What is the gold standard treatment for pulseless ventricular tachycardia?
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An AED reads and analyzes the rhythm and determines if a shock is needed. The AED is programmed to only prompt the user to defibrillate pulseless VT and VF rhythms. The machine does not know if the individual has a pulse or not. This is the primary reason you should not use an AED in someone with a palpable pulse. ACLS responses to pulseless VT and VF within a hospital will likely be conducted using a cardiac monitor and a manual defibrillator. Thus, the ACLS provider must read and analyze the rhythm. Shocks should only be delivered for pulseless VT and VF. Likewise, antiarrhythmic drugs and drugs to support blood pressure may be used. Show
Rules for Ventricular Fibrillation (RF) Figure 24 RegularityThere is no regular shape of the QRS complex because all electrical activity is disorganized.RateThe rate appears rapid but the disorganized electrical activity prevents the heart from pumping.P WaveThere are no P waves present.PR IntervalThere is no PR Interval present.QRS ComplexThe ventricle complex varies. Table 5 Rules for Ventricular Tachycardia(Regular/Rapid Wide Complex Tachycardia)Figure 25 RegularityR-R intervals are usually, but not always, regular. RATERateThe atrial rate cannot be determined. Ventricular rate is usually between 150 and 250 beats per minute.P WaveQRS complexes are not preceded by P waves. There are occasionally P waves in the strip, but they are not associated with the ventricular rhythm.PR IntervalPR interval is not measured since this is a ventricular rhythm.QRS ComplexQRS complex measures more than 0.12 seconds. The QRS will usually be wide and bizarre. It is usually difficult to see a separation between the QRS complex and the T wave. Table 6 Rules for Torsades De Pointes(Irregular Wide Complex Tachycardia)Figure 26 RegularityThere is no regularity.RateThe atrial rate cannot be determined. Ventricular rate is usually between 150 and 250 beats per minute.P WaveThere are no P waves present.PR IntervalThere are no PR intervals present.QRS ComplexThe ventricle complex varies. Table 7 Take Note VF and pulseless VT are both shockable rhythms. The AED cannot tell if the individual has a pulse or not. Pulseless ventricular tachycardia occurs when heart ventricles contract too fast and don’t have time to fill with blood. When blood flow stops, a person’s pulse stops. Survival depends on receiving fast emergency treatment and defibrillation. Heart-healthy habits and careful management of existing heart conditions are key to prevention.
OverviewWhat is pulseless ventricular tachycardia?Your heart has four chambers. There are two upper chambers (atria) and two lower chambers (ventricles). The ventricles are the main pumping chambers of your heart. With each heartbeat, they contract forcefully to send blood out to your body and lungs. Pulseless ventricular tachycardia occurs when the ventricles beat too fast. It is a type of ventricular arrhythmia or abnormal heartbeat of the ventricles. In pulseless ventricular tachycardia, the heart contracts too fast (tachycardia). This prevents the ventricles from filling with blood and stops blood flow to the body. Without blood flow, a person has no pulse. This lack of blood flow can quickly lead to organ failure, heart failure and sudden cardiac arrest. Pulseless ventricular tachycardia can be monomorphic (heart beats have similar electrical waveforms) or polymorphic (heart beats have varying waveforms). Sudden cardiac arrest is a life-threatening emergency. If you suspect you or someone you're with is experiencing cardiac arrest, do not hesitate to call 911 (or your local emergency services phone number). Time is critical in treating cardiac arrest, and a delay of even a few minutes can result in permanent damage or death. Is ventricular tachycardia always pulseless?Ventricular tachycardia is not always pulseless. In ventricular tachycardia, the heart rate usually exceeds 100 beats per minute. A normal resting heart rate is 60 to 100 beats per minute. The severity of ventricular tachycardia depends on how:
Ventricular tachycardia is often treatable. If it becomes severe it can lead to pulseless ventricular tachycardia. It is more likely to occur in people who have other heart conditions. How common is pulseless ventricular tachycardia?Each year in the U.S., about 350,000 people, mostly over age 35, die from sudden cardiac death. The majority of deaths from sudden cardiac arrest are due to ventricular arrhythmias. Symptoms and CausesHow does pulseless ventricular tachycardia occur?Your heartbeat is controlled by electrical signals (impulses) that travel through the heart. This condition can occur when the electrical signals don’t follow the normal pathway. This can result in rapid heartbeats. What causes pulseless ventricular tachycardia?Many conditions can alter the electrical signals in the heart. Structural heart diseases are the most common cause. These include:
Other causes of pulseless ventricular tachycardia include:
What are the symptoms of pulseless ventricular tachycardia?People with pulseless ventricular tachycardia are:
Before becoming unconscious, you may experience symptoms of ventricular tachycardia, including:
Diagnosis and TestsHow is pulseless ventricular tachycardia diagnosed?Because it is a medical emergency, it's not always possible to diagnose. Call 911 and start CPR right away. Management and TreatmentHow is pulseless ventricular tachycardia treated?If it occurs outside the hospital, first responders will perform CPR, as well as:
The goal is to get your heart beating normally again. Then healthcare providers will check for any health problems caused by cardiac arrest. To protect the brain from damage, they may cool your body. If a heart attack occurred, they will provide immediate treatment. Your provider may recommend an implantable cardioverter defibrillator (ICD). This device monitors your heartbeat 24/7. If it detects an abnormal heart rhythm, it sends an electrical shock to correct it. Studies show that defibrillators are highly effective at reducing sudden cardiac death. PreventionHow can I prevent pulseless ventricular tachycardia?A heart-healthy lifestyle can reduce your chance of developing many types of heart conditions and diseases. Important habits include:
How can I prevent pulseless ventricular tachycardia if I already have heart disease?Follow your treatment plan and check in with your healthcare provider routinely. This will help reduce your chance of developing a more dangerous heart condition. Outlook / PrognosisWhat is the prognosis for people with pulseless ventricular tachycardia?The outlook depends on how long it takes to restore a person’s pulse. Survival rates are only about 5% if the delay is more than 15 minutes. What are complications of pulseless ventricular tachycardia?Damage to the brain can occur if cardiac arrest lasts longer than three to five minutes. Other life-threatening complications can include:
Your healthcare team will coordinate your care to help minimize these complications and optimize your recovery. Living WithWhen should I contact my healthcare provider?Seek medical care right away if you have symptoms of ventricular tachycardia, including:
A note from Cleveland Clinic Pulseless ventricular tachycardia is a serious condition that must receive immediate emergency treatment. Though the prognosis is poor, it can be prevented. The first and most important step is to adopt a heart-healthy lifestyle. If you have any type of heart condition, check in with your provider regularly and follow your treatment plan. Your provider should be your go-to resource for any questions or concerns you may have about your heart health. Share Facebook Twitter LinkedIn Email Print Last reviewed by a Cleveland Clinic medical professional on 06/03/2022. References
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What is the treatment of choice for ventricular fibrillation and pulseless ventricular tachycardia?The vasopressor that is used for the treatment of VF/Pulseless VT is epinephrine. Epinephrine is primarily used for its vasoconstrictive effects. Vasoconstriction is important during CPR because it will help increase blood flow to the brain and heart. Rhythm checks should be performed after 5 cycles of CPR.
Why is epinephrine used for pulseless ventricular tachycardia?It is used for its potent vasoconstrictive effects and also for its ability to increase cardiac output. Epinephrine is considered a vasopressor.
What would be appropriate treatments for ventricular tachycardia?Treatment for ventricular tachycardia may include medication, a shock to the heart (cardioversion), catheter procedures or surgery to slow the fast heart rate and reset the heart rhythm.
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