Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Ventricular fibrillation eMedicine Article


Published on

Published in: Education, Health & Medicine
  • Be the first to comment

  • Be the first to like this

Ventricular fibrillation eMedicine Article

  1. 1. Ventricular Fibrillation Author: Michael E Zevitz, MD; Chief Editor: Jeffrey N Rottman, MD more... Updated: Jun 20, 2011 Background Ventricular fibrillation (VF) is the most commonly identified arrhythmia in cardiac arrest patients. This arrhythmia is a severe derangement of the heartbeat that usually ends in death within minutes unless corrective measures are promptly taken. The number of survivors after out-of-hospital cardiac arrest has increased with expansion of community-based emergency rescue systems, widespread use of automatic external defibrillators (AEDs), and increasing numbers of lay persons trained in bystander cardiopulmonary resuscitation (CPR). Pathophysiology VF occurs in a variety of clinical situations but is most often associated with coronary artery disease (CAD) and as a terminal event. VF may be due to acute myocardial infarction or ischemia, or it may occur in the setting of chronic infarct scar. Intracellular calcium accumulation, the action of free radicals, metabolic alterations, and autonomic modulation are some important influences on the development of VF during ischemia. Thrombolytic agents reduce the incidence of ventricular arrhythmias and inducible ventricular tachycardia (VT) after myocardial infarction (MI). Cardiovascular events, including sudden cardiac death (SCD) from VF (but not asystole), most frequently occur in the morning and may be related to increased platelet aggregability. (Aspirin reduces the frequency of this form of mortality.) A spike in the number of SCDs appears to occur during the winter months. VF can occur during any of the following conditions or situations: Antiarrhythmic drug administration Hypoxia Ischemia Atrial fibrillation Very rapid ventricular rates in the preexcitation syndrome Electrical shock administered during cardioversion Electrical shock caused by accidental contact with improperly grounded equipment Competitive ventricular pacing to terminate VT Most prehospitalized patients with cardiac arrest (65-85%) have VF identified as the initial rhythm by emergency rescue personnel. Approximately 20-30% of patients from all documented sudden death events have bradyarrhythmia or asystole at the time of initial contact, indicating a terminal event from massive myocyte necrosis, pump failure, or VF progression to asystole. Only 7-10% have sustained VT as the initial rhythm on contact, and VT is associated with the best overall prognosis. When documentation is available, it often shows that rapid VT precedes VF. In patients with ischemic heart disease, the most common form of VT is monomorphic, which arises from a reentrant focus. In patients who survive an MI, it has been demonstrated that those with frequent premature ventricular contractions (PVCs), particularly complex forms such as multiform PVCs, short coupling intervals (R-on-T phenomenon), or VT (salvos of 3 or more ectopic beats), are at increased risk of sudden death. Even though many patients have anatomic and functional cardiac substrates that predispose them to develop ventricular arrhythmias, only a small percentage develop VF. The interplay among the regional ischemia, left ventricular (LV) dysfunction, and transient inciting events (eg, worsened ischemia, acidosis, hypoxemia, wall tension, drugs, metabolic disturbances) has been proposed to be the precipitator of VF. Epidemiology Frequency1 of 11 9/3/2011 8:21 AM
