If amiodarone is contraindicated for wide-complex tachycardia with a pulse, what is an appropriate alternative?

• A. Lidocaine
• B. Procainamide
• C. Amiodarone
• D. Adenosine

Answer: (A)

When you see a wide-complex tachycardia with a pulse, treat it as ventricular tachycardia and choose an antiarrhythmic that acts on ventricular tissue. If amiodarone cannot be used, lidocaine is a solid alternative because it’s a fast-acting sodium-channel blocker that preferentially suppresses ectopic ventricular activity, especially in ischemic or infarcted heart tissue. Its use in acute VT is well established, and it tends to have a safer profile in the setting of compromised hemodynamics compared with some other options.

Adenosine is not suitable here because it targets mostly narrow-complex SVTs and can be ineffective or harmful in VT. Procainamide could be used in VT, but it carries risks such as hypotension and proarrhythmia, so lidocaine is the better match when amiodarone isn’t an option. Amiodarone itself is the drug being contraindicated in this scenario.