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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.


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).


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.


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.


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.



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.

Contributor Information and Disclosures

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.


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.


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

  1. 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. 1984 Jul 1. 54(1):65-73. [Medline].

  2. Anthony R, Daubert JP, Zareba W, Andrews ML, McNitt S, Levine E. Mechanisms of ventricular fibrillation initiation in MADIT II patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol. 2008 Feb. 31(2):144-50. [Medline].

  3. Menegazzi JJ, Callaway CW, Sherman LD, Hostler DP, Wang HE, Fertig KC, et al. Ventricular fibrillation scaling exponent can guide timing of defibrillation and other therapies. Circulation. 2004 Feb 24. 109(7):926-31. [Medline].

  4. Rissanen V. Coronary atherosclerosis in cases of coronary death as compared with that occurring in the populatiom. A study of a medico-legal autopsy series of coronary deaths and violent deaths. Ann Clin Res. 1975 Dec. 7(6):412-25. [Medline].

  5. 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. 1989 Mar 1. 13(3):524-30. [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. 1984 Feb. 69(2):250-8. [Medline].

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

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

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

  10. 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. 1987 Apr 1. 59(8):740-5. [Medline].

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

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

  13. Maron BJ, Wolfson JK, Epstein SE, Roberts WC. Intramural ("small vessel") coronary artery disease in hypertrophic cardiomyopathy. J Am Coll Cardiol. 1986 Sep. 8(3):545-57. [Medline].

  14. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002 Feb 21. 346(8):549-56. [Medline].

  15. 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. 1997 Nov 15. 30(6):1512-20. [Medline].

  16. Pilichou K, Nava A, Basso C, Beffagna G, Bauce B, Lorenzon A, et al. Mutations in desmoglein-2 gene are associated with arrhythmogenic right ventricular cardiomyopathy. Circulation. 2006 Mar 7. 113(9):1171-9. [Medline].

  17. McKenna WJ, Beiras AC, Lado MP. The cardiomyopathies. Br Heart J. 1994 Dec. 72(6 Suppl):S1. [Medline]. [Full Text].

  18. [Guideline] Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010 Apr 6. 121(13):1533-41. [Medline]. [Full Text].

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

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

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

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

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

  24. Bezzina CR, Pazoki R, Bardai A, Marsman RF, de Jong JS, Blom MT, et al. Genome-wide association study identifies a susceptibility locus at 21q21 for ventricular fibrillation in acute myocardial infarction. Nat Genet. 2010 Aug. 42(8):688-91. [Medline].

  25. Watanabe H, Nogami A, Ohkubo K, Kawata H, Hayashi Y, Ishikawa T, et al. Electrocardiographic characteristics and SCN5A mutations in idiopathic ventricular fibrillation associated with early repolarization. Circ Arrhythm Electrophysiol. 2011 Dec. 4(6):874-81. [Medline].

  26. Knecht S, Sacher F, Wright M, Hocini M, Nogami A, Arentz T, et al. Long-term follow-up of idiopathic ventricular fibrillation ablation: a multicenter study. J Am Coll Cardiol. 2009 Aug 4. 54(6):522-8. [Medline].

  27. Yokokawa M, Good E, Crawford T, Chugh A, Pelosi F Jr, Latchamsetty R, et al. Reasons for failed ablation for idiopathic right ventricular outflow tract-like ventricular arrhythmias. Heart Rhythm. 2013 Aug. 10(8):1101-8. [Medline].

  28. Viskin S, Rosso R, Rogowski O, Belhassen B. The "short-coupled" variant of right ventricular outflow ventricular tachycardia: a not-so-benign form of benign ventricular tachycardia?. J Cardiovasc Electrophysiol. 2005 Aug. 16(8):912-6. [Medline].

  29. P Doppalapudi H. Idiopathic focal epicardial ventricular tachycardia originating from the crux of the heart. Heart Rhythm. 2009 Jan. 6(1):44-50.

  30. Nanthakumar K, Massé S, Umapathy K, Dorian P, Sevaptsidis E, Waxman M. Cardiac stimulation with high voltage discharge from stun guns. CMAJ. 2008 May 20. 178(11):1451-7. [Medline]. [Full Text].

  31. Zipes DP. Sudden cardiac arrest and death following application of shocks from a TASER electronic control device. Circulation. 2012 May 22. 125(20):2417-22. [Medline].

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

  33. Schwartz PJ, Moss AJ, Vincent GM, Crampton RS. Diagnostic criteria for the long QT syndrome. An update. Circulation. 1993 Aug. 88(2):782-4. [Medline].

