Analysis of ambulatory electrocardiograms in 15 patients during spontaneous ventricular fibrillation with special reference to preceding arrhythmic events

Fifteen patients sustained ventricular fibrillation during ambulatory electrocardiographic recording in a period of 3.5 years over which time 16,500 ambulatory electrocardiograms were analyzed (prevalence = 0.09% or 1/1,100). Eight patients died, and seven survived cardiopulmonary resuscitation. Quantitative analysis of hourly ventricular arrhythmias prior to ventricular fibrillation revealed an increased frequency of premature ventricular beats and ventricular tachycardia, especially in the 2 hours immediately before ventricular fibrillation. Ventricular fibrillation was initiated by ventricular tachycardia in all 15 cases. These runs of ventricular tachycardia were characterized by their unusual length (mean = 560 +/- 536 beats) and their rapid rate (241 +/- 45 beats/min). Although an R on T premature ventricular beat initiated ventricular tachycardia and ventricular fibrillation occasionally, the mean prematurity index of the initiating premature ventricular beat was not early (mean = 1.27 +/- 0.28). QT prolongation was present in only 3 of the 15 patients (mean QTc interval = 0.42 +/- 0.06). Left ventricular dysfunction (mean left ventricular ejection fraction = 34.9 +/- 9.9%) and coronary artery disease were nearly always present. The cardiac medications most frequently associated with these patients at the time of ventricular fibrillation were digitalis and quinidine.

This article has been cited by other articles:

				U. J. O. Gang, C. Jons, R. M. Jorgensen, S. Z. Abildstrom, J. Haarbo, M. D. Messier, H. V. Huikuri, P. E. B. Thomsen, and on behalf of the CARISMA investigators Heart rhythm at the time of death documented by an implantable loop recorder Europace, February 1, 2010; 12(2): 254 - 260. [Abstract] [Full Text] [PDF]

				R. M. Carney, K. E. Freedland, and R. C. Veith Depression, the Autonomic Nervous System, and Coronary Heart Disease Psychosom Med, May 1, 2005; 67(Supplement_1): S29 - S33. [Abstract] [Full Text] [PDF]

				A. W.C. Chow, O. R. Segal, D. W. Davies, and N. S. Peters Mechanism of Pacing-Induced Ventricular Fibrillation in the Infarcted Human Heart Circulation, September 28, 2004; 110(13): 1725 - 1730. [Abstract] [Full Text] [PDF]

				G. Gronefeld and S. H Hohnloser What do implantable cardioverter/defibrillators teach us about the mechanisms of sudden cardiac death? Cardiovasc Res, May 1, 2001; 50(2): 232 - 241. [Abstract] [Full Text] [PDF]

				L. Mont, M. Valentino, A. Sambola, M. Matas, L. Aguinaga, and J. Brugada Arrhythmia recurrence in patients with a healed myocardial infarction who received an implantable defibrillator: analysis according to the clinical presentation J. Am. Coll. Cardiol., August 1, 1999; 34(2): 351 - 357. [Abstract] [Full Text] [PDF]

				V. Shusterman, B. Aysin, V. Gottipaty, R. Weiss, S. Brode, D. Schwartzman, K. P. Anderson, and for the ESVEM Investigators Autonomic nervous system activity and the spontaneous initiation of ventricular tachycardia J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1891 - 1899. [Abstract] [Full Text] [PDF]

				A. R. R. Misier, T. Opthof, N. M. van Hemel, J. T. Vermeulen, J. M.T. de Bakker, J. J.A.M. Defauw, F. J.L. van Capelle, and M. J. Janse Dispersion of `Refractoriness' in Noninfarcted Myocardium of Patients With Ventricular Tachycardia or Ventricular Fibrillation After Myocardial Infarction Circulation, May 15, 1995; 91(10): 2566 - 2572. [Abstract] [Full Text]

				M. H. Raitt, G. L. Dolack, P. J. Kudenchuk, J. E. Poole, and G. H. Bardy Ventricular Arrhythmias Detected After Transvenous Defibrillator Implantation in Patients With a Clinical History of Only Ventricular Fibrillation : Implications for Use of Implantable Defibrillator Circulation, April 1, 1995; 91(7): 1996 - 2001. [Abstract] [Full Text]

				R. Brooks, B. A. McGovern, H. Garan, and J. N. Ruskin Current Treatment of Patients Surviving Out-of-Hospital Cardiac Arrest JAMA, February 13, 1991; 265(6): 762 - 768. [Abstract] [PDF]

				P. J. Podrid Resuscitation in the Elderly: A Blessing or a Curse? Ann Intern Med, August 1, 1989; 111(3): 193 - 195. [Abstract] [PDF]

				A. E. BUXTON Sudden Cardiac Death--1986 Ann Intern Med, May 1, 1986; 104(5): 716 - 718. [Abstract] [PDF]