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Ventricular Fibrillation

Ventricular Fibrillation is a topic covered in the 5-Minute Emergency Consult.

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  • Ventricular fibrillation (VF) is completely disorganized depolarization and contraction of small areas of the ventricle without effective cardiac output.
  • Cardiac monitor displays absence of QRS complexes and T-waves with the presence of high-frequency, irregular undulations that are variable in both amplitude and periodicity.


  • Damaged myocardium creates sites for re-entrant circuits:
    • Myocardial damage may be caused by multiple factors including ischemia, necrosis, reperfusion, healing, and scar formation
  • Most often a result of severe myocardial ischemia:
    • 7% of patients with STEMI develop sustained VF, 80–85% occurring in the 1st 24 hr
  • Complication of cardiomyopathy:
    • Up to 50% of patients with dilated cardiomyopathy suffer an episode of VF.
    • In hypertrophic cardiomyopathy, unexpected sudden death occurs with reported frequency of up to 3%/yr.
  • Nonischemic causes of ventricular tachycardia may evolve into VF:
    • Drug toxicities (cyclic antidepressants, digitalis)
    • Electrolyte or acid–base abnormalities
    • Congenital and acquired prolonged QT syndromes.
    • Short QT syndrome
    • Brugada syndrome
  • Premature ventricular complexes (PVCs) with R-on-T phenomenon
  • Other less common causes of VF:
    • Electrocution
    • Hypoxia
    • Hypothermia
    • Blunt chest trauma
    • Iatrogenic myocardial irritation from pacemaker placement or pulmonary artery catheter
  • Idiopathic VF (5–10%)

Pediatric Considerations
  • Primary ventricular dysrhythmias are extremely rare in children.
  • VF usually results from a respiratory arrest, hypothermia, or near drowning.

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Rosen, Peter, et al., editors. "Ventricular Fibrillation." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307468/all/Ventricular_Fibrillation.
Ventricular Fibrillation. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307468/all/Ventricular_Fibrillation. Accessed April 23, 2019.
Ventricular Fibrillation. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307468/all/Ventricular_Fibrillation
Ventricular Fibrillation [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307468/all/Ventricular_Fibrillation.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ventricular Fibrillation ID - 307468 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307468/all/Ventricular_Fibrillation PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -