The management of wide QRS complex tachycardia depends on the patient’s hemodynamic status. For hemodynamically unstable patients, emergency treatment is required. Stabilization takes precedence over further diagnostic evaluation.

Patients with pulseless wide QRS complex tachycardia are managed according to advanced cardiac life support (ACLS) algorithms. Immediate high-energy defibrillation and cardiopulmonary resuscitation are required.

Patients with wide QRS complex tachycardia who are hemodynamically unstable but have a pulse should undergo urgent cardioversion. If the QRS complex and T wave can be distinguished, emergency synchronized shock with a biphasic defibrillator is optimal.

Hemodynamically stable patients with regular and monomorphic VT can be treated with vagal maneuvers. If those attempts are ineffective, adenosine is used next.

Chronic therapy for patients is geared toward treating the underlying cause. Some patients may need to have a cardioverter-defibrillator implanted.

The clinician must be certain of the diagnosis of VT before intervening. A misdiagnosis may provoke life-threatening complications after therapy. For example, if a patient with supraventricular tachycardia with bundle-branch block aberration is treated for VT and is given a calcium channel blocker such as verapamil, the patient can become hypotensive without an improvement in the tachycardia. These instances have been known to cause the death of a patient.