What Is Ventricular Fibrillation?

Ventricular flutter and ventricular fibrillation are severe ectopic rhythms, and the ventricle loses its effective overall contraction ability, but is replaced by fast and uncoordinated fibrillation of each heart. The hemodynamic effects of both are equivalent to ventricular arrest. Ventricular flutter is often a prelude to ventricular fibrillation and is often a fatal arrhythmia before death.

Basic Information

Visiting department: Cardiology
Disease site: heart

Disease characteristics: Loss of consciousness, convulsions, pale or bruising, pulse disappearance, heart sounds not heard, blood pressure at zero, breathing and heartbeat stopped

Causes of ventricular flutter and ventricular fibrillation

1. Coronary heart disease, especially acute myocardial infarction or acute coronary ischemia.

2. Cardiomyopathy with complete atrioventricular block.

3. Severe electrolyte disorders, such as severe low or high potassium.

4. Drug toxicity, such as poisoning of quinidine, digitalis, chloroquine, antimony and other drugs.

5. Electric shock, lightning strike or drowning.

6. Various ventricular tachycardia further worsened.

7. Pre-excitation syndrome with atrial fibrillation, misuse of digitalis.

Ventricular flutter and ventricular fibrillation clinical manifestations

1. Loss of consciousness, convulsions, that is, Alzheimer's syndrome.

2. Pale or bruising, pulse disappeared, heart sounds were not heard, and blood pressure was zero.

3. If not rescued in time, breathing and heartbeat will stop.

Ventricular flutter and ventricular fibrillation

Blood electrolyte disorders

Such as blood potassium, sodium, chlorine and other abnormalities.

2. ECG monitoring

Abnormal heart rate.

3. ECG examination

(1) The electrocardiogram characteristics of ventricular flutter are fast and regular ventricular ectopic rhythms, but QRS waves and ST segments and T waves cannot be identified. The frequency is 150 to 250 times / minute.

(2) Ventricular fibrillation electrocardiogram characteristics QRS complexes and T waves completely disappeared, and replaced with tremor waves of varying shapes and frequencies, with frequencies of 250 to 500 times per minute.

Ventricular flutter and ventricular fibrillation diagnosis

Based on the patient's clinical manifestations and ECG, a clear diagnosis can be made. Ventricular flutter and fibrillation are arrhythmias that quickly lead to death of patients, and rarely stop themselves. Therefore, a diagnosis should be made as soon as possible so that patients can be promptly treated.

1. Typical ECG characteristics of ventricular flutter

Continuous, regular, wide, deformed QRS waves, namely ventricular flutter waves. The time limit of the QRS wave is longer than 0.12s. The QRS wave has an upward and downward amplitude like a sine-like curve and cannot be separated from the T wave. There is no equal wire between the QRS waves. The QRS wave frequency is mostly 180 to 250 times / minute, sometimes it can be as low as 150 times / minute or as high as 300 times / minute. The P wave disappears.

2. Typical ECG characteristics of ventricular fibrillation

The QRS-T complex completely disappeared, replaced by tremor waves (f waves) with different shapes and extremely uneven spacings, with a frequency of 250 to 500 times / minute, and there is no equal wire between the tremor waves.

Differential diagnosis of ventricular flutter and ventricular fibrillation

Clinically, it should be distinguished from cardiac arrest with Asthma syndrome.

Ventricular flutter and ventricular fibrillation treatment

1. DC cardioversion and defibrillation is the first choice for treatment of ventricular flutter and ventricular fibrillation. It should be strived to provide asynchronous DC defibrillation within a short time (1 to 2 minutes). Generally, 300-400Ws electric shock can be injected intravenously or trachea if it is invalid. Intracardiac injection of epinephrine or tosibromide (bromobenzylamine) or lidocaine, followed by electric shock, can improve the success rate. If defibrillation is performed within 4 minutes after the onset, the success rate is more than 50%, and only 4% after 4 minutes. If there is no defibrillator nearby, first make 2 to 3 taps in the anterior region of the heart, and tap the heart without returning, immediately perform chest heart compression, 70 to 80 times / min.

2. Drug defibrillation, intravenous lidocaine or procainamide. If digitalis poisoning causes ventricular fibrillation, phenytoin is administered intravenously.

3. After the above treatments to restore the autonomic heart rhythm, continuous intravenous drip of lidocaine or procainamide is maintained. In addition, the intravenous infusion of toxibromide (bromobenzylamine), sotalol, and amiodarone also have good effects in preventing ventricular fibrillation. Digitalis poisoning can give phenytoin sodium.

4. While adhering to the above treatment, pay attention to keeping the airway unobstructed, adhere to artificial respiration, and provide sufficient oxygen.

5. At the same time of rescue treatment, attention should also be paid to correct acid-base balance disorders and electrolyte disorders. Because the duration of ventricular flutter and fibrillation is slightly longer, acidosis occurs in the body, which is not conducive to defibrillation. At this time, 11.2% sodium lactate or 4% to 5% sodium bicarbonate can be administered intravenously.

6. If conditions permit, you can also insert a temporary pacing catheter for right ventricular pacing.