  2. 2. Ventricular Fibrillation United States SCD accounts for approximately 300,000 deaths per year in the United States, of which 75-80% are due to VF. More deaths are attributable to VF than to lung cancer, breast cancer, or AIDS. This represents an incidence of 0.08-0.16% per year in the adult population. VF is commonly the first expression of CAD and is responsible for approximately 50% of deaths from CAD, often within the first hour after the onset of an acute MI or coronary syndrome. In several population-based studies, the incidence of out-of-hospital cardiac arrest has been noted as declining in the past 2 decades, but the proportion of sudden CAD deaths in the United States due to VF has not changed. A high incidence of VF occurs among certain population subgroups (eg, patients with congestive heart failure [CHF] with ejection fraction < 30%, patients in the convalescent phase after MI, patients who survived cardiac arrest); unfortunately, only a small percentage of total VF events occur in these patients. The time dependence of risk for VF has been noted in several studies, with an increased number of events in the first 6-24 months after surviving a major cardiovascular event. Recurrence of VF in survivors of cardiac arrest can be up to 30% in the first year. International The frequency of VF in industrialized Western nations is similar to that in the United States. The incidence of VF in other countries varies as a reflection of CAD prevalence in those populations. The trend toward increasing frequency of VF events in developing nations is thought to reflect a change in dietary and lifestyle habits. Mortality/Morbidity A witness is not present in up to 40% of the approximately 225,000 deaths attributed to VF in the United States each year. For most people who experience VF, survival depends on the presence of individuals who are competent in performing basic life support, rapid availability or arrival of personnel and apparatus for defibrillation and advanced life support, and transfer to a hospital. Even under ideal circumstances, only an estimated 20% of patients who have out-of-hospital cardiac arrest survive to hospital discharge. In a study of out-of-hospital cardiac arrest survival in New York City, only 1.4% of patients survived to hospital discharge.[1] Other studies in suburban and rural areas have indicated survival rates up to 35%.[2] Placement of AEDs throughout communities and training people to use them has the potential to markedly improve outcomes from SCD. One study suggests routine coronary angiography with potentially associated percutaneous coronary intervention may favorably alter the prognosis of resuscitated patients with stable hemodynamics who are submitted to mild therapeutic hypothermia after out-of-hospital cardiac arrest.[3] Upon presentation to an emergency department (ED), the most important determinants of survival include (1) an unsupported systolic blood pressure (SBP) greater than 90 mm Hg, (2) a time from loss of consciousness to return of spontaneous circulation (ROSC) of less than 25 minutes, and (3) some degree of neurological responsiveness. A major adverse outcome from a VF event is anoxic encephalopathy, which occurs in 30-80% of patients. Race Most data are inconclusive regarding racial differences and the incidence of VF. Some studies suggest that a greater proportion of coronary deaths were sudden in blacks compared with whites. In a report by Gillum on SCD from 1980-1985, the percentage of CAD deaths occurring out of the hospital and in EDs was found to be higher in blacks than in whites.[4] Sex Men have a higher incidence of VF than women (3:1). This ratio generally reflects the higher incidence of CAD in men. Recent evidence suggests that a major sex difference may exist in the mechanism of MI. Basic and observational data point to the fact that men tend to have coronary plaque rupture, whereas women tend to have plaque erosion. Whether this biologic difference accounts for the male predominance of VF is unclear. Age The incidence of VF parallels the incidence of CAD, with the peak of VF occurring in people aged 45-75 years. The incidence of VF increases with age in men and women of all races because the prevalence of CAD increases with2 of 11 9/3/2011 8:21 AM
