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Wide Complex Tachycardia — RACP Adult Medicine MCQ

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ModerateEmergency MedicineWide Complex TachycardiaRACP Adult Medicine

A 45-year-old man with no prior cardiac history presents with palpitations and lightheadedness. ECG shows a wide-complex tachycardia at 160 bpm that is regular. The QRS morphology is different from his sinus rhythm ECG. He is haemodynamically stable. What is the safest initial approach?

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Correct answer: E — IV amiodarone

A regular wide-complex tachycardia should be treated as ventricular tachycardia (VT) until proven otherwise. In a haemodynamically stable patient, IV amiodarone (150–300 mg over 20–60 minutes) is the preferred first-line agent. Verapamil is CONTRAINDICATED in WCT as it can cause cardiovascular collapse if the rhythm is VT. Adenosine may be considered diagnostically but carries risks in VT. If the patient becomes haemodynamically unstable, immediate synchronised DC cardioversion is indicated.

Reference: eTG – 2025 – Cardiovascular; ARC – 2024 – Advanced Life Support Guidelines