eMedicine Specialties > Cardiology > Arrhythmias

Ventricular Fibrillation: Differential Diagnoses & Workup

Author: Michael E Zevitz, MD, Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice
Contributor Information and Disclosures

Updated: Jul 18, 2006

Differential Diagnoses

Aortic Stenosis
Myocardial Infarction
Cardiomyopathy, Dilated
Myocardial Ischemia
Cardiomyopathy, Hypertrophic
Myocardial Rupture
Coronary Artery Atherosclerosis
Tetralogy of Fallot
Ebstein Anomaly
Torsade de Pointes
Endomyocardial Fibrosis
Ventricular Premature Complexes
Implantable Cardioverter-Defibrillators
Ventricular Tachycardia
Long QT Syndrome
Wolff-Parkinson-White Syndrome
Lown-Ganong-Levine Syndrome

Other Problems to Be Considered

Arrhythmogenic RV dysplasia
Brugada syndrome

Workup

Laboratory Studies

  • Cardiac enzymes (eg, creatine kinase, myoglobin, troponin): Elevations in these enzyme levels may indicate ischemia and MI. The extent of myocardial damage can usually be correlated to the extent of elevation in the enzyme levels. Patients are at increased risk for arrhythmia in the peri-infarct period.
  • Electrolytes, calcium, and magnesium: Severe metabolic acidosis, hypokalemia, hyperkalemia, hypocalcemia, and hypomagnesemia are some of the conditions that can increase the risk for arrhythmia and sudden death.
  • Quantitative drug levels (eg, quinidine, procainamide, tricyclic antidepressants, digoxin): Drug levels higher than those indicated in the therapeutic index may have a proarrhythmic effect. Subtherapeutic levels of these drugs in patients being treated for specific cardiac conditions can also lead to an increased risk for arrhythmia. Most of the antiarrhythmia medications also have a proarrhythmic effect.
  • Toxicology screen: Looking for drugs that can lead to vasospasm-induced ischemia (eg, cocaine) is warranted if suspicion exists. Obtaining drug serum levels (eg, antiarrhythmics) may also be warranted.
  • Thyroid-stimulating hormone: Hyperthyroidism can lead to tachycardia and tachyarrhythmias. Over a period of time, it can also lead to heart failure.
  • B-type natriuretic peptide (BNP) may be useful in the diagnosis of decompensated CHF as the provocative etiology of VF. BNP is highly specific and sensitive for the diagnosis of decompensated CHF when elevated LV end-diastolic pressure is causing increased myocardial oxygen consumption and decreased cardiac output, leading to the abnormal myocardial substrate conditions conducive to the development of VF.

Imaging Studies

  • Chest radiography: This may reveal whether a patient is experiencing CHF. Radiographs can also show signs of LV or RV hypertrophy. Signs of pulmonary hypertension may be evident.
  • Echocardiography: Two-dimensional echocardiography with Doppler is essential in the evaluation of VF.
    • A number of studies have demonstrated that the use of 2-dimensional echocardiograms to evaluate left wall-motion abnormalities after an acute MI (using the LV wall-motion score index) is useful in predicting outcome and the risk for major cardiac events, including sudden death.
    • A decrease in the ejection fraction and worsening wall-motion abnormalities upon exercise echocardiography in patients who have had an MI has been suggested to confer increased risk for the development of VF.
    • In the course of resuscitative attempts, VF may deteriorate or be succeeded by electromechanical dissociation or pulseless electrical activity; when this occurs, consideration of possible cardiac tamponade arises and may prompt desperate attempts at pericardiocentesis. In such situations, having echocardiographic information regarding not only LV function but also presence or absence of pericardial fluid is advantageous.
  • Nuclear imaging techniques
    • Resting thallium Tl or technetium Tc 99m scintigraphy is helpful in assessing myocardial damage after MI.
    • A larger defect has been associated with greater risk for future cardiac events.
    • Exercise nuclear scintigraphy is very sensitive when detecting the presence, extent, and location of myocardial ischemia.
    • Gibson et al found that pharmacologic-stress nuclear (dipyridamole or adenosine) scintigraphy was better than submaximal exercise ECG and coronary angiography in predicting cardiac death and other cardiac events.
    • These tests can be very helpful in patients with low functional capacity such as occurs in chronic obstructive pulmonary disease, peripheral vascular disease, or orthopedic problems.
    • The Multicenter Post-Infarction Research Group provided evidence that resting ejection fraction was the most important noninvasive predictor of SCD, most commonly VF, and other cardiac events in patients with MI.

