Ventricular Fibrillation

A chaotic unorganized cardiac rhythm with several firing regions within the ventricles; the result is uncoordinated ventricular activity and NO cardiac output – a lethal dysrhythmia; fine ventricular fibrillation defines an amplitude less than 3 mm; coarse ventricular fibrillation has amplitudes of 3 mm or more.

Ventricular fibrillation is the most common presenting rhythm for victims of sudden cardiac death. Rather than pumping as a cohesive unit, multiple sites in the ventricles fire simultaneously, effecting only a quiver. A resulting fibrillation rate is 350-600/minute.

The presence of chaotic ventricular fibrillatory waves of at least 3 mm in amplitude is often referred to as coarse ventricular fibrillation. It follows, then, that shallow ventricular fibrillatory waves (less than 3 mm in amplitude) is called fine ventricular fibrillation. The larger amplitude of coarse VF represents a higher degree of ventricular electrical activity, a positive indicator for successful defibrillation.

Note that what looks like ventricular fibrillation may also be a loose or unconnected lead wire. When considering the treatment for this rhythm – a high-energy electrical discharge across the heart – it should come as no surprise that ventricular fibrillation must be initially confirmed with a pulse/circulation check.

Cardiac output is non-existent with ventricular fibrillation. Without the benefit of a cardiac monitor, the patient appears lifeless: pulseless and without respirations. The definitive treatment for ventricular fibrillation is rapid defibrillation with ample current across the ventricular myocardium. For every minute, the likelihood of a successful resuscitation for a patient in VF falls by about 10%. Recognizing this rhythm and responding accordingly truly is a matter of life and death.

coarse ventricular fibrillation

1. Six Second ECG Guidebook (2012), T Barill, p. 114, 120-121, 208

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