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23-36: Ventricular Fibrillation

Maite A. Huis in ‘t Veld; Amal Mattu; R. Jason Thurman

ECG Findings

  • Chaotic, irregular deflections without clear P waves, QRS complexes, or T waves

  • Rate up to 600 bpm

Pearls

  1. This rhythm is not compatible with effective cardiac output; hence, the patient will be in pulseless cardiac arrest. Immediate defibrillation is indicated.

  2. Given the above, ventricular fibrillation should generally not be identified on ECG, but rather by rhythm strip and clinical picture (similar to the principle of tension pneumothorax on chest x-ray). The examples seen here were obtained when patients receiving continuous ECG monitoring fibrillated during stress testing.

  3. Amplitude of deflections often decreases over time (coarse or fine ventricular fibrillation).

FIGURE 23.36A

Ventricular Fibrillation. (ECG contributor: Frank G. Yanowitz, MD. Used with permission from Frank G. Yanowitz, MD at the ECG Learning Center [https://ecg.utah.edu].)

An E C G tracing of 12 leads from a patient with ventricular fibrillation. Leads 1, 2, 3, a V R, a V L, a V F, V 1, V 2, V 3, V 4, V 5, and V 6 consist of fluctuating baselines, and peaks and dips occurring at irregular frequencies and amplitudes.
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FIGURE 23.36B

Note the chaotic baseline with no discernable complexes. Immediate defibrillation is indicated. (ECG contributor: Jason Winter. Used with permission from https://ecg-educator.blogspot.com/?m=0.)

An E C G tracing with four leads from a patient with ventricular fibrillation. Leads 1, 2, a V R, and a V L consist of fluctuating baselines, and peaks and dips occurring at irregular frequencies and amplitudes.
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