Other Tests

  • ECG: This study is indicated in all patients with VF. Seek evidence of MI, prolonged QT interval, epsilon sign, Brugada sign, short PR, WPW pattern, or other conditions.
  • Signal-averaged ECG is of limited value.
  • Genetic testing: The value of genetic testing in conditions such as congenital long QT and HCM is still being evaluated. Some studies have recommended the testing of siblings and close relatives of people with VF due to these conditions.

Procedures

  • Coronary angiography: Perform cardiac catheterization in patients who survive VF to assess the state of ventricular function and the severity and extent of CAD.
    • The number of vessels with severe obstruction and the degree of LV dysfunction are important variables in predicting cardiac events. Ejection fraction is the best predictor of significant cardiac events and survival.
    • Coronary angiography can also help identify coronary anomalies and other forms of congenital heart disease.
    • Angiography is performed with the goal of identifying patients who may benefit from revascularization. Revascularization is the single greatest treatment for the underlying substrate of VT/VF, ischemic myocardium.
  • EPS: In targeted patients, EPS play diagnostic, prognostic, and therapeutic roles. EPS are usually performed after ischemic and structural heart disease has been diagnosed and addressed. EPS are generally not indicated for the subset of patients whose VF occurred within the first 24-48 hours of an acute MI, unless the patient had previous VF events. In all other patients with VF, however, consider EPS for diagnostic and therapeutic reasons.
    • These studies have been used to identify patients who have inducible VT/VF versus noninducible sustained monomorphic VT. The presence of inducible sustained VT or VF, at baseline or when the patient is on antiarrhythmic medications, confers a higher risk for sudden death. Significantly lower ventricular function has also been observed in patients with inducible sustained VT or VF.
    • Inducible bundle-branch reentrant VT can be observed in patients with DCM and in the postoperative period after valvular replacement. Up to 20% of patients with HCM have inducible sustained monomorphic VT. Identification of accessory pathways is possible with these studies. EPS are performed the following in mind:
      • Ablation of VT foci, eg, bundle-branch VT, RVOT tachycardia, and some cases of idiopathic LV tachycardia
      • ICD placement (generally recommended in survivors of VF)

More on Ventricular Fibrillation

Overview: Ventricular Fibrillation
Differential Diagnoses & Workup: Ventricular Fibrillation
Treatment & Medication: Ventricular Fibrillation
Follow-up: Ventricular Fibrillation
Multimedia: Ventricular Fibrillation
References
[ CLOSE WINDOW ]

References

  1. Alings M, Wilde A. "Brugada" syndrome: clinical data and suggested pathophysiological mechanism. Circulation. Feb 9 1999;99(5):666-73. [Medline].

  2. Antzelevitch C, Sicouri S. Clinical relevance of cardiac arrhythmias generated by afterdepolarizations. Role of M cells in the generation of U waves, triggered activity and torsade de pointes. J Am Coll Cardiol. Jan 1994;23(1):259-77. [Medline].

  3. Becker LB, Han BH, Meyer PM, et al. Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project. N Engl J Med. Aug 26 1993;329(9):600-6. [Medline].

  4. Bedell SE, Delbanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. Sep 8 1983;309(10):569-76. [Medline].

  5. Belhassen B, Viskin S. Idiopathic ventricular tachycardia and fibrillation. J Cardiovasc Electrophysiol. Jun 1993;4(3):356-68. [Medline].

  6. Bigger JT Jr, Fleiss JL, Kleiger R, et al. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation. Feb 1984;69(2):250-8. [Medline].

  7. Bigger JT Jr. Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery. Coronary Artery Bypass Graft (CABG) Patch Trial Investigators. N Engl J Med. Nov 27 1997;337(22):1569-75. [Medline].

  8. Bikkina M, Larson MG, Levy D. Prognostic implications of asymptomatic ventricular arrhythmias: the Framingham Heart Study. Ann Intern Med. Dec 15 1992;117(12):990-6. [Medline].

  9. Borggrefe M, Chen X, Martinez-Rubio A, et al. The role of implantable cardioverter defibrillators in dilated cardiomyopathy. Am Heart J. Apr 1994;127(4 Pt 2):1145-50. [Medline].

  10. Boutitie F, Boissel JP, Connolly SJ, et al. Amiodarone interaction with beta-blockers: analysis of the merged EMIAT (European Myocardial Infarct Amiodarone Trial) and CAMIAT (Canadian Amiodarone Myocardial Infarction Trial) databases. The EMIAT and CAMIAT Investigators. Circulation. May 4 1999;99(17):2268-75. [Medline].

