Recurrent Ventricular Tachycardia/Fibrillation Post- CPB
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NB do not treat ectopic beats, couplets, triplets, non-sustained VT (<10 seconds) unless
interfering with balloon pump
Correct ischaemia / hypokalaemia / hypomagnesaemia / hypocalcaemia / hypoxia / acidosis
/ heart failure
Perform 12 lead ECG to detect acute infarction / graft occlusion
Ensure central line is not “irritating” the right ventricle
Consider the possibility of proarrhythmia from any drug already used
Consider inappropriate pacing (pace on T) because of poor pacemaker sensing
Ventricular pacing (100-110 bpm) may prevent need for antiarrhythmic drugs
If VT / VF is occurring infrequently it may be preferable to monitor and consult
asthma?
chronic airways disease?
inotrope dependent?
pulmonary oedema?
yes
no
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lignocaine 1mg/kg IVI
& infusion3
sotalol2
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ineffective?
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amiodarone1
1. Amiodarone dose: 300mg IVI over 120 minutes. Review when half of dose given – if hypotensive
consider stopping infusion. Following the first dose give 450 mg over 12 hours. Se amiodarone
infusion protocol Cardiology.
2. Sotalol dose: Oral: 80mg bd. Intravenous: 0.5 – 1.0mg/kg bd. Watch for hypotension/bradycardia.
Dose must be adjusted with renal failure.
3. Lignocaine Dose: 1mg/kg IVI followed by infusion of 2-4mg/min according to Cardiology
Lignocaine infusion protocol. N.B. lignocaine infusion dose must be reduced with hepatic
impairment or cardiac failure.