Tachyarrhythmia - Management of ( Adult Critical Care )

Publication: 20/12/2016  
Next review: 04/12/2022  
Standard Operating Procedure
ID: 4860 
Approved By: ACC Clinical Governance 
Copyright© Leeds Teaching Hospitals NHS Trust 2019  


This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Management of Tachyarrhythmia

  • Is this a primary cardiac problem?
    • Remember fast AF may reflect hypovolaemia not inadequate rate control
  • Is the patient compromised?
    • e.g significant escalation in vasopressors, hypotension, cardiac failure or ischaemia
    • If yes then synchronised DC cardioversion
    • Do you need to initiate ALS?
  • Broad or narrow complex?
  • Regular or irregular?
  • Is there a correctable precipitating cause?
    • e.g CVC in too far, electrolyte abnormality, prolonged QTc

Narrow complex

  • Regular
    • SVT
    • Vagal maneuvers
    • Adenosine 6mg, 12mg, 12mg
    • If SR not restored consider B blockers (e.g. metoprolol)
    • Atrial flutter treat as per AF
  • Irregular
    • New AF or A.flutter with variable block
    • Magnesium 5g over 1hr
    • If no response amiodarone 300mg over 20-60 mins
    • Consider follow up 900mg amiodarone 24hr infusion
    • If no/inadequate response consider digoxin or B blockers
  • If unclear rhythm then short acting B blockers may reveal underlying pathology

Broad complex

  • Regular
    • Amiodarone 300mg over 20 – 60 mins
    • Beware pre-existing bundle branch block and SVT
  • Irregular
    • AF with bundle branch block – treat as for AF
    • Polymorphic VT – Torsades de pointes – Magnesium 2g over 10 mins

AF in Wolf Parkinson White

  • Avoid adenosine, B blockers, Ca channel blockers. Amiodarone may be unsafe also.
  • DC cardioversion, procainamide, ibutilide may be options – suggest d/w cardiology/ICU.

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Record: 4860
Clinical condition:

Patients in Adult Critical Care

Target patient group: Patients in Adult Critical Care
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Not supplied

Approved By

ACC Clinical Governance

Document history

LHP version 1.0

Related information

Not supplied

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