  11. Breithardt G, Wichter T, Haverkamp W, et al. Implantable cardioverter defibrillator therapy in patients with arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, or no structural heart disease. Am Heart J. Apr 1994;127(4 Pt 2):1151-8. [Medline].

  12. Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST-segment elevation in leads V1 through V3: a marker for sudden death in patients without demonstrable structural heart disease. Circulation. Feb 10 1998;97(5):457-60. [Medline].

  13. Brugada P, Geelen P. Some electrocardiographic patterns predicting sudden cardiac death that every doctor should recognize. Acta Cardiol. 1997;52(6):473-84. [Medline].

  14. Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol. Nov 15 1992;20(6):1391-6. [Medline].

  15. Cappato R. Secondary prevention of sudden death: the Dutch Study, the Antiarrhythmics Versus Implantable Defibrillator Trial, the Cardiac Arrest Study Hamburg, and the Canadian Implantable Defibrillator Study. Am J Cardiol. Mar 11 1999;83(5B):68D-73D. [Medline].

  16. Chizner MA, Pearle DL, deLeon AC Jr. The natural history of aortic stenosis in adults. Am Heart J. Apr 1980;99(4):419-24. [Medline].

  17. Cobb LA, Baum RS, Alvarez H 3rd, Schaffer WA. Resuscitation from out-of-hospital ventricular fibrillation: 4 years follow-up. Circulation. Dec 1975;52(6 Suppl):III223-35. [Medline].

  18. Cobb LA, Fahrenbruch CE, Walsh TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA. Apr 7 1999;281(13):1182-8. [Medline].

  19. Conley MJ, McNeer JF, Lee KL, et al. Cardiac arrest complicating acute myocardial infarction: predictability and prognosis. Am J Cardiol. Jan 1977;39(1):7-12. [Medline].

  20. Connolly SJ, Gent M, Roberts RS, et al. Canadian Implantable Defibrillator Study (CIDS): study design and organization. CIDS Co-Investigators. Am J Cardiol. Nov 26 1993;72(16):103F-108F. [Medline].

  21. Consensus Statement of the Joint Steering Committees of the Unexplained Cardiac, and of the Idiopathic Ventricular Fibrillation Registry of the United States. Survivors of out-of-hospital cardiac arrest with apparently normal heart. Need for definition and standardized clinical evaluation. Circulation. Jan 7 1997;95(1):265-72. [Medline].

  22. Cooper RS, Simmons BE, Castaner A, et al. Left ventricular hypertrophy is associated with worse survival independent of ventricular function and number of coronary arteries severely narrowed. Am J Cardiol. Feb 15 1990;65(7):441-5. [Medline].

  23. Corrado D, Basso C, Thiene G, et al. Spectrum of clinicopathologic manifestations of arrhythmogenic right ventricular cardiomyopathy/dysplasia: a multicenter study. J Am Coll Cardiol. Nov 15 1997;30(6):1512-20. [Medline].

  24. Cox JL, Daniel TM, Boineau JP. The electrophysiologic time-course of acute myocardial ischemia and the effects of early coronary artery reperfusion. Circulation. Nov 1973;48(5):971-83. [Medline].

  25. Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med. May 3 1984;310(18):1137-40. [Medline].

  26. Domanski MJ, Sakseena S, Epstein AE, et al. Relative effectiveness of the implantable cardioverter-defibrillator and antiarrhythmic drugs in patients with varying degrees of left ventricular dysfunction who have survived malignant ventricular arrhythmias. AVID Investigators. Antiarrhythmics Ver. J Am Coll Cardiol. Oct 1999;34(4):1090-5. [Medline].

  27. Doval HC, Nul DR, Grancelli HO, et al. Nonsustained ventricular tachycardia in severe heart failure. Independent marker of increased mortality due to sudden death. GESICA- GEMA Investigators. Circulation. Dec 15 1996;94(12):3198-203. [Medline].

  28. Driscoll DJ, Edwards WD. Sudden unexpected death in children and adolescents. J Am Coll Cardiol. Jun 1985;5(6 Suppl):118B-121B. [Medline].

  29. Eisenberg MS, Copass MK, Hallstrom AP, et al. Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med. Jun 19 1980;302(25):1379-83. [Medline].

  30. Epstein SE, Quyymi AA, Bonow RO. Sudden cardiac death without warning. Possible mechanisms and implications for screening asymptomatic populations. N Engl J Med. Aug 3 1989;321(5):320-4. [Medline].

