Ventricular Tachycardia Medical Slides

Present the Brugada algorithm step-by-step: (1) absence of RS complex in all precordial leads = VT, (2) RS interval >100 ms = VT, (3) AV dissociation = VT, (4) morphology criteria in V1/V6. Emphasize the clinical pearl that if in doubt, treat as VT — treating SVT with aberrancy as VT is safe, but the reverse can be fatal.

For pulseless VT: defibrillation at 200J biphasic, CPR, epinephrine every 3-5 minutes, amiodarone 300 mg then 150 mg. For stable monomorphic VT: IV procainamide (preferred per AHA) or amiodarone. For unstable VT with a pulse: synchronized cardioversion at 100J. Emphasize that polymorphic VT with long QT requires IV magnesium and isoproterenol, not amiodarone.

Define VT storm as ≥3 sustained VT episodes or appropriate ICD shocks within 24 hours. Present the management stepladder: correct reversible causes (electrolytes, ischemia), IV amiodarone + beta-blocker (esmolol), deep sedation, overdrive pacing, and emergent catheter ablation. Reference the VANISH trial showing superiority of escalated ablation over escalated antiarrhythmic therapy for recurrent VT.