  3. 3. Ventricular Fibrillation age. However, the proportion of sudden deaths from CAD decreases with age. In the Framingham Heart Study, the proportion of sudden CAD deaths was 62% in men aged 45-54 years, but this percentage fell to 58% in men aged 55-64 years and to 42% in men aged 65-74 years.[5] According to Kuller, 31% of deaths are sudden in people aged 20-29 years.[6] Contributor Information and Disclosures Author Michael E Zevitz, MD Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice Michael E Zevitz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and Michigan State Medical Society Disclosure: Nothing to disclose. Specialty Editor Board Robert E Fowles, MD Clinical Professor of Medicine, University of Utah College of Medicine; Consulting Staff, Intermountain Medical Center and LDS Hospital; Director and Consulting Staff, Department of Cardiology, Salt Lake Clinic Robert E Fowles, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Heart Association Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Brian Olshansky, MD Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine Brian Olshansky, MD is a member of the following medical societies: American Autonomic Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Sports Medicine, American Federation for Clinical Research, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, and New York Academy of Sciences Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting Amer Suleman, MD Private Practice Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions Disclosure: Nothing to disclose. Chief Editor Jeffrey N Rottman, MD Professor of Medicine and Pharmacology, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE) Disclosure: Nothing to disclose. References3 of 11 9/3/2011 8:21 AM
  4. 4. Ventricular Fibrillation 1. Lombardi G, Gallagher J, Gennis P. Outcome of out-of-hospital cardiac arrest in New York City. The Pre- Hospital Arrest Survival Evaluation (PHASE) Study. JAMA. Mar 2 1994;271(9):678-83. [Medline]. 2. Waalewijn RA, de Vos R, Koster RW. Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in Utstein style. Resuscitation. Sep 1998;38(3):157-67. [Medline]. 3. Cronier P, Vignon P, Bouferrache K, et al. Impact of routine percutaneous coronary intervention after out-of- hospital cardiac arrest due to ventricular fibrillation. Crit Care. May 11 2011;15(3):R122. [Medline]. 4. Gillum RF. Sudden cardiac death in Hispanic Americans and African Americans. Am J Public Health. Sep 1997;87(9):1461-6. [Medline]. 5. Gordon T, Kannel WB. Premature mortality from coronary heart disease. The Framingham study. JAMA. Mar 8 1971;215(10):1617-25. [Medline]. 6. Kuller LH. Sudden death--definition and epidemiologic considerations. Prog Cardiovasc Dis. Jul-Aug 1980;23(1):1-12. [Medline]. 7. Thompson RJ, McCullough PA, Kahn JK. Prediction of death and neurologic outcome in the emergency department in out-of-hospital cardiac arrest survivors. Am J Cardiol. Jan 1 1998;81(1):17-21. [Medline]. 8. McCullough PA, Prakash R, Tobin KJ. Application of a cardiac arrest score in patients with sudden death and ST segment elevation for triage to angiography and intervention. J Interv Cardiol. Aug 2002;15(4):257-61. [Medline]. 9. Holmes DR Jr, Davis K, Gersh BJ, et al. Risk factor profiles of patients with sudden cardiac death and death from other cardiac causes: a report from the Coronary Artery Surgery Study (CASS). J Am Coll Cardiol. Mar 1 1989;13(3):524-30. [Medline]. 10. Chizner MA, Pearle DL, deLeon AC Jr. The natural history of aortic stenosis in adults. Am Heart J. Apr 1980;99(4):419-24. [Medline]. 11. Kligfield P, Levy D, Devereux RB. Arrhythmias and sudden death in mitral valve prolapse. Am Heart J. May 1987;113(5):1298-307. [Medline]. 12. Driscoll DJ, Edwards WD. Sudden unexpected death in children and adolescents. J Am Coll Cardiol. Jun 1985;5(6 Suppl):118B-121B. [Medline]. 13. Belhassen B, Viskin S. Idiopathic ventricular tachycardia and fibrillation. J Cardiovasc Electrophysiol. Jun 1993;4(3):356-68. [Medline]. 14. Morrison LJ, Deakin CD, Morley PT, Callaway CW, Kerber RE, Kronick SL, et al. Part 8: advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. Oct 19 2010;122(16 Suppl 2):S345-421. [Medline]. 15. Hazinski MF, Nolan JP, Billi JE et al. Part 1: executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. Oct 19 2010;122(16 Suppl 2):S250-75. [Medline]. 