📈 Stable Wide-QRS Tachycardia (ACLS)
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.
Stable Wide-QRS Tachycardia (ACLS)
Situation
When to use
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.
How it works
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).
Key points
- 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.
References
- Panchal AR, et al. Part 3: Adult Basic and Advanced Life Support (tachycardia). AHA Guidelines. Circulation 2020.
- American Heart Association — Adult Tachycardia (With Pulse) Algorithm.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.