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FAQ of the Week: One of my colleagues expressed the belief that ventricular tachycardia and ventricular fibrillation should be treated the same way.

FAQ of the Week: One of my colleagues expressed the belief that ventricular tachycardia and ventricular fibrillation should be treated the same way.

One of my colleagues expressed the belief that ventricular tachycardia and ventricular fibrillation should be treated the same way. This does not square with my knowledge of electrophysiology and pharmacology. Please comment.
 
We wholeheartedly agree with your approach of beginning with basic cardiac electrophysiology; electrical therapy and pharmacology. 

Ventricular fibrillation (VF) is fibrillating myocardium. The usual route of therapeutic termination is to simultaneously depolarize a critical mass of fibrillating myocardium (DC counter-shock). Ventricular tachycardia (VT), on the other hand, is a circuitry issue. Unlike VF, which is fatal if not treated quickly, patients in VT are more likely to be clinically stable. Thus, drug therapy may be the best treatment approach. 

If a patient with VT is unstable (inadequate perfusion), immediate DC counter-shock is indicated. However, VT rarely requires high therapeutic energy to terminate anomalous circuitry conduction, compared to VF, which routinely requires high energy to depolarize a critical mass of fibrillating myocardium. 
 
Another major difference in treating unstable VT and VF is the appropriateness of the use of epinephrine. While an agent often employed when treating refractory VF, it is pro-arrhythmic and is therefore not a logical drug for VT. Further, VT is virtually never seen being refractory to counter-shock.
 
The confusion seems to be solved by this approach: “Treat pulseless VT as quickly as VF, not the same.” The common thread is rapid use of electrical therapy.
AMRI Staff

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