CathLabHub

CathLabHub complications toolkitcathlabhub.com/toolkit/vt-vfIn review, October 24, 2026

Recognize

The signs on the monitor, the image and the patient.

  • MonitorA wide fast rhythm with a falling or absent arterial pressure; chaotic VF; loss of the waveform 1.
  • ImageAfter a forceful left coronary injection, a wedged catheter, reperfusion, or a pigtail at the left ventricular apex 2.
  • PatientLoss of consciousness within seconds of VF; a stable patient with palpitations in monomorphic VT.

Act now

In the order the operator does them. The first three come first, whatever else is happening.

  1. No pulse: defibrillate at once; biphasic 120 to 200 J as the manufacturer recommends, or the maximum 1.
  2. Witnessed VF in the lab with pads on: up to three quick successive shocks before compressions 3.
  3. CPR at 100 to 120 a minute between shocks; epinephrine 1 mg every 3 to 5 minutes 1.
  4. Amiodarone 300 mg IV after the third shock, then 150 mg; or lidocaine 1 to 1.5 mg/kg, then 0.5 to 0.75 mg/kg 1.
  5. Stop the trigger: pull the catheter back, deflate the balloon, reposition the pigtail.
  6. VT with a pulse but unstable: synchronized cardioversion, 100 J for monomorphic VT 1.
  7. Stable monomorphic VT: amiodarone 150 mg over 10 minutes 14.
  8. Refractory arrest: mechanical CPR to keep working, and venoarterial ECMO if the patient does not recover 2.
  9. Open the culprit vessel during the resuscitation when ischemia is the cause 2.

Equipment

From the complications cart. Linked items open in the equipment directory.

Drugs

Adult doses as the cited source gives them. Check your formulary and the label.

  • Epinephrine1 mg IV every 3 to 5 minutes in arrest 1.
  • AmiodaroneArrest: 300 mg IV, then 150 mg 1. Stable VT: 150 mg over 10 minutes, then 1 mg/min 4.
  • Lidocaine1 to 1.5 mg/kg IV, then 0.5 to 0.75 mg/kg 1.Product in the directory
  • MagnesiumFor torsades de pointes 1.

Who to call

The escalation ladder, first call first.

  1. Code team: at once.
  2. Anesthesia: airway.
  3. Shock team and ECMO: for refractory arrest or electrical storm 2.
  4. Electrophysiology: for recurrent VT.

The bailout step by step

Witnessed VF on the table 31

  1. Shout VF; charge while the operator steps back from the table.
  2. Shock; if VF persists, shock again quickly, up to three times 3.
  3. Still VF: start compressions, 100 to 120 a minute; mechanical CPR if available 12.
  4. Epinephrine and amiodarone per ACLS after the third shock 1.
  5. Find the trigger: catheter position, ischemia, reperfusion, electrolytes.
  6. Open the vessel while compressions continue, or go to venoarterial ECMO 2.

Prevent

  • Pads on before high risk PCI and shock cases.
  • Never inject on a damped pressure; disengage between injections 5.
  • Correct potassium and magnesium before the case.

After care and documentation

  • ECG, electrolytes, troponin; post arrest care if circulation was lost.
  • Document the times of arrest, each shock and drug, and return of circulation.

Practice

Emergency simulator cases in the Cath Trainer app. The link opens Cases; type the case number in the search box.

  • EMG-0030: Alarm and a chaotic trace after a left coronary injection
  • EMG-0005: Alarm moments after flow is restored
  • EMG-0009: A fast wide rhythm during the ventriculogram

References

  1. Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: adult basic and advanced life support. 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2020;142(suppl 2):S366-S468.
  2. Brilakis ES. Manual of Percutaneous Coronary Interventions. Elsevier; 2021. Chapter 28, Other complications: hypotension, radiation skin injury, contrast induced acute kidney injury.
  3. Soar J, Bottiger BW, Carli P, et al. European Resuscitation Council guidelines 2021: adult advanced life support. Resuscitation 2021;161:115-151.
  4. Brilakis ES. Manual of Percutaneous Coronary Interventions: A Step-by-Step Approach. Academic Press, Elsevier; 2021. Chapter 3, Medications.
  5. Brilakis ES. Manual of Percutaneous Coronary Interventions. Elsevier; 2021. Chapter 25, Acute vessel closure.
  6. CathLabHub Cath Trainer app, emergency simulator: case library (cathlabhub.com/app, Cases).

Educational reference for cath lab teams, not medical advice and not a standard of care. Your local policy, the device instructions for use and current guidelines govern. Verify every dose before use. Printed from cathlabhub.com/toolkit/vt-vf. First version, in clinical review: an interventional cardiologist is checking every card before it is final. Every number cites its source on the card.