Stable Wide-QRS Tachycardia (ACLS) — free guideline decision tool

This tool guides management of stable wide-QRS (≥ 0.12 s) tachycardia: adenosine for regular monomorphic rhythms and antiarrhythmic infusion, per AHA 2020 — with explicit cautions for irregular and long-QT cases.

Branches: regular monomorphic (adenosine 6→12 mg, amiodarone 150 mg / procainamide 20–50 mg/min / sotalol) → irregular/WPW (no AV-nodal blockers, cardiovert) → long QT (magnesium, avoid procainamide/sotalol) → unstable (synchronized cardioversion; polymorphic → defibrillation).

Use to classify the rhythm (regular monomorphic, irregular/pre-excited, long QT, or unstable) and select adenosine, an antiarrhythmic, magnesium, or synchronized cardioversion accordingly, with early expert consultation.

In irregular wide-QRS tachycardia such as AF with WPW pre-excitation, AV-nodal blockers (adenosine, β-blockers, calcium antagonists, digoxin) can accelerate the ventricular rate and trigger VF — avoid them. (original synthesis · not guideline verbatim) Adenosine is appropriate only for regular, monomorphic wide-QRS tachycardia to help differentiate SVT with aberrancy. Long-QT/torsades is treated with magnesium and avoidance of QT-prolonging antiarrhythmics; an unstable pulseless rhythm follows the VF/pulseless VT algorithm.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Situation Regular, monomorphic (suspected VT or SVT with aberrancy) → Result: Stable wide QRS Adenosine (optional) + antiarrhythmic（Adenosine (regular + monomorphic only): 6 mg rapid IV push → if ineffective 12 mg; can help differentiate and convert SVT with aberrancy. Contraindicated in irregular/polymorphic/pre-excited, Amiodarone: 150 mg IV over 10 minutes, repeat if needed; then 1 mg/min × 6 h (≤ 2.2 g/24 h), Procainamide: 20–50 mg/min until conversion/hypotension/QRS ↑ > 50%/reaching 17 mg/kg; then 1–4 mg/min. Avoid in long QT/heart failure） Inputs: Situation Hemodynamically unstable → Result: Stable wide QRS Immediate synchronized cardioversion（Synchronized cardioversion: Wide-QRS tachycardia with a pulse but unstable → immediate synchronized cardioversion (regular wide QRS from ~100 J, escalate per manufacturer); sedate first (if feasible), Polymorphic/irregular unstable: Polymorphic VT treated as VF → unsynchronized defibrillation, Pulseless: Pulseless VT → follow the VF/pulseless VT algorithm (see the VF/pulseless VT tool)）