Pediatric Ventricular Fibrillation Medication

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

Medication Summary

Patients who have been resuscitated from ventricular fibrillation arrests should be evaluated for risk of recurrence. If ventricular fibrillation was secondary to degeneration of another arrhythmia that may recur, medication and other therapies (eg, radiofrequency catheter ablation [RFCA], pacemaker placement, automatic ICD [AICD], surgery) may be aimed at prevention of that arrhythmia. These potentially degenerating arrhythmias should be considered, particularly in patients without evidence of severe electrolyte disturbance, metabolic derangement, hypoxia, myocardial infarction, or drug toxicity. Medications to treat such arrhythmias are discussed in Ventricular Tachycardia. Some evidence suggests that vasopressin may play a role in the treatment of adult shock-refractory ventricular fibrillation; however, the safety and efficacy of this drug in children has not been evaluated.

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Antiarrhythmic agents

Class Summary

These agents alter the electrophysiologic mechanisms responsible for arrhythmia. Use during cardiac arrest follows administration of epinephrine and attempted defibrillation.

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Amiodarone (Cordarone)

 

May inhibit AV conduction and sinus node function. Prolongs action potential and refractory period in myocardium and inhibits adrenergic stimulation.

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Lidocaine (Xylocaine)

 

Class IB antiarrhythmic agent that increases electrical stimulation threshold of the ventricle, suppressing automaticity of conduction through the tissue. Consider as alternate treatment for ventricular fibrillation or pulseless ventricular tachycardia.

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Magnesium sulfate

 

Used for suspected hypomagnesemia or torsade de pointes. Consider use in refractory ventricular tachycardia following lidocaine.

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Vasopressors

Class Summary

Patients most likely to adequately respond are those in whom physiologic parameters (eg, urine flow, myocardial function, blood pressure) have not profoundly deteriorated.

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Epinephrine (Adrenalin)

 

Used for asystole or pulseless arrest. Also used for symptomatic bradycardia unresponsive to oxygen and ventilation.

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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

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