ACLS Tachycardia with Pulse Algorithm (AHA 2025)
ACLS Tachycardia with Pulse Algorithm (AHA 2025): Tachycardia with Pulse → Hemodynamically Unstable? → Synchronized Cardioversion → Rhythm Converts? → S...
Interactive Decision Tree
Algorithm Steps
- ▶Start
Tachycardia with Pulse
HR >150 bpm with symptoms
- ◆Decision
Hemodynamically Unstable?
Signs of instability
- Hypotension
- Altered mental status
- Signs of shock
- Chest pain
- Acute heart failure
If Yes:
- ●Action
Synchronized Cardioversion
IMMEDIATE if unstable
- Sedate if possible
- Use device-recommended energy
- Sync mode ON
- ◆Decision
Rhythm Converts?
If Yes:
- ✓Outcome
SVT Confirmed
Maintenance therapy, EP referral
If No:
- ✓Outcome
Cardiology/EP Consult
Further management
If No:
- ◆Decision
QRS Width?
Determine rhythm type
- ●Action
Narrow Regular
Likely SVT
- 1. Vagal maneuvers
- 2. Adenosine 6mg rapid IV
- 3. Adenosine 12mg if no response
- 4. Beta-blocker or CCB
- ●Action
Narrow Irregular
AFib, AFlutter, MAT
- Rate control (BB, CCB, digoxin)
- Anticoagulation consideration
- Avoid adenosine
- ⚠Warning
WPW/Pre-excitation WARNING
AVOID these drugs
- Adenosine
- Digoxin
- Calcium channel blockers
- Beta-blockers
- IV Amiodarone
- ●Action
Wide Regular
VT or SVT with aberrancy
- If VT or uncertain: Amiodarone 150mg/10min
- Adenosine if SVT suspected (Class IIb)
- Procainamide or Sotalol alternatives
- ⚠Warning
Wide Irregular
DANGER - Expert consult
- If polymorphic VT/Torsades: DEFIBRILLATE (not sync)
- Pre-excited AF: AVOID adenosine, CCB, BB, digoxin
- Use procainamide or cardioversion
Guideline Source
2025 AHA Guidelines for CPR and ECC - Adult Advanced Life Support
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
Applicable Regions
EU: ERC guidelines similar approach
US: AHA 2025 - specific energies deferred to device manufacturer
Next steps
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Related Resources
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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