ICD placement is recommended for primary prevention of SCD in patients at increased risk of life-threatening VF/VT. Trials comparing ICD with antiarrhythmic therapy such as AVID (Antiarrhythmic Versus Implantable Defibrillator) have shown similar results. Randomized control trials such as MADIT-I (Multicenter Automated Defibrillator Implantation Trial), MADIT-II, SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) have clearly demonstrated mortality benefits with ICD when compared to standard medical therapy. Lower SCD incidence has been reported in patients on chronic beta-blocker therapy for heart failure with reduced ejection fraction. A meta-analysis published in 2007 showed a significant reduction in risk of SCD with statin treatment. Sotalol, on the other hand, is associated with an increased risk of mortality by decreasing the defibrillation threshold. Most studies have failed to show any added benefit when compared to placebo or ICD. The overall effect of amiodarone on survival is controversial. Healthcare professionals should offer family members of patients with inherited arrhythmia syndromes genetic testing and counseling for risk stratification.Īmiodarone is the most commonly studied antiarrhythmic for prevention of SCD. In patients with symptoms suspected to be related to VA, detection using ambulatory electrocardiography and implanted cardiac monitors is recommended. Most VF transition from VT and other VA and hence identifying such arrhythmias at an early stage can help prevent VF. Primary prevention has been a significant factor in reducing VF-related SCDs. Once the patient attains return of spontaneous circulation (ROSC), physicians should begin a definitive evaluation for coronary artery disease. Professionals should undertake cause-specific measures such as securing the airway, correcting electrolytes, administrating fluids, decompressing pneumothorax, draining tamponade while resuscitating the patient. Identifying and addressing the cause of inciting event is equally important. Amiodarone significantly improves survival to hospital admission without affecting survival to hospital discharge. Administer epinephrine and amiodarone as per ACLS protocol in patients sustaining VF rhythm regardless of receiving 3 shocks. Patients receiving prompt defibrillation have shown improved survival (39.3%) compared to patients in whom defibrillation was delayed by 2 minutes or more (22.2%). Pulseless VT and VF are both shockable rhythm, and once the staff identifies the rhythm as VF, patients should be shocked immediately with 120 to 200 joules on a biphasic defibrillator or 360 joules using a monophasic. All patients with cardiac arrest should have an initial assessment while receiving quality CPR. There is a lower likelihood of survival if the healthcare professional deviates from the ACLS guidelines. Healthcare professionals should immediately initiate guideline-directed management as per Advanced Cardiac Life Support (ACLS) protocol. The rates of survival for VF patients outside the hospitals have increased slightly but many continue to have residual anoxic brain damage and neurological deficits.ĭue to the high mortality rate and extreme acuity of the condition, VF patients warrant immediate attention. Without treatment, the condition is fatal within minutes. VF has been identified in nearly 70% of cardiac arrest patients. VF is an extremely dangerous rhythm significantly compromising cardiac output and ultimately leading to sudden cardiac death (SCD). QRS morphology in VF varies in shape, amplitude, and duration with a prominent irregular rhythm. VF is a WCT caused by irregular electrical activity and characterized by a ventricular rate of usually greater than 300 with discrete QRS complexes on the electrocardiogram (ECG). This includes a subset of arrhythmias such as ventricular tachycardia (VT), ventricular fibrillation (VF), premature ventricular contractions (PVC), and ventricular flutter. Wide complex tachycardia (WCT) is used to define all tachyarrhythmia with QRS complex duration greater than 0.12 seconds. Arrhythmias originating from the ventricular myocardium or His-Purkinje system are grouped under ventricular arrhythmia (VA).
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