DESCRIPTION

Just a chaotic squiggle. It can be a coarse squiggle (“coarse ventricular fibrillation”) or a fine squiggle (“fine ventricular fibrillation”). There is a subtle (so subtle nobody except aging professor emeriti can see it) distinction between very rapid polymorphic ventricular tachycardia (VT) and ventricular fibrillation. Any distinction is moot, since neither is hemodynamically stable and both would need to be defibrillated immediately!

HABITAT

Unfortunately, this can appear suddenly anywhere, and is likely the cause for a majority of the sudden deaths that occur outside of hospitals. It generally occurs in individuals with either severe coronary disease, a poor ejection fraction, or acute ischemia. In hospitals you are more likely to find this in the Emergency Department, in cardiac units, maybe in the cath lab, and most commonly in the electrophysiology lab, where they actually like to trigger the arrhythmia to the delight of their staff. Odd birds, those electrophysiology chaps!

CALL

“Charging … clear …<zap!!>”

RESEMBLANCE TO OTHER ARRHYTHMIAS

We already discussed the academic and generally irrelevant distinction between ventricular fibrillation and a rapid polymorphic VT; probably the only point to be made is that subsequent therapy may differ greatly if the arrhythmia occurred in the setting of a prolonged QT (see above). Otherwise, ventricular fibrillation may be mimicked by a disconnected or jiggled lead, but in those cases the patient won’t be turning blue and seizing.

CARE AND FEEDING

Shock it. While someone is running for the defibrillator, finding the pads or paddles, etc., you can do CPR, bag the patient, check the insurance card and whatnot, but the key is to shock the patient as quickly as you can! Absolutely don’t waste time starting an intravenous line, intubating the patient, or anything else … just shock him (or her). After the dust settles and hopefully a sinus rhythm is restored, you can check electrolytes, think about antiarrhythmics (amiodarone, lidocaine), and/or other drugs (β-blockers) to prevent a recurrence, and so forth.

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