Disease Description (Causes and Symptoms)
Ventricular fibrillation (VF) is a condition in which the ventricles generate disorganized and irregular electrical activity approximately 350–600 times per minute, resulting in no significant blood ejection through effective ventricular contractions. It immediately causes circulatory arrest and loss of consciousness and is fatal without appropriate treatment.
Major causes: acute coronary artery occlusion (acute myocardial infarction), cardiomyopathy, heart failure, pericarditis, thyrotoxicosis, hypertensive heart disease, rheumatic heart disease, cardiac surgery, heavy alcohol consumption, and others. It may also occur due to electrophysiological abnormalities without structural abnormalities.
Major symptoms: sudden syncope (unconsciousness), respiratory arrest, an unpalpable pulse, and sometimes preceding complaints of palpitations, tachycardia, dyspnea, or chest pain.
Treatment Methods
- Emergency treatment (time is the highest priority)
- Immediate defibrillation (unsynchronized DC shock) is the top-priority treatment. If a defibrillator is unavailable, begin high-quality cardiopulmonary resuscitation (CPR) immediately.
- Secure the airway, provide ventilation, establish intravenous (or intraosseous) access, and administer epinephrine (1 mg IV/IO every 3–5 minutes) according to ACLS (advanced cardiac life support) guidelines.
- If persistent asystole/unconsciousness remains after defibrillation, consider an antiarrhythmic drug (amiodarone 300 mg bolus → an additional 150 mg if necessary; lidocaine as an alternative).
- Immediately correct reversible causes (Hs and Ts: hypoxia, hypovolemia, hypo-/hyperkalemia, hypothermia, acidosis, tension pneumothorax, thrombosis (occlusion), cardiac tamponade, toxins/drugs, etc.) when present.
- Post-resuscitation (ROSC) treatment
- Identify and treat the cause: immediately consider percutaneous coronary intervention (PCI) if acute myocardial infarction is suspected.
- Provide neuroprotection through targeted temperature management.
- Provide continuous cardiovascular and respiratory support and correct electrolyte and metabolic abnormalities.
- Consider an implantable cardioverter-defibrillator (ICD) in patients at high risk of recurrence, particularly when the cause cannot be corrected or recurrence occurs even after eliminating the triggering cause.
- Medication and long-term management
- Optimize treatment of underlying diseases (coronary artery disease, heart failure, thyroid disease, etc.).
- Consider maintenance therapy with an antiarrhythmic drug (e.g., amiodarone) in some patients.
- Precautions and self-management
- Cardiac arrest is time-sensitive: in an emergency, call 119 promptly and attempt CPR immediately.
- When taking anticoagulants or antiarrhythmic drugs, check for medication side effects and interactions.
- After ICD implantation, avoid electromagnetic fields (strong magnetic fields) and undergo regular device checks.
- Be aware of and monitor for possible complications (hypoxic brain injury, reduced myocardial function, recurrent arrhythmias, etc.).
Checklist Before an Outpatient Visit (Including Sample Questions)
Items/materials to prepare
- A list of all medications currently being taken (prescription drugs, OTC drugs, and herbal medicines, including doses and dosing times)
- Medical history: myocardial infarction, percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG), heart failure, cardiac surgery, thyroid disease, etc.
- Records of recently occurring symptoms: syncope/presyncope, time of onset, duration, pattern of recovery, and whether CPR was performed
- Previous electrocardiograms (ECGs), echocardiograms (Echo), blood tests (electrolytes, cardiac enzymes, thyroid tests), and coronary angiography/PCI results
- Family history: sudden death or hereditary heart disease
- Allergies and whether implants (pacemaker or ICD) are present
Items to report to the medical staff in advance at the outpatient visit
- Whether recent syncope or acute chest pain occurred and whether emergency treatment (defibrillation or CPR) was provided at that time
- Antiarrhythmic drugs, anticoagulants, thyroid medications, and other medications currently being taken
Examples of General Questions to Ask the Doctor
- What are the immediate survival rate and long-term prognosis for this condition?
- Do I need an ICD (implantable cardioverter-defibrillator)? If so, when should it be implanted?
- What are the side effects and interactions of the medications I am currently taking?
- What lifestyle changes should I make to reduce the risk of recurrence?
Examples of Disease-Specific Questions
- Can it be determined with certainty whether the cause of this ventricular fibrillation was an acute myocardial infarction (coronary artery occlusion)? Do I need immediate percutaneous coronary intervention (PCI)?
- Based on the initial tests, is an ICD recommended for me, and if so, according to what criteria is that decision made?