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Ventricular Fibrillation Medication

  • Author: Sandeep K Goyal, MD; Chief Editor: Jeffrey N Rottman, MD  more...
 
Updated: Apr 29, 2014
 

Medication Summary

In acute ventricular fibrillation (VF), drugs (eg, vasopressin, epinephrine, amiodarone) are used after 3 defibrillation attempts are performed to restore normal rhythm. Amiodarone can also be used on a long-term basis in patients who refuse an implantable cardioverter-defibrillator (ICD) or who are not candidates for an ICD. However, amiodarone has not been shown to be of value for primary prevention of VF in patients with a depressed left ventricular (LV) ejection fraction.

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Antidysrhythmics, Ia

Class Summary

Class Ia antiarrhythmics increase the refractory periods of the atria and ventricles. Myocardial excitability is reduced by an increase in the threshold for excitation and inhibition of ectopic pacemaker activity.

Procainamide (Procanbid, Pronestyl, Pronestyl [SR])

 

Procainamide is a third-line drug of choice for VF. This drug is generally not recommended for VF patients, but because of its long loading time, it can be used to prevent recurrences of VF or for treatment of sustained ventricular tachycardia (VT).

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Antidysrhythmics, Ib

Class Summary

Class Ib antidysrhythmics suppress automaticity of conduction tissue by increasing the electrical stimulation threshold of the ventricle and His-Purkinje system and by inhibiting spontaneous depolarization of the ventricles during diastole by a direct action on the tissues. Class Ib antidysrhythmics block the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, resulting in inhibition of depolarization, with resultant blockade of conduction.

Lidocaine (Xylocaine, Nervocaine, LidoPen, Duo-Trach)

 

Lidocaine is a local anesthetic and a class Ib antiarrhythmic agent that increases the electrical stimulation threshold of the ventricle, suppressing the automaticity of conduction through the tissue. Class Ib agents particularly shorten the action potential. Lidocaine may be tried in patients with VT due to ischemia.

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Antidysrhythmics, III

Class Summary

Class III antidysrhythmics prolong the action potential duration. Some agents in this class inhibit adrenergic stimulation (alpha- and beta-blocking properties); affect sodium, potassium, and calcium channels; and prolong the action potential and refractory period in myocardial tissue. These effects result in decreased atrioventricular (AV) conduction and sinus node function.

Amiodarone (Pacerone, Cordarone, Nexterone)

 

Amiodarone is a class III antiarrhythmic agent indicated for the management of life-threatening recurrent VF.

Amiodarone may be administered intravenously or orally.

Recurrent VF that is not due to a reversible cause can be treated with intravenous (IV) amiodarone. It decreases AV conduction and sinus node function. It also prolongs action potential and refractory period in myocardium and inhibits adrenergic stimulation. Amiodarone can also be used orally on a long-term basis in patients who refuse ICDs, are not candidates for ICDs, or have frequent ventricular arrhythmias.

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Antidysrhythmics, V

Class Summary

Class V antidysrhythmics have a mechanism of action different from those of agents in classes I-IV; in many cases their mechanism of action is unknown.

Magnesium sulfate

 

Magnesium acts as an anti-arrhythmic agent and diminishes the frequency of premature ventricular contractions, particularly when secondary to acute ischemia. Clinical trials have been inconclusive in demonstrating its ability to improve mortality rates in the setting of refractory VF.

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Vasopressors

Class Summary

These agents augment the coronary and cerebral blood flow that is present during the low-flow state associated with hemodynamic compromise from VF.

Epinephrine (Adrenalin)

 

Epinephrine is considered to be the single most useful drug in cardiac arrest, although it has never been shown to benefit long-term survival or functional recovery. Epinephrine stimulates alpha, beta1, and beta2 receptors, resulting in relaxation of smooth muscle, cardiac stimulation, and dilation of muscle vasculature.

Vasopressin (ADH, Pitressin)

 

Vasopressin is a peptide hormone that regulates the body's retention of water by increasing water absorption in the collecting duct of the kidney nephron. It also increases arterial blood pressure by affecting peripheral vascular resistance.

Vasopressin has an off-label indication for VF that is causing pulseless arrest. This agent may improve vital organ blood flow, cerebral oxygen delivery, the patient's ability to be resuscitated, and the patient's neurologic recovery.

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Contributor Information and Disclosures
Author

Sandeep K Goyal, MD Clinical Fellow in Cardiac Electrophysiology, Division of Cardiovascular Medicine, Vanderbilt University Medical Center

Sandeep K Goyal, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, American Medical Association, Heart Rhythm Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey N Rottman, MD Professor of Medicine, Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine; Cardiologist/Electrophysiologist, University of Maryland Medical System and VA Maryland Health Care System

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association, Heart Rhythm Society

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD Professor of Medicine, Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine; Cardiologist/Electrophysiologist, University of Maryland Medical System and VA Maryland Health Care System

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association, Heart Rhythm Society

Disclosure: Nothing to disclose.

Acknowledgements

Robert E Fowles, MD Clinical Professor of Medicine, University of Utah College of Medicine; Consulting Staff, Intermountain Medical Center and 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.

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; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Epsilon wave on the electrocardiogram of a patient with arrhythmogenic right ventricular dysplasia.
Ventricular fibrillation appeared during rapid atrial fibrillation in a patient with Wolff-Parkinson-White syndrome.
Ventricular fibrillation in a patient with a left ventricular assist device (LVAD).
Table 1. Long QT syndrome diagnostic criteria
Category Criteria Points
Electrocardiographic Findings Corrected QT interval ≥480 ms 3
460-479 ms 2
450-459 ms (in males) 1
Torsade de pointes 2
T wave alternans 1
Notched T waves in three leads 1
Low heart rate for age (resting rate below second percentile 0.5
Clinical History Syncope With stress 2
Without stress 1
Congenital deafness 0.5
Family History Family members with definite long QT syndrome 1
Unexplained SCD before age 30 in immediate family members without definite long QT syndrome 0.5
Adapted from Schwartz PJ, Moss AJ, Vincent GM, Crampton RS. Diagnostic criteria for the long QT syndrome. An update. Circulation. 1993 Aug;88(2):782-4. PMID: 8339437[33]



Scoring:



≤1 point = low probability of long QT syndrome



>1 to 3 points = intermediate probability of long QT syndrome



≥3.5 points = high probability of long QT syndrome



Table 2: Outcome according to initial cardiac arrest score
Cardiac Arrest Score In-hospital mortality rate (%) Neurologic Recovery (%)
0 90 3
1 71 17
2 42 57
3 18 89
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