eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Ventricular Fibrillation: Follow-up

Author: Elizabeth A Stephenson, MD, MSc, Assistant Professor of Pediatrics, University of Toronto; Consulting Staff, Division of Cardiology, The Hospital for Sick Children
Coauthor(s): Charles Berul, MD, Associate Professor of Pediatrics, Harvard Medical School; Senior Associate, Department of Cardiology, Children's Hospital of Boston
Contributor Information and Disclosures

Updated: Jul 17, 2008

Follow-up

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.

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.

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

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).

Miscellaneous

Medicolegal Pitfalls

  • A child with susceptibility to ventricular fibrillation (particularly, a child resuscitated from ventricular fibrillation) and continued potential susceptibility to ventricular fibrillation substrates should be aggressively treated.
  • Treatment should include a comprehensive pediatric electrophysiology evaluation and probable AICD implantation.
  • Guidelines of expert consensus from the AHA and the American College of Cardiology provide general recommendations regarding adult and pediatric patients in whom AICD implantation may be indicated.
 


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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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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Further Reading

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Keywords

ventricular fibrillation, VF, ventricular tachycardia, VT, cardiac arrest, heart attack, malignant arrhythmia, cardiac arrhythmia, primary ventricular fibrillation, ventricular arrhythmia, malignant ventricular arrhythmia, congenital heart disease, cardiac tumors, long QT syndrome, torsade de pointes, sudden cardiac death, tetralogy of Fallot, aortic stenosis, deafness, congestive heart failure, low cardiac output, myocarditis, abnormal heart sounds, aortic stenosis, ventricular outflow obstruction, electrolyte abnormalities, proarrhytmic medications, hypothermia, hyperthermia, hypoxia/ischemia, Wolff-Parkinson-White syndrome, WPW syndrome, Chagas disease, atrial fibrillation, AF, commotio cordis

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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, Heart Rhythm Society, and Pediatric and Congential Electrophysiology Society
Disclosure: Nothing to disclose.

Coauthor(s)

Charles Berul, MD, Associate Professor of Pediatrics, Harvard Medical School; Senior Associate, Department of Cardiology, Children's Hospital of Boston
Charles Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Heart Rhythm Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Alvin J Chin, MD, Professor of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine
Alvin J Chin, MD is a member of the following medical societies: American Association for the Advancement of Science and American Heart Association
Disclosure: Nothing to disclose.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert 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.

 
 
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