For stable wide-complex tachycardia with a pulse, which medication is commonly used as first-line therapy?

For stable wide-complex tachycardia with a pulse, which medication is commonly used as first-line therapy?

• A. Lidocaine
• B. Sotalol
• C. Procainamide
• D. Amiodarone 150 mg IV over 10 minutes

Answer: (D)

When evaluating stable wide-complex tachycardia with a pulse, the priority is to terminate the tachycardia with an antiarrhythmic that works well for ventricular origin and is safe in a patient who is hemodynamically stable. Amiodarone fits this best because it has broad antiarrhythmic activity across sodium, potassium, and calcium channels, making it effective for ventricular tachycardia and for tachycardias with aberrant conduction. It tends to preserve blood pressure better than some alternatives and has a relatively lower risk of triggering dangerous proarrhythmias in this scenario. The standard rapid loading dose is 150 mg given IV over about 10 minutes, providing fast therapeutic levels, with the option to continue with an infusion if needed. Other drugs can be used in certain contexts, but amiodarone is favored first-line for a stable wide-complex tachycardia due to its broad efficacy and favorable safety profile in this setting.

When evaluating stable wide-complex tachycardia with a pulse, the priority is to terminate the tachycardia with an antiarrhythmic that works well for ventricular origin and is safe in a patient who is hemodynamically stable. Amiodarone fits this best because it has broad antiarrhythmic activity across sodium, potassium, and calcium channels, making it effective for ventricular tachycardia and for tachycardias with aberrant conduction. It tends to preserve blood pressure better than some alternatives and has a relatively lower risk of triggering dangerous proarrhythmias in this scenario. The standard rapid loading dose is 150 mg given IV over about 10 minutes, providing fast therapeutic levels, with the option to continue with an infusion if needed. Other drugs can be used in certain contexts, but amiodarone is favored first-line for a stable wide-complex tachycardia due to its broad efficacy and favorable safety profile in this setting.