16. Cappato R. Secondary prevention of sudden death: the Dutch Study, the Antiarrhythmics Versus Implantable Defibrillator Trial, the Cardiac Arrest Study Hamburg, and the Canadian Implantable Defibrillator Study. Am J Cardiol. Mar 11 1999;83(5B):68D-73D. [Medline]. 17. Domanski MJ, Sakseena S, Epstein AE, et al. Relative effectiveness of the implantable cardioverter- defibrillator and antiarrhythmic drugs in patients with varying degrees of left ventricular dysfunction who have survived malignant ventricular arrhythmias. AVID Investigators. Antiarrhythmics Ver. J Am Coll Cardiol. Oct 1999;34(4):1090-5. [Medline]. 18. Moss AJ. Clinical management of patients with the long QT syndrome: drugs, devices, and gene-specific therapy. Pacing Clin Electrophysiol. Aug 1997;20(8 Pt 2):2058-60. [Medline]. 19. Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with4 of 11 9/3/2011 8:21 AM
  5. 5. Ventricular Fibrillation coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. Dec 26 1996;335(26):1933-40. [Medline]. 20. Lessmeier TJ, Lehmann MH, Steinman RT, et al. Outcome with implantable cardioverter-defibrillator therapy for survivors of ventricular fibrillation secondary to idiopathic dilated cardiomyopathy or coronary artery disease without myocardial infarction. Am J Cardiol. Oct 15 1993;72(12):911-5. [Medline]. 21. Meissner MD, Lehmann MH, Steinman RT, et al. Ventricular fibrillation in patients without significant structural heart disease: a multicenter experience with implantable cardioverter- defibrillator therapy. J Am Coll Cardiol. May 1993;21(6):1406-12. [Medline]. 22. Maron BJ, Shen WK, Link MS, et al. Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy. N Engl J Med. Feb 10 2000;342(6):365-73. [Medline]. 23. Alings M, Wilde A. "Brugada" syndrome: clinical data and suggested pathophysiological mechanism. Circulation. Feb 9 1999;99(5):666-73. [Medline]. 24. Anthony R, Daubert JP, Zareba W, Andrews ML, McNitt S, Levine E. Mechanisms of ventricular fibrillation initiation in MADIT II patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol. Feb 2008;31(2):144-50. [Medline]. 25. Antzelevitch C, Sicouri S. Clinical relevance of cardiac arrhythmias generated by afterdepolarizations. Role of M cells in the generation of U waves, triggered activity and torsade de pointes. J Am Coll Cardiol. Jan 1994;23(1):259-77. [Medline]. 26. Becker LB, Han BH, Meyer PM, et al. Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project. N Engl J Med. Aug 26 1993;329(9):600-6. [Medline]. 27. Bedell SE, Delbanco TL, Cook EF, Epstein FH. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. Sep 8 1983;309(10):569-76. [Medline]. 28. Berkowitsch A, Zareba W, Neumann T, Erdogan A, Nitt SM, Moss AJ. Risk stratification using heart rate turbulence and ventricular arrhythmia in MADIT II: usefulness and limitations of a 10-minute holter recording. Ann Noninvasive Electrocardiol. Jul 2004;9(3):270-9. [Medline]. 29. Bigger JT Jr. Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery. Coronary Artery Bypass Graft (CABG) Patch Trial Investigators. N Engl J Med. Nov 27 1997;337(22):1569-75. [Medline]. 30. Bigger JT Jr, Fleiss JL, Kleiger R, et al. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation. Feb 1984;69(2):250-8. [Medline]. 31. Bikkina M, Larson MG, Levy D. Prognostic implications of asymptomatic ventricular arrhythmias: the Framingham Heart Study. Ann Intern Med. Dec 15 1992;117(12):990-6. [Medline]. 32. Borggrefe M, Chen X, Martinez-Rubio A, et al. The role of implantable cardioverter defibrillators in dilated cardiomyopathy. Am Heart J. Apr 1994;127(4 Pt 2):1145-50. [Medline]. 33. Boutitie F, Boissel JP, Connolly SJ, et al. Amiodarone interaction with beta-blockers: analysis of the merged EMIAT (European Myocardial Infarct Amiodarone Trial) and CAMIAT (Canadian Amiodarone Myocardial Infarction Trial) databases. The EMIAT and CAMIAT Investigators. Circulation. May 4 1999;99(17):2268-75. [Medline]. 34. Breithardt G, Wichter T, Haverkamp W, et al. Implantable cardioverter defibrillator therapy in patients with arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, or no structural heart disease. Am Heart J. Apr 1994;127(4 Pt 2):1151-8. [Medline]. 35. Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST-segment elevation in leads V1 through V3: a marker for sudden death in patients without demonstrable structural heart disease. Circulation. Feb 10 1998;97(5):457-60. [Medline]. 36. Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol. Nov 155 of 11 9/3/2011 8:21 AM
