The two drugs indicated for the treatment of sustained ventricular tachycardia are lidocaine and amiodarone. Procainamide and sotalol are also rarely used.

Amiodarone is the prefered therapy since it also can treat supraventricular tachycardia with aberrancy. Ischemic ventricular tachycardia as occurs during an acute coronary syndrome responds best to lidocaine. Surprisingly, procainamide can terminate almost 50% of sustained ventricular tachycardia episodes while lidocaine and amiodarone efficacy is somewhat lower.

Treating the precipitating factor for the ventricular tachycardia is important as well including PCI in acute coronary syndromes, electrolyte abnormalities and heart failure. Some rare forms of ventricular tachycardia respond to adenosine and verapamil. Mexiletine is an oral formulation of a class 1C antiarrhythmic drug (like lidocaine) which can be used in the outpatient setting.