In this case, after the patient arrived at the emergency unit of RSUD CUT MEUTIA,

cardioversion was performed on the patient to treat ventricular tachycardia. In principle, the
purpose of ventricular tachycardia treatment is to restore normal heart rhythm (regulate rhythm),
decreased heart rate (regulating heart rate) and prevents the formation of blood clots(1).
VT is the most common arrhythmia, espe- cially in patients with a history of heart
disease. When wide QRS tachycardia is complicated by unstable vital signs, electrical
cardioversion should be performed immediately. Treatment of ventricular tachycardia depends
on the clinical condition of the patient, conscious patient with intermittent episodes of VT
management should be by using drugs, conscious patient with ongoing VT triggered
(synchronized) using direct current (DC) cardioversion under general anaesthesia, disturbed and
unconscious patient with ongoing VT triggered (synchronized) with DC cardioversion according
to guidelines ACLS(1).
VA with hemodynamic instability, including VF and pulseless monomorphic or
polymorphic VT, causes loss of consciousness and leads to death if untreated. A short time to
direct current cardioversion is the major determinant of survival, and defibrillation should be
performed as quickly as possible. CPR is used until a perfusing rhythm is restored. If
defibrillation is unsuccess ful in returning spontaneous circulation, responders follow advanced
cardiovascular life support activities. The initial management of any tachycardia should proceed
according to published AHA advanced cardiovascular life support guidelines. Immediate
cardioversion should be performed for hemodynamic instability at presentation or if it develops
subsequently. An ECG should be obtained for stable rhythms(1)(2).
If the hemodynamic state is stable, termination of VT is carried out by administering
intravenous drugs such as amiodarone, lidocaine, and procainamide. Amiodarone and
procainamide are superior to lidocaine. Amiodarone can given in a loading dose of 15 mg/min
given in 10 minutes and followed by a continuous infusion of 1 mg/minute for 6 hours, and a
dose of maintenance 0.5 mg/minute for the next 18 hours. If it fails With medication, electrical
cardioversion is performed, which can be started at low energy (10 J and 50 J). In acute
management, it is necessary to look for causative factors that can corrected such as ischemia,
electrolyte disturbances, hypotension and acidosis. When the situation hemodynamically
unstable (hypotension, anginal shock, heart failure, and cerebral hypoperfusion) then the first
option is electrical cardioversion(2).
 This patient also diagnosed with STEMI. PCI is a strategy for reperfusion in STEMI.
Primary PCI is the preferred reperfusion strategy in patients with STEMI within 12 h of
symptom onset, provided it can be performed expeditiously 120 min from STEMI diagnosis.
Lower mortality rates among patients undergoing primary PCI are observed in centres with a
high volume of PCI procedures. Real life data confirm that primary PCI is performed faster and
results in lower mortality if per formed in high-volume centres. Randomized clinical trials in
high volume, experienced centres have repeatedly shown that, if delay to treatment is similar,
primary PCI is superior to fibrinolysis in reducing mortality, reinfarction, or stroke. However, in
some circum stances, primary PCI is not an immediate option and fibrinolysis could be initiated
expeditiously(3).
The extent to which the PCI-related time delay diminishes the advantages of PCI over
fibrinolysis has been widely debated. Because no specifically designed study has addressed this
issue, caution is needed when interpreting available data from post hoc analyses. A PCI-related
time delay potentially mitigating the benefits of PCI has been calculated as 60 min, 110 min,and
120 min in different studies. Registry data estimated this time limit as 114 min for in-hospital
patients and 120 min in patients presenting in a non-PCI centre. All these data are old and
patients under going fibrinolysis did not undergo routine early angiography, which improves
outcomes in patients receiving fibrinolysis(3).
 DAFTAR PUSTAKA

1. Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al.
2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular
Arrhythmias and the Prevention of Sudden Cardiac Death. Vol. 138, Circulation. 2018.
272–391 p.
2. Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Bloma N, Borggrefe M, Camm J, et al.
2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the
prevention of sudden cardiac death the Task Force for the Management of Patients with
Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European
Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and
Congenital Cardiology (AEPC). Eur Heart J. 2015;36(41):2793-2867l.
3. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017
ESC Guidelines for the management of acute myocardial infarction in patients presenting
with ST-segment elevation. Eur Heart J. 2018;39(2):119–77.