IV Procainamide for Stable VT — EECC MCQ

Correct answer: A — IV procainamide — an alternative or adjunctive IV antiarrhythmic for stable sustained monomorphic VT; it may be more effective than amiodarone for acute VT termination based on the PROCAMIO trial

For haemodynamically stable sustained monomorphic VT, IV antiarrhythmic options include: (1) IV amiodarone (300 mg over 20-60 min, then infusion — most commonly used); (2) IV procainamide (10-17 mg/kg over 20-30 min — the PROCAMIO trial showed higher VT termination rates and fewer adverse events than amiodarone for stable VT). The 2022 ESC VA/SCD Guidelines include both as options for stable VT. Verapamil is only safe for fascicular VT (idiopathic, structurally normal heart) — it is DANGEROUS in VT with structural heart disease (can cause haemodynamic collapse). Flecainide is contraindicated in structural heart disease. Adenosine terminates AV-node-dependent SVTs but not VT (except rare adenosine-sensitive RVOT VT). If VT is not terminated pharmacologically, synchronised DC cardioversion should be performed.

Reference: ESC (2022): VA/SCD Guidelines; PROCAMIO Trial