Which antiarrhythmic dose is used for pediatric VT after initial cardioversion if VT persists?

• A. Amiodarone 5 mg/kg in 50 mL NS over 20 min
• B. Lidocaine 1 mg/kg
• C. Sotalol 1 mg/kg
• D. Procainamide 15 mg/kg

Answer: (A)

When a child’s ventricular tachycardia remains after cardioversion, the goal is to stabilize the rhythm with a fast-acting IV antiarrhythmic. Amiodarone is the preferred choice because it effectively suppresses a wide range of ventricular tachyarrhythmias and has a favorable safety profile in pediatric patients during the acute setting. The standard dose is 5 mg/kg given IV over about 20 minutes, diluted in 50 mL of normal saline. If the VT recurs or remains after the first dose, you can give another 5 mg/kg, up to a total of 15 mg/kg in 24 hours.

Lidocaine can be used if amiodarone isn’t available, but it’s considered secondary because amiodarone generally provides broader control with a longer-lasting effect. Sotalol and procainamide are not first-line in this immediate post-cardioversion scenario due to risks such as QT prolongation and hypotension and are reserved for specific circumstances or longer-term management rather than acute stabilization.