  31. Every NR, Fahrenbruch CE, Hallstrom AP, et al. Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest. J Am Coll Cardiol. Jun 1992;19(7):1435-9. [Medline].

  32. Fananpazir L, McAreavy D, Epstein ND. Hypertrophic cardiomyopathy. In: Zipes D, Jalife J, eds. Cardiac Elecrophysiology: From Cell to Bedside. 2nd ed. Philadelphia:. WB Saunders Co;1994:769-779.

  33. Fontaine G, Fontaliran F, Lascault G. Arrhythmogenic right ventricular dysplasia. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 2nd ed. Philadelphia:. WB Saunders Co;1994:754-769.

  34. Furukawa T, Rozanski JJ, Nogami A, et al. Time-dependent risk of and predictors for cardiac arrest recurrence in survivors of out-of-hospital cardiac arrest with chronic coronary artery disease. Circulation. Sep 1989;80(3):599-608. [Medline].

  35. Gascho JA, Crampton RS, Cherwek ML, et al. Determinants of ventricular defibrillation in adults. Circulation. Aug 1979;60(2):231-40. [Medline].

  36. Gibson RS, Watson DD, Craddock GB. Prediction of cardiac events after uncomplicated myocardial infarction: a prospective study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography. Circulation. Aug 1983;68(2):321-36. [Medline].

  37. Gillum RF. Sudden cardiac death in Hispanic Americans and African Americans. Am J Public Health. Sep 1997;87(9):1461-6. [Medline].

  38. Gilman JK, Jalal S, Naccarelli GV. Predicting and preventing sudden death from cardiac causes. Circulation. Aug 1994;90(2):1083-92. [Medline].

  39. Goldstein S. The necessity of a uniform definition of sudden coronary death: witnessed death within 1 hour of the onset of acute symptoms. Am Heart J. Jan 1982;103(1):156-9. [Medline].

  40. Gordon T, Kannel WB. Premature mortality from coronary heart disease. The Framingham study. JAMA. Mar 8 1971;215(10):1617-25. [Medline].

  41. Greene HL. The CASCADE Study: randomized antiarrhythmic drug therapy in survivors of cardiac arrest in Seattle. CASCADE Investigators. Am J Cardiol. Nov 26 1993;72(16):70F-74F. [Medline].

  42. Gueugniaud PY, Mols P, Goldstein P, et al. A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital. European Epinephrine Study Group. N Engl J Med. Nov 26 1998;339(22):1595-601. [Medline].

  43. Gussak I, Antzelevitch C, Bjerregaard P, et al. The Brugada syndrome: clinical, electrophysiologic and genetic aspects. J Am Coll Cardiol. Jan 1999;33(1):5-15. [Medline].

  44. Hallstrom A, Boutin P, Cobb L, Johnson E. Socioeconomic status and prediction of ventricular fibrillation survival. Am J Public Health. Feb 1993;83(2):245-8. [Medline].

  45. Hallstrom AP, Bigger JT Jr, Roden D, et al. Prognostic significance of ventricular premature depolarizations measured 1 year after myocardial infarction in patients with early postinfarction asymptomatic ventricular arrhythmia. J Am Coll Cardiol. Aug 1992;20(2):259-64. [Medline].

  46. Haverkamp W, Shenasa M, Borggrofe M, Breithardt G. Torsade de pointes. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 2nd ed. Philadelphia:. WB Saunders Co;1995:885.

  47. Holmberg M, Holmberg S, Herlitz J. The problem of out-of-hospital cardiac-arrest prevalence of sudden death in Europe today. Am J Cardiol. Mar 11 1999;83(5B):88D-90D. [Medline].

  48. Holmes DR Jr, Davis K, Gersh BJ, et al. Risk factor profiles of patients with sudden cardiac death and death from other cardiac causes: a report from the Coronary Artery Surgery Study (CASS). J Am Coll Cardiol. Mar 1 1989;13(3):524-30. [Medline].

  49. Hondeghem LM. Class III agents: amiodarone, bretylium and sotalol. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: Cell to Bedside. 2nd ed. Philadelphia:. WB Saunders Co;1994:1330-1336.

  50. Jaggarao NS, Heber M, Grainger R, et al. Use of an automated external defibrillator-pacemaker by ambulance staff. Lancet. Jul 10 1982;2(8289):73-5. [Medline].

  51. Kannel WB, Doyle JT, McNamara PM, et al. Precursors of sudden coronary death. Factors related to the incidence of sudden death. Circulation. Apr 1975;51(4):606-13. [Medline].