  6. 6. Ventricular Fibrillation 1992;20(6):1391-6. [Medline]. 37. Brugada P, Geelen P. Some electrocardiographic patterns predicting sudden cardiac death that every doctor should recognize. Acta Cardiol. 1997;52(6):473-84. [Medline]. 38. Budeus M, Reinsch N, Wieneke H, Sack S, Erbel R. The prediction of ICD therapy in multicenter automatic defibrillator implantation trial (MADIT) II like patients: a retrospective analysis. Indian Pacing Electrophysiol J. 2008;8(2):80-93. [Medline]. 39. Coats AJ. MADIT II, the Multi-center Autonomic Defibrillator Implantation Trial II stopped early for mortality reduction, has ICD therapy earned its evidence-based credentials?. Int J Cardiol. Jan 2002;82(1):1-5. [Medline]. 40. Cobb LA, Baum RS, Alvarez H 3rd, Schaffer WA. Resuscitation from out-of-hospital ventricular fibrillation: 4 years follow-up. Circulation. Dec 1975;52(6 Suppl):III223-35. [Medline]. 41. Cobb LA, Fahrenbruch CE, Walsh TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA. Apr 7 1999;281(13):1182-8. [Medline]. 42. Cohen RJ. Enhancing specificity without sacrificing sensitivity: potential benefits of using microvolt T-wave alternans testing to risk stratify the MADIT-II population. Card Electrophysiol Rev. Dec 2003;7(4):438-42. [Medline]. 43. Conley MJ, McNeer JF, Lee KL, et al. Cardiac arrest complicating acute myocardial infarction: predictability and prognosis. Am J Cardiol. Jan 1977;39(1):7-12. [Medline]. 44. Connolly SJ, Gent M, Roberts RS, et al. Canadian Implantable Defibrillator Study (CIDS): study design and organization. CIDS Co-Investigators. Am J Cardiol. Nov 26 1993;72(16):103F-108F. [Medline]. 45. Consensus Statement of the Joint Steering Committees of the Unexplained Cardiac, and of the Idiopathic Ventricular Fibrillation Registry of the United States. Survivors of out-of-hospital cardiac arrest with apparently normal heart. Need for definition and standardized clinical evaluation. Circulation. Jan 7 1997;95(1):265-72. [Medline]. 46. Cooper RS, Simmons BE, Castaner A, et al. Left ventricular hypertrophy is associated with worse survival independent of ventricular function and number of coronary arteries severely narrowed. Am J Cardiol. Feb 15 1990;65(7):441-5. [Medline]. 47. Corrado D, Basso C, Thiene G, et al. Spectrum of clinicopathologic manifestations of arrhythmogenic right ventricular cardiomyopathy/dysplasia: a multicenter study. J Am Coll Cardiol. Nov 15 1997;30(6):1512-20. [Medline]. 48. Couderc JP, Zareba W, McNitt S, Maison-Blanche P, Moss AJ. Repolarization variability in the risk stratification of MADIT II patients. Europace. Sep 2007;9(9):717-23. [Medline]. 49. Cox JL, Daniel TM, Boineau JP. The electrophysiologic time-course of acute myocardial ischemia and the effects of early coronary artery reperfusion. Circulation. Nov 1973;48(5):971-83. [Medline]. 50. Cummins, R.O., et. al. American Heart Association. Advanced Cardiac Life Support. 2006. 51. Daubert JP, Zareba W, Cannom DS, McNitt S, Rosero SZ, Wang P. Inappropriate implantable cardioverter- defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol. Apr 8 2008;51(14):1357-65. [Medline]. 52. Daubert JP, Zareba W, Hall WJ, Schuger C, Corsello A, Leon AR. Predictive value of ventricular arrhythmia inducibility for subsequent ventricular tachycardia or ventricular fibrillation in Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients. J Am Coll Cardiol. Jan 3 2006;47(1):98-107. [Medline]. 53. Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med. May 3 1984;310(18):1137-40. [Medline]. 54. de Vreede-Swagemakers JJ, Gorgels AP, Weijenberg MP, et al. Risk indicators for out-of-hospital cardiac arrest in patients with coronary artery disease. J Clin Epidemiol. Jul 1999;52(7):601-7. [Medline]. 55. Doval HC, Nul DR, Grancelli HO, et al. Nonsustained ventricular tachycardia in severe heart failure.6 of 11 9/3/2011 8:21 AM
