eMedicine Specialties > Cardiology > Arrhythmias

Ventricular Fibrillation: Follow-up

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

Follow-up

Further Inpatient Care

  • Resuscitated patients must be admitted to an intensive care unit and monitored because of the high recurrence risk.
    • Patients typically have an underlying etiology that must be investigated and treated.
    • They require stabilization and monitoring for possibility of a coexistent emergency or complication.
    • Intubated patients require mechanical ventilation.
    • Evaluation of ischemic injury to the CNS, myocardium, and other organs is essential.
  • Survivors should have thorough diagnostic testing to establish the underlying etiology of the VF episode.
  • If available, perform indicated interventions to improve long-term prognosis.
  • ICDs are used for patients at high risk for recurrent VF. Studies indicate that patients with VF arrest who receive ICDs have improved long-term survival rates compared with those receiving only medications. ICDs effectively provide early defibrillation (Lessmeier, 1993; Meissner, 1993; Domanski, 1999; Maron, 2000).

Further Outpatient Care

  • Provide typical outpatient ICD follow-up in addition to the follow-up care appropriate for associated cardiac and other conditions.

Transfer

  • Patients should be cared for at centers where intensive cardiac monitoring and appropriate invasive and noninvasive studies can be performed. In general, a cardiovascular service, including interventional cardiology, electrophysiology, and cardiac surgery, is needed.

Complications

  • CNS ischemic injury
  • Myocardial injury
  • Postdefibrillation arrhythmias
  • Aspiration pneumonia
  • Defibrillation injury to self or others
  • Injuries from CPR and resuscitation
  • Skin burns
  • Damage to implanted electronics (eg, ICDs, pacemakers)
  • Death

Prognosis

  • Prognosis for survivors of VF strongly depends on the time elapsed between onset and medical intervention as well as on the particular etiology for VF. VF that occurs within the first 48 hours of the onset of acute MI has no bearing on prognosis, but VF associated with acute MI that occurs outside this time frame is associated with a high rate of recurrence and a poorer prognosis.
    • Early defibrillation often makes the difference between long-term disability and functional recovery. Prognosis of morbidity and mortality for people who have had VF can be made using the cardiac arrest score developed by Thompson and McCullough (see Physical).
    • The detection of the underlying cause of VF and the availability of treatment options play an important role in the natural history and prognosis of VF.
  • VF is a frequently encountered problem for emergency physicians, internists, and cardiologists. Ischemic cardiomyopathy in all adult cases and HCM in pediatric and adolescent cases are at the top of the differential diagnosis.
    • Death and disability after successful resuscitation directly correlate with the degree of CNS damage occurring during the event. Prognosis is poor without intervention by 4-6 minutes after onset of VF. Few individuals survive when VF lasts more than 8 minutes without intervention. Once the patient is resuscitated, the clinical course is largely predicted by the ED presentation of hemodynamic stability, early neurologic recovery, and duration of the resuscitation. Reported survival rates after defibrillation vary widely. Some systems report survival rates exceeding 50%, whereas others are as low as 3%.
    • Patients who survive the initial phases require a systematic evaluation of LV performance, myocardial perfusion, and electrophysiologic instability. Survivors of VF have a recurrence rate on the order of 20-25% per year, making ICD placement important in most patients.
    • Modern treatment with ICD placement has saved lives and will likely be an area of continued clinical growth.
    • Preventive measures are essentially measures of CAD prevention. Efforts to inform and train the public about external defibrillator use will probably have the greatest public health impact on improving survival rates of VF.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize ischemic heart disease and to initiate early treatment: The importance of early recognition and treatment cannot be overestimated because approximately 80% of SCD cases can be attributed to ischemic heart disease.
  • Failure to use appropriate medical therapy for ischemic heart disease (eg, beta-blockers): A specialist in cardiovascular disease must be involved in the care of patients who have had a VT/VF cardiac arrest or who have symptoms of ischemic heart disease, valvular disorders, or presentations with complex arrhythmias.
  • Failure to educate patients about the consequences of noncompliance with medical therapy
  • Failure to consider survivors of VF for ICD placement
  • Failure to counsel families regarding the poor likelihood of favorable outcome according to risk stratification level
 


More on Ventricular Fibrillation

Overview: Ventricular Fibrillation
Differential Diagnoses & Workup: Ventricular Fibrillation
Treatment & Medication: Ventricular Fibrillation
Follow-up: Ventricular Fibrillation
Multimedia: Ventricular Fibrillation
References
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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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