  52. Kerber RE, Becker LB, Bourland JD, et al. Automatic external defibrillators for public access defibrillation: recommendations for specifying and reporting arrhythmia analysis algorithm performance, incorporating new waveforms, and enhancing safety. Circulation. Mar 18 1997;95(6):1677-82. [Medline].

  53. Kim SG, Fisher JD, Choue CW, et al. Influence of left ventricular function on outcome of patients treated with implantable defibrillators. Circulation. Apr 1992;85(4):1304-10. [Medline].

  54. Klein GJ, Bashore TM, Sellers TD, et al. Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med. Nov 15 1979;301(20):1080-5. [Medline].

  55. Kligfield P, Hochreiter C, Kramer H. Complex arrhythmias in mitral regurgitation with and without mitral valve prolapse: contrast to arrhythmias in mitral valve prolapse without mitral regurgitation. Am J Cardiol. Jun 1 1985;55(13 Pt 1):1545-9. [Medline].

  56. Kligfield P, Levy D, Devereux RB. Arrhythmias and sudden death in mitral valve prolapse. Am Heart J. May 1987;113(5):1298-307. [Medline].

  57. Kron IL, Lerman BB, Haines DE, et al. Coronary artery bypass grafting in patients with ventricular fibrillation. Ann Thorac Surg. Jul 1989;48(1):85-9. [Medline].

  58. Kuller LH. Sudden death--definition and epidemiologic considerations. Prog Cardiovasc Dis. Jul-Aug 1980;23(1):1-12. [Medline].

  59. Larsen L, Markham J, Haffajee CI. Sudden death in idiopathic dilated cardiomyopathy: role of ventricular arrhythmias. Pacing Clin Electrophysiol. May 1993;16(5 Pt 1):1051-9. [Medline].

  60. Lessmeier TJ, Lehmann MH, Steinman RT, et al. Outcome with implantable cardioverter-defibrillator therapy for survivors of ventricular fibrillation secondary to idiopathic dilated cardiomyopathy or coronary artery disease without myocardial infarction. Am J Cardiol. Oct 15 1993;72(12):911-5. [Medline].

  61. Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR. Prehospital ventricular defibrillation. Prognosis and follow-up course. N Engl J Med. Aug 15 1974;291(7):317-21. [Medline].

  62. Lie KI, Liem KL, Schuilenburg RM, et al. Early identification of patients developing late in-hospital ventricular fibrillation after discharge from the coronary care unit. A 5 1/2 year retrospective and prospective study of 1,897 patients. Am J Cardiol. Apr 1978;41(4):674-7. [Medline].

  63. Lombardi G, Gallagher J, Gennis P. Outcome of out-of-hospital cardiac arrest in New York City. The Pre- Hospital Arrest Survival Evaluation (PHASE) Study. JAMA. Mar 2 1994;271(9):678-83. [Medline].

  64. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. Jun 12 1999;353(9169):2001-7. [Medline].

  65. Maggioni AP, Zuanetti G, Franzosi MG, et al. Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results. Circulation. Feb 1993;87(2):312-22. [Medline].

  66. Manolio TA, Furberg CD. Epidemiology of sudden cardiac death. In: Akhtar M, Myerburg RJ, Ruskin JN, eds. Sudden Cardiac Death: Prevalence, Mechanisms, and Approaches to Diagnosis and Management. Malvern, Pa:. Lippincott Williams & Wilkins;1984:3.

  67. Maron BJ, Epstein SE, Roberts WC. Causes of sudden death in competitive athletes. J Am Coll Cardiol. Jan 1986;7(1):204-14. [Medline].

  68. Maron BJ, Roberts WC, Epstein SE. Sudden death in hypertrophic cardiomyopathy: a profile of 78 patients. Circulation. Jun 1982;65(7):1388-94. [Medline].

  69. Maron BJ, Shen WK, Link MS, et al. Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy. N Engl J Med. Feb 10 2000;342(6):365-73. [Medline].

  70. Masrani K, Cowley C, Bekheit S, el-Sherif N. Recurrent syncope for over a decade due to idiopathic ventricular fibrillation. Chest. Nov 1994;106(5):1601-3. [Medline].

  71. McCullough PA, Thompson RJ, Tobin KJ. Validation of a decision support tool for the evaluation of cardiac arrest victims. Clin Cardiol. Mar 1998;21(3):195-200. [Medline].

