Pediatric Ventricular Fibrillation Follow-up

  • Author: Elizabeth A Stephenson, MD, MSc; Chief Editor: Stuart Berger, MD   more...
 
Updated: Jul 1, 2010
 

Further Inpatient Care

  • Evaluate patients presenting with ventricular fibrillation arrest or averted sudden death for evidence of risk of repeated events (see Workup).
  • Appropriate follow-up care is determined by any substrate for further arrhythmia that is identified.
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Transfer

A patient who has experienced any life-threatening arrhythmia should have an electrophysiologic evaluation, ideally by a pediatric electrophysiologist; transfer to a facility with appropriate staff and an EP laboratory may be required.

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Prognosis

  • The short-term prognosis of a patient with ventricular fibrillation is primarily dictated by time to defibrillation, and long-term issues are modulated by any underlying conditions that may have led to the ventricular fibrillation event.
  • One study demonstrated a good outcome in 17% of patients presenting with cardiac arrest and ventricular fibrillation, all of whom had early defibrillation.[9]
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Patient Education

  • Families of patients with life-threatening arrhythmias, such as ventricular fibrillation, must be competent in bystander CPR and must be aware of the need for early defibrillation.
  • Any patient who has averted sudden death or has been identified as at risk for such an event is likely to require psychological support and counseling, as may family members.
  • Driving can be an issue in adolescents with life-threatening arrhythmias. Individual states have restrictions that must be followed that are often based on a certain length of time that the driver has been free of an event.
  • In patients with long QT syndrome, Brugada syndrome, arrhythmogenic right ventricular dysplasia, familial dilated or hypertrophic cardiomyopathy, and other inherited arrhythmia disorders, family members should be evaluated for the presence of the disease.
  • For excellent patient education resources, visit eMedicine's Heart Center and Public Health Center. Also, see eMedicine's patient education articles Atrial Fibrillation and Cardiopulmonary Resuscitation (CPR).
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Contributor Information and Disclosures
Author

Elizabeth A Stephenson, MD, MSc  Assistant Professor of Pediatrics, University of Toronto; Consulting Staff, Division of Cardiology, The Hospital for Sick Children

Elizabeth A Stephenson, MD, MSc is a member of the following medical societies: American Heart Association, Canadian Cardiovascular Society, and Pediatric and Congenital Electrophysiology Society

Disclosure: Nothing to disclose.

Coauthor(s)

Charles I Berul, MD  Professor of Pediatrics, George Washington University School of Medicine; Chief, Division of Cardiology, Children's National Medical Center

Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society, and Society for Pediatric Research

Disclosure: Johnson & Johnson Consulting fee Consulting

Specialty Editor Board

Christopher Johnsrude, MD  Associate Professor of Pediatrics, Director of Electrophysiology, University of Louisville School of Medicine; Consulting Staff, Pediatric Cardiology Associates, PSC

Christopher Johnsrude, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Cardiology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Alvin J Chin, MD  Professor of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician, Cardiology Division, Children's Hospital of Philadelphia

Alvin J Chin, MD, is a member of the following medical societies: American Association for the Advancement of Science, American Heart Association, and Society for Developmental Biology

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

References

  1. Safranek DJ, Eisenberg MS, Larsen MP. The epidemiology of cardiac arrest in young adults. Ann Emerg Med. Sep 1992;21(9):1102-6. [Medline].

  2. Mogayzel C, Quan L, Graves JR, et al. Out-of-hospital ventricular fibrillation in children and adolescents: causes and outcomes. Ann Emerg Med. Apr 1995;25(4):484-91. [Medline].

  3. Walsh CK, Krongrad E. Terminal cardiac electrical activity in pediatric patients. Am J Cardiol. Feb 1983;51(3):557-61. [Medline].

  4. Pedersen DH, Zipes DP, Foster PR, Troup PJ. Ventricular tachycardia and ventricular fibrillation in a young population. Circulation. Nov 1979;60(5):988-97. [Medline].

  5. Cecchin F, Jorgenson DB, Berul CI, et al. Is arrhythmia detection by automatic external defibrillator accurate for children?: sensitivity and specificity of an automatic external defibrillator algorithm in 696 pediatric arrhythmias. Circulation. May 22 2001;103(20):2483-8. [Medline].

  6. Vlay S. A Practical Approach to Cardiac Arrhythmias. Boston, MA: Little Brown & Co; 1996.

  7. Benson DW Jr, Benditt DG, Anderson RW, et al. Cardiac arrest in young, ostensibly healthy patients: clinical, hemodynamic, and electrophysiologic findings. Am J Cardiol. Jul 1983;52(1):65-9. [Medline].

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

  9. Garson A Jr, Smith RT, Moak JP, et al. Ventricular arrhythmias and sudden death in children. J Am Coll Cardiol. Jun 1985;5(6 Suppl):130B-133B. [Medline].

  10. Berul CI, Hill SL, Geggel RL, et al. Electrocardiographic markers of late sudden death risk in postoperative tetralogy of Fallot children. J Cardiovasc Electrophysiol. Dec 1997;8(12):1349-56. [Medline].

  11. Alexander ME, Berul CI. Ventricular arrhythmias: when to worry. Pediatr Cardiol. Nov-Dec 2000;21(6):532-41. [Medline].

  12. Morady F, Scheinman MM, Hess DS, et al. Clinical characteristics and results of electrophysiologic testing in young adults with ventricular tachycardia or ventricular fibrillation. Am Heart J. Dec 1983;106(6):1306-14. [Medline].

  13. Leenhardt A, Lucet V, Denjoy I, et al. Catecholaminergic polymorphic ventricular tachycardia in children. A 7-year follow-up of 21 patients. Circulation. Mar 1 1995;91(5):1512-9. [Medline].

  14. Link MS. Commotio cordis: sudden death due to chest wall impact in sports. Heart. Feb 1999;81(2):109-10. [Medline].

  15. Link MS, Wang PJ, Pandian NG, et al. An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis). N Engl J Med. Jun 18 1998;338(25):1805-11. [Medline].

  16. Maron BJ, Poliac LC, Kaplan JA, Mueller FO. Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. N Engl J Med. Aug 10 1995;333(6):337-42. [Medline].

  17. American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. Dec 13 2005;112(24 Suppl):IV1-203. [Medline]. [Full Text].

  18. American Heart Association. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric advanced life support. Pediatrics. May 2006;117(5):e1005-28. [Medline]. [Full Text].

  19. Berg RA, Samson RA, Berg MD, et al. Better outcome after pediatric defibrillation dosage than adult dosage in a swine model of pediatric ventricular fibrillation. J Am Coll Cardiol. Mar 1 2005;45(5):786-9. [Medline].

  20. Stephenson EA, Batra AS, Knilans TK, et al. A multicenter experience with novel implantable cardioverter defibrillator configurations in the pediatric and congenital heart disease population. J Cardiovasc Electrophysiol. Jan 2006;17(1):41-6. [Medline].

 
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Ventricular fibrillation with polymorphic morphology and cycle lengths varying from 80-280 milliseconds.
 
 
 
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