Tachycardia Algorithm
The ACLS tachycardia algorithm asks one question before anything else: is the patient stable? The answer decides between immediate synchronised cardioversion and a more considered approach. It is a core case on the ACLS course.
The pathway
Assess and support ABCs, monitor, 12-lead ECG if possible → is the tachyarrhythmia causing instability? → unstable: synchronised cardioversion → stable, narrow and regular: vagal manoeuvres, then adenosine → stable, wide: consider adenosine only if regular and monomorphic, an antiarrhythmic infusion and expert consultation.
Support the airway and breathing, attach the monitor, obtain IV access and a 12-lead ECG if it will not delay treatment. Look for causes such as fever, dehydration, pain and hypoxia: sinus tachycardia treats the cause, not the rate.
If the tachyarrhythmia is causing hypotension, altered mental status, shock, ischaemic chest pain or acute heart failure, perform synchronised cardioversion, with sedation if the patient is conscious and it does not delay treatment. Energy selection depends on the rhythm — see electrical therapy.
Typically supraventricular tachycardia. Try vagal manoeuvres; if they fail, give adenosine as a rapid IV push followed by a saline flush, with a larger second dose if needed. See ACLS drugs.
Often atrial fibrillation; management focuses on rate control and expert input, and is outside the core ACLS algorithm.
Consider adenosine only if the rhythm is regular and monomorphic. Otherwise an antiarrhythmic infusion is considered, with expert consultation. Treat a wide complex tachycardia of uncertain origin as ventricular tachycardia until proven otherwise.
Pulseless VT is cardiac arrest: go to the shockable pathway. Recognising the rhythms is covered in ACLS rhythms; the slow-rate counterpart is the bradycardia algorithm.
This guide summarises what the ACLS course teaches for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s policies.
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Synchronised cardioversion.
Adenosine, after vagal manoeuvres.
Only if the rhythm is regular and monomorphic.
Hypotension, altered mental status, shock, ischaemic chest pain or acute heart failure caused by the rhythm.
Treat as cardiac arrest using the shockable pathway.
Reading an algorithm is not the same as running one. Safety First Medical Services is an American Heart Association training centre on Al Reem Island, Abu Dhabi, with HeartCode, classroom and on-site ACLS and a two-year AHA ACLS Provider eCard.
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Last reviewed by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.