  72. McCullough PA, Prakash R, Tobin KJ. Application of a cardiac arrest score in patients with sudden death and ST segment elevation for triage to angiography and intervention. J Interv Cardiol. Aug 2002;15(4):257-61. [Medline].

  73. Meinertz T, Hofmann T, Kasper W, et al. Significance of ventricular arrhythmias in idiopathic dilated cardiomyopathy. Am J Cardiol. Mar 15 1984;53(7):902-7. [Medline].

  74. Meissner MD, Lehmann MH, Steinman RT, et al. Ventricular fibrillation in patients without significant structural heart disease: a multicenter experience with implantable cardioverter- defibrillator therapy. J Am Coll Cardiol. May 1993;21(6):1406-12. [Medline].

  75. Messerli FH, Ventura HO, Elizardi DJ, et al. Hypertension and sudden death. Increased ventricular ectopic activity in left ventricular hypertrophy. Am J Med. Jul 1984;77(1):18-22. [Medline].

  76. Morady F, DiCarlo L, Winston S, et al. Clinical features and prognosis of patients with out of hospital cardiac arrest and a normal electrophysiologic study. J Am Coll Cardiol. Jul 1984;4(1):39-44. [Medline].

  77. Moss AJ. Clinical management of patients with the long QT syndrome: drugs, devices, and gene-specific therapy. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 2):2058-60. [Medline].

  78. Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. Dec 26 1996;335(26):1933-40. [Medline].

  79. Multiple Risk Factor Intervention Trial Research Group. Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial. Am J Cardiol. Jan 1 1985;55(1):1-15. [Medline].

  80. Murphy JG, Gersh BJ, Mair DD, et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med. Aug 26 1993;329(9):593-9. [Medline].

  81. Myerburg RJ, Kessler KM, Kimura S. Life-threatening ventricular arrhythmias: the link between epidemiology and pathophysiology. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 3rd ed. Philadelphia:. WB Saunders Co;2000:521-590.

  82. Myerburg RJ, Conde CA, Sung RJ, et al. Clinical, electrophysiologic and hemodynamic profile of patients resuscitated from prehospital cardiac arrest. Am J Med. Apr 1980;68(4):568-76. [Medline].

  83. Myerburg RJ, Mitrani R, Interian A Jr, Castellanos A. Identification of risk of cardiac arrest and sudden cardiac death in athletes. In: Estes NA, Salem DN, Wang PJ, eds. Sudden Cardiac Death in the Athlete. Armonk, NY:. Futura Publishing;1996:25.

  84. Myerburg RJ, Kessler KM, Kimura S, et al. Life-threatening ventricular arrhythmias: the link between epidemiology and pathophysiology. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 2nd ed. Philadelphia:. WB Saunders Co;1995:723.

  85. Myerburg RJ, Kessler KM, Zaman L, et al. Survivors of prehospital cardiac arrest. JAMA. Mar 12 1982;247(10):1485-90. [Medline].

  86. Myerburg RJ, Conde C, Sheps DS, et al. Antiarrhythmic drug therapy in survivors of prehospital cardiac arrest: comparison of effects on chronic ventricular arrhythmias and recurrent cardiac arrest. Circulation. May 1979;59(5):855-63. [Medline].

  87. Myerburg RJ, Kessler KM, Zaman L, et al. Factors leading to decreasing mortality among patients resuscitated from out-of-hospital cardiac arrest. In: Brugada P, Wellens HJ, eds. Cardiac Arrhythmias: Where to Go from Here?. Mt. Kisko, NY:. Futura Publishing;1987:505-525.

  88. Myerburg RJ, Zaman L. Indications for intracardiac electrophysiologic studies in survivors of prehospital cardiac arrest. Circulation. 1987;75:151.

  89. Myerburg RJ, Mitrani R, Interian A Jr, Castellanos A. Interpretation of outcomes of antiarrhythmic clinical trials: design features and population impact. Circulation. Apr 21 1998;97(15):1514-21. [Medline].

  90. Nalos PC, Ismail Y, Pappas JM, et al. Intravenous amiodarone for short-term treatment of refractory ventricular tachycardia or fibrillation. Am Heart J. Dec 1991;122(6):1629-32. [Medline].

  91. Nasir N Jr, Doyle TK, Wheeler SH, Pacifico A. Usefulness of Holter monitoring in predicting efficacy of amiodarone therapy for sustained ventricular tachycardia associated with coronary artery disease. Am J Cardiol. Mar 15 1994;73(8):554-8. [Medline].