  7. 7. Ventricular Fibrillation Independent marker of increased mortality due to sudden death. GESICA- GEMA Investigators. Circulation. Dec 15 1996;94(12):3198-203. [Medline]. 56. Eisenberg MS, Copass MK, Hallstrom AP, et al. Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med. Jun 19 1980;302(25):1379-83. [Medline]. 57. Epstein SE, Quyymi AA, Bonow RO. Sudden cardiac death without warning. Possible mechanisms and implications for screening asymptomatic populations. N Engl J Med. Aug 3 1989;321(5):320-4. [Medline]. 58. Every NR, Fahrenbruch CE, Hallstrom AP, et al. Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest. J Am Coll Cardiol. Jun 1992;19(7):1435-9. [Medline]. 59. Fananpazir L, McAreavy D, Epstein ND. Hypertrophic cardiomyopathy. In: Zipes D, Jalife J, eds. Cardiac Elecrophysiology: From Cell to Bedside. 2nd ed. Philadelphia: WB Saunders Co; 1994:769-779. 60. Fontaine G, Fontaliran F, Lascault G. Arrhythmogenic right ventricular dysplasia. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. WB Saunders Co; 1994:754-769. 61. Furukawa T, Rozanski JJ, Nogami A, et al. Time-dependent risk of and predictors for cardiac arrest recurrence in survivors of out-of-hospital cardiac arrest with chronic coronary artery disease. Circulation. Sep 1989;80(3):599-608. [Medline]. 62. Gascho JA, Crampton RS, Cherwek ML, et al. Determinants of ventricular defibrillation in adults. Circulation. Aug 1979;60(2):231-40. [Medline]. 63. Gibson RS, Watson DD, Craddock GB. Prediction of cardiac events after uncomplicated myocardial infarction: a prospective study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography. Circulation. Aug 1983;68(2):321-36. [Medline]. 64. Gilman JK, Jalal S, Naccarelli GV. Predicting and preventing sudden death from cardiac causes. Circulation. Aug 1994;90(2):1083-92. [Medline]. 65. Gold MR, Nisam S. Primary prevention of sudden cardiac death with implantable cardioverter defibrillators: lessons learned from MADIT and MUSTT. Pacing Clin Electrophysiol. Nov 2000;23(11 Pt 2):1981-5. [Medline]. 66. Goldstein S. The necessity of a uniform definition of sudden coronary death: witnessed death within 1 hour of the onset of acute symptoms. Am Heart J. Jan 1982;103(1):156-9. [Medline]. 67. Greenberg H, Case RB, Moss AJ, Brown MW, Carroll ER, Andrews ML. Analysis of mortality events in the Multicenter Automatic Defibrillator Implantation Trial (MADIT-II). J Am Coll Cardiol. Apr 21 2004;43(8):1459-65. [Medline]. 68. Greene HL. The CASCADE Study: randomized antiarrhythmic drug therapy in survivors of cardiac arrest in Seattle. CASCADE Investigators. Am J Cardiol. Nov 26 1993;72(16):70F-74F. [Medline]. 69. Gueugniaud PY, Mols P, Goldstein P, et al. A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital. European Epinephrine Study Group. N Engl J Med. Nov 26 1998;339(22):1595-601. [Medline]. 70. Gussak I, Antzelevitch C, Bjerregaard P, et al. The Brugada syndrome: clinical, electrophysiologic and genetic aspects. J Am Coll Cardiol. Jan 1999;33(1):5-15. [Medline]. 71. Hallstrom A, Boutin P, Cobb L, Johnson E. Socioeconomic status and prediction of ventricular fibrillation survival. Am J Public Health. Feb 1993;83(2):245-8. [Medline]. 72. Hallstrom AP, Bigger JT Jr, Roden D, et al. Prognostic significance of ventricular premature depolarizations measured 1 year after myocardial infarction in patients with early postinfarction asymptomatic ventricular arrhythmia. J Am Coll Cardiol. Aug 1992;20(2):259-64. [Medline]. 73. Haverkamp W, Shenasa M, Borggrofe M, Breithardt G. Torsade de pointes. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 2nd ed. Philadelphia: WB Saunders Co; 1995:885. 74. Holmberg M, Holmberg S, Herlitz J. The problem of out-of-hospital cardiac-arrest prevalence of sudden7 of 11 9/3/2011 8:21 AM
