contraindicated in A-fib if you were concerned about it possibly being WPW?
Wouldn’t slowing down the AV node allow for simulation of the ventricles through other pathways causing ventricular rates to climb to dangerous levels?
It has been thought and taught that amiodarone is safe is WPW with a wide complex tachycardia but I agree with you 100%. I don’t think it’s safe. Procainamide has more evidence and experience behind it but I elect for simply giving electricity (after procedural sedation if tolerated).