  92. O''Rourke RA. Role of myocardial revascularization in sudden cardiac death. Circulation. Jan 1992;85(1 Suppl):I112-7. [Medline].

  93. Perry JC, Knilans TK, Marlow D, et al. Intravenous amiodarone for life-threatening tachyarrhythmias in children and young adults. J Am Coll Cardiol. Jul 1993;22(1):95-8. [Medline].

  94. Pogwizd SM. Focal mechanisms underlying ventricular tachycardia during prolonged ischemic cardiomyopathy. Circulation. Sep 1994;90(3):1441-58. [Medline].

  95. Primo J, Geelen P, Brugada J, et al. Hypertrophic cardiomyopathy: role of the implantable cardioverter- defibrillator. J Am Coll Cardiol. Apr 1998;31(5):1081-5. [Medline].

  96. Rahimtoola SH. Valvular heart disease: a perspective. J Am Coll Cardiol. Jan 1983;1(1):199-215. [Medline].

  97. Roden DM, George AL Jr, Bennett PB. Recent advances in understanding the molecular mechanisms of the long QT syndrome. J Cardiovasc Electrophysiol. Nov 1995;6(11):1023-31. [Medline].

  98. Roelke M, Ruskin JN. Dilated cardiomyopathy: ventricular arrhythmias and sudden death. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 2nd ed. Philadelphia:. WB Saunders Co;1994:774-753.

  99. Roy D, Waxman HL, Kienzle MG, et al. Clinical characteristics and long-term follow-up in 119 survivors of cardiac arrest: relation to inducibility at electrophysiologic testing. Am J Cardiol. Nov 1 1983;52(8):969-74. [Medline].

  100. Schatzkin A, Cupples LA, Heeren T, et al. The epidemiology of sudden unexpected death: risk factors for men and women in the Framingham Heart Study. Am Heart J. Jun 1984;107(6):1300-6. [Medline].

  101. Schatzkin A, Cupples LA, Heeren T, et al. Sudden death in the Framingham Heart Study. Differences in incidence and risk factors by sex and coronary disease status. Am J Epidemiol. Dec 1984;120(6):888-99. [Medline].

  102. Sharma B, Asinger R, Francis GS, et al. Demonstration of exercise-induced painless myocardial ischemia in survivors of out-of-hospital ventricular fibrillation. Am J Cardiol. Apr 1 1987;59(8):740-5. [Medline].

  103. Sheps DS, Conde CA, Mayorga-Cortes A, et al. Primary ventricular fibrillation. Some unusual features. Chest. Aug 1977;72(2):235-8. [Medline].

  104. Singh B, al Shahwan SA, Habbab MA, et al. Idiopathic long QT syndrome: asking the right question. Lancet. Mar 20 1993;341(8847):741-2. [Medline].

  105. Stewart JT, McKenna WJ. Management of arrhythmias in hypertrophic cardiomyopathy. Cardiovasc Drugs Ther. Feb 1994;8(1):95-9. [Medline].

  106. Sueta CA, Clarke SW, Dunlap SH, et al. Effect of acute magnesium administration on the frequency of ventricular arrhythmia in patients with heart failure. Circulation. Feb 1994;89(2):660-6. [Medline].

  107. Surawicz B. Ventricular fibrillation. J Am Coll Cardiol. Jun 1985;5(6 Suppl):43B-54B. [Medline].

  108. Teerlink JR, Jalaluddin M, Anderson S, et al. Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death. PROMISE (Prospective Randomized Milrinone Survival Evaluation) Investigators. Circulation. Jan 4-11 2000;101(1):40-6. [Medline].

  109. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. Nov 27 1997;337(22):1576-83. [Medline].

  110. Thompson RJ, McCullough PA, Kahn JK. Prediction of death and neurologic outcome in the emergency department in out-of-hospital cardiac arrest survivors. Am J Cardiol. Jan 1 1998;81(1):17-21. [Medline].

  111. Torp-Pedersen C, Kober L, Elming H, et al. Classification of sudden and arrhythmic death. Pacing Clin Electrophysiol. Oct 1997;20(10 Pt 2):2545-52. [Medline].

  112. Tung RT, Shen WK, Hammill SC, Gersh BJ. Idiopathic ventricular fibrillation in out-of-hospital cardiac arrest survivors. Pacing Clin Electrophysiol. Aug 1994;17(8):1405-12. [Medline].

  113. Turitto G, Ahuja RK, Caref EB, el-Sherif N. Risk stratification for arrhythmic events in patients with nonischemic dilated cardiomyopathy and nonsustained ventricular tachycardia: role of programmed ventricular stimulation and the signal-averaged electrocardiogram. J Am Coll Cardiol. Nov 15 1994;24(6):1523-8. [Medline].