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

  35. Splawski I, Timothy KW, Sharpe LM, Decher N, Kumar P, Bloise R, et al. Ca(V)1.2 calcium channel dysfunction causes a multisystem disorder including arrhythmia and autism. Cell. 2004 Oct 1. 119(1):19-31. [Medline].

  36. Priori SG, Napolitano C, Memmi M, Colombi B, Drago F, Gasparini M, et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation. 2002 Jul 2. 106(1):69-74. [Medline].

  37. Watanabe H, Chopra N, Laver D, Hwang HS, Davies SS, Roach DE, et al. Flecainide prevents catecholaminergic polymorphic ventricular tachycardia in mice and humans. Nat Med. 2009 Apr. 15(4):380-3. [Medline]. [Full Text].

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

  39. Moore JP, Kannankeril PJ, Fish FA. Isoproterenol administration during general anesthesia for the evaluation of children with ventricular preexcitation. Circ Arrhythm Electrophysiol. 2011 Feb. 4(1):73-8. [Medline].

  40. 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. 1992 Nov 15. 20(6):1391-6. [Medline].

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

  42. Kapplinger JD, Tester DJ, Alders M, Benito B, Berthet M, Brugada J, et al. An international compendium of mutations in the SCN5A-encoded cardiac sodium channel in patients referred for Brugada syndrome genetic testing. Heart Rhythm. 2010 Jan. 7(1):33-46. [Medline]. [Full Text].

  43. Wilde AA, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada P, et al. Proposed diagnostic criteria for the Brugada syndrome. Eur Heart J. 2002 Nov. 23(21):1648-54. [Medline].

  44. 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. 1998 Feb 10. 97(5):457-60. [Medline].

  45. Priori SG, Gasparini M, Napolitano C, Della Bella P, Ottonelli AG, Sassone B, et al. Risk stratification in Brugada syndrome: results of the PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) registry. J Am Coll Cardiol. 2012 Jan 3. 59(1):37-45. [Medline].

  46. Belhassen B, Glick A, Viskin S. Efficacy of quinidine in high-risk patients with Brugada syndrome. Circulation. 2004 Sep 28. 110(13):1731-7. [Medline].

  47. McNally B, Robb R, Mehta M, Vellano K, Valderrama AL, Yoon PW, et al. Out-of-hospital cardiac arrest surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010. MMWR Surveill Summ. 2011 Jul 29. 60(8):1-19. [Medline].

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

  49. 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. 1993 Aug 26. 329(9):600-6. [Medline].

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

  51. 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. 1984 Dec. 120(6):888-99. [Medline].

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

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

  54. Winkle RA. The effectiveness and cost effectiveness of public-access defibrillation. Clin Cardiol. 2010 Jul. 33(7):396-9. [Medline].

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

  56. 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. 1994 Mar 2. 271(9):678-83. [Medline].

  57. 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. 1998 Sep. 38(3):157-67. [Medline].

  58. Cronier P, Vignon P, Bouferrache K, et al. Impact of routine percutaneous coronary intervention after out-of-hospital cardiac arrest due to ventricular fibrillation. Crit Care. 2011 May 11. 15(3):R122. [Medline].

  59. Hollenbeck RD, McPherson JA, Mooney MR, Unger BT, Patel NC, McMullan PW Jr, et al. Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI. Resuscitation. 2014 Jan. 85(1):88-95. [Medline].

  60. Mateen FJ, Josephs KA, Trenerry MR, et al. Long-term cognitive outcomes following out-of-hospital cardiac arrest: A population-based study. Neurology. 2011 Sep 14. [Medline].

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

  62. 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. 1998 Jan 1. 81(1):17-21. [Medline].

  63. 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. 2002 Aug. 15(4):257-61. [Medline].

  64. 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. 1994 Nov 15. 24(6):1523-8. [Medline].

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

  66. 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. 1983 Aug. 68(2):321-36. [Medline].

  67. Risk stratification and survival after myocardial infarction. N Engl J Med. 1983 Aug 11. 309(6):331-6. [Medline].

  68. 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. 1988 Dec 1. 62(17):1213-7. [Medline].

  69. Buxton AE, Waxman HL, Marchlinski FE, Untereker WJ, Waspe LE, Josephson ME. Role of triple extrastimuli during electrophysiologic study of patients with documented sustained ventricular tachyarrhythmias. Circulation. 1984 Mar. 69(3):532-40. [Medline].

