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 — with explicit cautions for irregular and long-QT cases.

Branches: regular monomorphic (adenosine 6→12 mg, amiodarone 150 mg / procainamide 20–50 mg/min) → 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.

Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.

Inputs: Situation Irregular (suspected AF with pre-excitation/WPW or polymorphic VT) → Result: Stable wide QRS No AV-nodal blockers, expert consult（Key warning: Irregular wide QRS (e.g. AF with WPW pre-excitation): avoid adenosine/β-blockers/calcium antagonists/digoxin — blocking the AV node can accelerate the ventricular rate and trigger VF, Management: Prefer synchronized cardioversion (when unstable); medication may consider procainamide or ibutilide (pre-excited AF); polymorphic VT → see the long-QT branch; early expert consult, Basis: AHA 2025 Adult Tachycardia Algorithm） 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, 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）