Synchronized cardioversion may be ineffective for idiopathic left ventricular tachycardia, challenging the universal application of the ACLS tachycardia algorithm for all unstable wide QRS tachycardias.
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Synchronized cardioversion failed in this idiopathic LV tachycardia case; hypothesis-generating for exceptions to the ACLS algorithm in unstable wide QRS tachycardia.
Accurate diagnosis of wide QRS complex tachycardia is difficult in emergent situations. According to the Advanced Cardiac Life Support (ACLS) tachycardia algorithm of the American Heart Association, immediate synchronized cardioversion should be applied to patients with wide QRS tachycardia with any evidence of hemodynamic instability. However, this may not be appropriate in all patients, especially those with idiopathic left ventricular tachycardia. In our patient, repetitively synchronized cardioversion failed to convert the arrhythmia. It is important for emergency physicians to recognize the electrocardiographic features of idiopathic left ventricular tachycardia and to manage these patients appropriately.
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Chou et al. (2009) studied this question.
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