  114. Vincent GM. Hypothesis for the molecular physiology of the Romano-Ward long QT syndrome. J Am Coll Cardiol. Aug 1992;20(2):500-3. [Medline].

  115. Waalewijn RA, de Vos R, Koster RW. Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in ''Utstein'' style. Resuscitation. Sep 1998;38(3):157-67. [Medline].

  116. Waller BF. Exercise-related sudden death in young (age 30 years) and old (age>30 years) conditioned subjects. In: Wengor NK, ed. Exercise and the Heart. Philadelphia:. FA Davis;1985:9-73.

  117. Warnes CA, Roberts WC. Sudden coronary death: relation of amount and distribution of coronary narrowing at necropsy to previous symptoms of myocardial ischemia, left ventricular scarring and heart weight. Am J Cardiol. Jul 1 1984;54(1):65-73. [Medline].

  118. Wever EF, Hauer RN, Oomen A, et al. Unfavorable outcome in patients with primary electrical disease who survived an episode of ventricular fibrillation. Circulation. Sep 1993;88(3):1021-9. [Medline].

  119. White RD, Hankins DG, Bugliosi TF. Seven years'' experience with early defibrillation by police and paramedics in an emergency medical services system. Resuscitation. Dec 1998;39(3):145-51. [Medline].

  120. Wilson AC, Kostis JB. The prognostic significance of very low frequency ventricular ectopic activity in survivors of acute myocardial infarction. BHAT Study Group. Chest. Sep 1992;102(3):732-6. [Medline].

  121. Young D, Mark H. Fate of the patient with the Eisenmenger syndrome. Am J Cardiol. Dec 1971;28(6):658-69. [Medline].

  122. Zheutlin TA, Steinman RT, Mattioni TA, Kehoe RF. Long-term arrhythmic outcome in survivors of ventricular fibrillation with absence of inducible ventricular tachycardia. Am J Cardiol. Dec 1 1988;62(17):1213-7. [Medline].

  123. de Vreede-Swagemakers JJ, Gorgels AP, Weijenberg MP, et al. Risk indicators for out-of-hospital cardiac arrest in patients with coronary artery disease. J Clin Epidemiol. Jul 1999;52(7):601-7. [Medline].

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Further Reading

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Keywords

ventricular fibrillation, VFib, VF, sudden cardiac death, SCD, ventricular flutter, ventricular arrhythmia, automatic external defibrillators, AEDs, coronary artery disease, CAD, myocardial infarction, MI, premature ventricular contractions, PVCs, congestive heart failure, CHF, anoxic encephalopathy, smoking, dyslipidemia, hypertension, diabetes, obesity, sedentary lifestyle, atherosclerosis, dilated cardiomyopathy, DCM, hypertrophic cardiomyopathy, HCM, arrhythmogenic right ventricular dysplasia, valvular heart disease, aortic stenosis, cystic medial necrosis, sinus node artery obstruction, commotio cordis, torsade de pointes, syncope, Brugada syndrome, implantable cardioverter-defibrillator, ICD, right ventricular outflow tract tachycardia, RVOT tachycardia, exercise-induced ventricular tachycardia, adenosine-sensitive ventricular tachycardia, repetitive monomorphic ventricular tachycardia, radiofrequency catheter ablation, Marfan syndrome, Ehlers-Danlossyndrome, aortic cystic medialnecrosis,wall-motionabnormalities, WMAs, revascularization, cardiopulmonary resuscitation, CPR, advanced cardiac life support, ACLS, coronary artery bypass grafting, CABG

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Contributor Information and Disclosures

Author

Michael E Zevitz, MD, Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice
Michael E Zevitz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Robert E Fowles, MD, Clinical Professor of Medicine, University of Utah College of Medicine; Consulting Staff, LDS Hospital; Director and Consulting Staff, Department of Cardiology, Salt Lake Clinic
Robert E Fowles, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Brian Olshansky, MD, Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine
Brian Olshansky, MD is a member of the following medical societies: American Autonomic Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Sports Medicine, American Federation for Clinical Research, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, and New York Academy of Sciences
Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting; Reliant Grant/research funds Other; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Leonard Ganz, MD, Associate Professor of Medicine, Temple University School of Medicine; Cardiac Electrophysiologist, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Cent, West Penn Hospital
Disclosure: Nothing to disclose.

 
 
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