Patients with SMVT who are hemodynamically stable on presentation may remain stable or may become unstable rapidly and without warning. As such, therapy should be promptly provided to most patients. The choice of initial treatments for hemodynamically stable SMVT includes electrical or pharmacologic cardioversion.
The preferred choice is, to begin with an intravenous antiarrhythmic agent and reserve electrical cardioversion for refractory patients or for those who become unstable. Pharmacologic cardioversion For pharmacologic cardioversion, one of the following antiarrhythmic drugs is recommended: Lidocaine: Intravenous lidocaine can be given in an initial dose of 1 to 1.5 mg/kg (typically 75 to 100 mg at a rate of 25 to 50 mg/minute); lower doses of 0.5 to 0.75 mg/kg can be repeated every 5 to 10 minutes as needed. If VT terminates, then we usually do not begin a continuous infusion.…
