📈 Stable Wide-QRS Tachycardia (ACLS)
UseUse to classify the rhythm (regular monomorphic, irregular/pre-excited, long QT, or unstable) and select aden…
SourceAHA 2025 Adult Tachycardia Algorithm
This-shift next steps
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Methodology · worked example, guidelines & full notes
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)
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) → 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
- [Guideline / primary source]AHA 2025 Adult Tachycardia Algorithm
- [Guideline / primary source]2025 AHA adult advanced cardiovascular life support guidelines (Part 9, PMID 41122884)
- American Heart Association — Adult Tachycardia (With Pulse) Algorithm.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Situation | Irregular (suspected AF with pre-excitation/WPW or polymorphic VT) |
|---|
→Stable wide QRSNo 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
| Situation | Regular, monomorphic (suspected VT or SVT with aberrancy) |
|---|
→Stable wide QRSAdenosine (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
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Stable Wide-QRS Tachycardia (ACLS)?
- 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.
- Does Stable Wide-QRS Tachycardia (ACLS) upload patient data? Where is it calculated?
- 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.
- How is Stable Wide-QRS Tachycardia (ACLS) calculated in practice? Can you show a worked example?
- 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）