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ACLS Tachycardia with Pulse Algorithm (AHA 2025)

ACLS Tachycardia with Pulse Algorithm (AHA 2025): Tachycardia with Pulse → Hemodynamically Unstable? → Synchronized Cardioversion → Rhythm Converts? → S...

Pathway Overview

12 steps

Algorithm Steps

12 total

  1. 01Start

    Tachycardia with Pulse

    HR >150 bpm with symptoms

  2. 02Decision

    Hemodynamically Unstable?

    Signs of instability

    • Hypotension
    • Altered mental status
    • Signs of shock
    • Chest pain
    • Acute heart failure
  3. If Yes
    1. 03Action

      Synchronized Cardioversion

      IMMEDIATE if unstable

      • Sedate if possible
      • Use device-recommended energy
      • Sync mode ON
    2. 04Decision

      Rhythm Converts?

    3. If Yes
      1. 05Outcome

        SVT Confirmed

        Maintenance therapy, EP referral

      If No
      1. 06Outcome

        Cardiology/EP Consult

        Further management

    If No
    1. 07Decision

      QRS Width?

      Determine rhythm type

    2. 08Action

      Narrow Regular

      Likely SVT

      • 1. Vagal maneuvers
      • 2. Adenosine 6mg rapid IV
      • 3. Adenosine 12mg if no response
      • 4. Beta-blocker or CCB
    3. 09Action

      Narrow Irregular

      AFib, AFlutter, MAT

      • Rate control (BB, CCB, digoxin)
      • Anticoagulation consideration
      • Avoid adenosine
    4. 10Warning

      WPW/Pre-excitation WARNING

      AVOID these drugs

      • Adenosine
      • Digoxin
      • Calcium channel blockers
      • Beta-blockers
      • IV Amiodarone
    5. Path rejoins step 04Shared downstream outcome
    6. 11Action

      Wide Regular

      VT or SVT with aberrancy

      • If VT or uncertain: Amiodarone 150mg/10min
      • Adenosine if SVT suspected (Class IIb)
      • Procainamide or Sotalol alternatives
    7. 12Warning

      Wide Irregular

      DANGER - Expert consult

      • If polymorphic VT/Torsades: DEFIBRILLATE (not sync)
      • Pre-excited AF: AVOID adenosine, CCB, BB, digoxin
      • Use procainamide or cardioversion
    8. Path rejoins step 06Shared downstream outcome
    9. Path rejoins step 04Shared downstream outcome

Guideline Source

2025 AHA Guidelines for CPR and ECC - Adult Advanced Life Support

DOI: 10.1161/CIR.0000000000001376View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Assumes adult with pulse
  • Cardioversion energies: use device manufacturer guidance
  • WPW/pre-excitation requires special considerations

Contraindicated Populations

pediatric

Applicable Regions

USEU

EU: ERC guidelines similar approach

US: AHA 2025 - specific energies deferred to device manufacturer

Version 1Next review: 2030-10-01

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Atrial Fibrillation Management (ESC 2024 AF-CARE)

Management

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Frequently Asked Questions

What is the ACLS Tachycardia with Pulse Algorithm (AHA 2025)?

The ACLS Tachycardia with Pulse Algorithm (AHA 2025) is a emergency clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2025 AHA Guidelines for CPR and ECC - Adult Advanced Life Support.

What guideline is the ACLS Tachycardia with Pulse Algorithm (AHA 2025) based on?

This algorithm is based on 2025 AHA Guidelines for CPR and ECC - Adult Advanced Life Support (DOI: 10.1161/CIR.0000000000001376).

What are the limitations of the ACLS Tachycardia with Pulse Algorithm (AHA 2025)?

Known limitations include: Assumes adult with pulse; Cardioversion energies: use device manufacturer guidance; WPW/pre-excitation requires special considerations. Individual patient factors may require deviation from these recommendations.

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