  70. Iesaka Y, Nogami A, Aonuma K, Nitta J, Chun YH, Fujiwara H, et al. Prognostic significance of sustained monomorphic ventricular tachycardia induced by programmed ventricular stimulation using up to triple extrastimuli in survivors of acute myocardial infarction. Am J Cardiol. 1990 May 1. 65(16):1057-63. [Medline].

  71. Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G. A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med. 1999 Dec 16. 341(25):1882-90. [Medline].

  72. Morrison LJ, Deakin CD, Morley PT, Callaway CW, Kerber RE, Kronick SL, et al. Part 8: advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010 Oct 19. 122(16 Suppl 2):S345-421. [Medline].

  73. Hazinski MF, Nolan JP, Billi JE et al. Part 1: executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010 Oct 19. 122(16 Suppl 2):S250-75. [Medline].

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

  75. 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. 1999 Oct. 34(4):1090-5. [Medline].

  76. 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. 1993 Oct 15. 72(12):911-5. [Medline].

  77. 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. 1993 May. 21(6):1406-12. [Medline].

  78. 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. 2000 Feb 10. 342(6):365-73. [Medline].

  79. Rea TD, Fahrenbruch C, Culley L, Donohoe RT, Hambly C, Innes J, et al. CPR with chest compression alone or with rescue breathing. N Engl J Med. 2010 Jul 29. 363(5):423-33. [Medline].

  80. Iwami T, Kitamura T, Kawamura T, Mitamura H, Nagao K, Takayama M, et al. Chest compression-only cardiopulmonary resuscitation for out-of-hospital cardiac arrest with public-access defibrillation: a nationwide cohort study. Circulation. 2012 Dec 11. 126(24):2844-51. [Medline].

  81. Ewy GA, Sanders AB. Alternative approach to improving survival of patients with out-of-hospital primary cardiac arrest. J Am Coll Cardiol. 2013 Jan 15. 61(2):113-8. [Medline].

  82. Hassan TB, Jagger C, Barnett DB. A randomised trial to investigate the efficacy of magnesium sulphate for refractory ventricular fibrillation. Emerg Med J. 2002 Jan. 19(1):57-62. [Medline]. [Full Text].

  83. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002 Feb 21. 346(8):557-63. [Medline].

  84. Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013 Dec 5. 369(23):2197-206. [Medline].

  85. [Guideline] Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation. 2008 May 27. 117(21):e350-408. [Medline].

  86. [Guideline] Tracy CM, Epstein AE, Darbar D, Dimarco JP, Dunbar SB, Estes NA 3rd, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2012 Oct 2. 60(14):1297-313. [Medline]. [Full Text].

  87. 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. 1999 Mar 11. 83(5B):68D-73D. [Medline].

  88. 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. 1997 Nov 27. 337(22):1576-83. [Medline].

  89. Matsue Y, Suzuki M, Nishizaki M, Hojo R, Hashimoto Y, Sakurada H. Clinical implications of an implantable cardioverter-defibrillator in patients with vasospastic angina and lethal ventricular arrhythmia. J Am Coll Cardiol. 2012 Sep 4. 60(10):908-13. [Medline].

  90. Klein H, Auricchio A, Reek S, Geller C. New primary prevention trials of sudden cardiac death in patients with left ventricular dysfunction: SCD-HEFT and MADIT-II. Am J Cardiol. 1999 Mar 11. 83(5B):91D-97D. [Medline].

  91. Callaway CW. Epinephrine for cardiac arrest. Curr Opin Cardiol. 2013 Jan. 28(1):36-42. [Medline].

  92. Haïssaguerre M, Shoda M, Jaïs P, Nogami A, Shah DC, Kautzner J, et al. Mapping and ablation of idiopathic ventricular fibrillation. Circulation. 2002 Aug 20. 106(8):962-7. [Medline].

  93. Huang J, Rogers JM, Killingsworth CR, Singh KP, Smith WM, Ideker RE. Evolution of activation patterns during long-duration ventricular fibrillation in dogs. Am J Physiol Heart Circ Physiol. 2004 Mar. 286(3):H1193-200. [Medline].

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

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

  96. 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. 1996 Dec 26. 335(26):1933-40. [Medline].

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

  98. Tanno K, Miyoshi F, Watanabe N, Minoura Y, Kawamura M, Ryu S, et al. Are the MADIT II criteria for ICD implantation appropriate for Japanese patients?. Circ J. 2005 Jan. 69(1):19-22. [Medline].

  99. Yoon G, Quitania L, Kramer JH, Fu YH, Miller BL, Ptácek LJ. Andersen-Tawil syndrome: definition of a neurocognitive phenotype. Neurology. 2006 Jun 13. 66(11):1703-10. [Medline].

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]


≤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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