  8. 8. Ventricular Fibrillation death in Europe today. Am J Cardiol. Mar 11 1999;83(5B):88D-90D. [Medline]. 75. Jaggarao NS, Heber M, Grainger R, et al. Use of an automated external defibrillator-pacemaker by ambulance staff. Lancet. Jul 10 1982;2(8289):73-5. [Medline]. 76. Kannel WB, Doyle JT, McNamara PM, et al. Precursors of sudden coronary death. Factors related to the incidence of sudden death. Circulation. Apr 1975;51(4):606-13. [Medline]. 77. Kerber RE, Becker LB, Bourland JD, et al. Automatic external defibrillators for public access defibrillation: recommendations for specifying and reporting arrhythmia analysis algorithm performance, incorporating new waveforms, and enhancing safety. Circulation. Mar 18 1997;95(6):1677-82. [Medline]. 78. Kim SG, Fisher JD, Choue CW, et al. Influence of left ventricular function on outcome of patients treated with implantable defibrillators. Circulation. Apr 1992;85(4):1304-10. [Medline]. 79. Klein GJ, Bashore TM, Sellers TD, et al. Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med. Nov 15 1979;301(20):1080-5. [Medline]. 80. Klein H, Auricchio A, Reek S, Geller C. New primary prevention trials of sudden cardiac death in patients with left ventricular dysfunction: SCD-HEFT and MADIT-II. Am J Cardiol. Mar 11 1999;83(5B):91D-97D. [Medline]. 81. Kligfield P, Hochreiter C, Kramer H. Complex arrhythmias in mitral regurgitation with and without mitral valve prolapse: contrast to arrhythmias in mitral valve prolapse without mitral regurgitation. Am J Cardiol. Jun 1 1985;55(13 Pt 1):1545-9. [Medline]. 82. Kron IL, Lerman BB, Haines DE, et al. Coronary artery bypass grafting in patients with ventricular fibrillation. Ann Thorac Surg. Jul 1989;48(1):85-9. [Medline]. 83. Larsen L, Markham J, Haffajee CI. Sudden death in idiopathic dilated cardiomyopathy: role of ventricular arrhythmias. Pacing Clin Electrophysiol. May 1993;16(5 Pt 1):1051-9. [Medline]. 84. Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR. Prehospital ventricular defibrillation. Prognosis and follow-up course. N Engl J Med. Aug 15 1974;291(7):317-21. [Medline]. 85. Lie KI, Liem KL, Schuilenburg RM, et al. Early identification of patients developing late in-hospital ventricular fibrillation after discharge from the coronary care unit. A 5 1/2 year retrospective and prospective study of 1,897 patients. Am J Cardiol. Apr 1978;41(4):674-7. [Medline]. 86. Maggioni AP, Zuanetti G, Franzosi MG, et al. Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results. Circulation. Feb 1993;87(2):312-22. [Medline]. 87. Manolio TA, Furberg CD. Epidemiology of sudden cardiac death. In: Akhtar M, Myerburg RJ, Ruskin JN, eds. Sudden Cardiac Death: Prevalence, Mechanisms, and Approaches to Diagnosis and Management. Malvern, Pa:. Lippincott Williams & Wilkins;1984:3. 88. Maron BJ, Epstein SE, Roberts WC. Causes of sudden death in competitive athletes. J Am Coll Cardiol. Jan 1986;7(1):204-14. [Medline]. 89. Maron BJ, Roberts WC, Epstein SE. Sudden death in hypertrophic cardiomyopathy: a profile of 78 patients. Circulation. Jun 1982;65(7):1388-94. [Medline]. 90. Masrani K, Cowley C, Bekheit S, el-Sherif N. Recurrent syncope for over a decade due to idiopathic ventricular fibrillation. Chest. Nov 1994;106(5):1601-3. [Medline]. 91. McCullough PA, Thompson RJ, Tobin KJ. Validation of a decision support tool for the evaluation of cardiac arrest victims. Clin Cardiol. Mar 1998;21(3):195-200. [Medline]. 92. Meinertz T, Hofmann T, Kasper W, et al. Significance of ventricular arrhythmias in idiopathic dilated cardiomyopathy. Am J Cardiol. Mar 15 1984;53(7):902-7. [Medline]. 93. MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. Jun 12 1999;353(9169):2001-7. [Medline]. 94. Messerli FH, Ventura HO, Elizardi DJ, et al. Hypertension and sudden death. Increased ventricular ectopic8 of 11 9/3/2011 8:21 AM
  9. 9. Ventricular Fibrillation activity in left ventricular hypertrophy. Am J Med. Jul 1984;77(1):18-22. [Medline]. 95. Morady F, DiCarlo L, Winston S, et al. Clinical features and prognosis of patients with out of hospital cardiac arrest and a normal electrophysiologic study. J Am Coll Cardiol. Jul 1984;4(1):39-44. [Medline]. 96. Moss AJ. MADIT-I and MADIT-II. J Cardiovasc Electrophysiol. Sep 2003;14(9 Suppl):S96-8. [Medline]. 97. Moss AJ,. MADIT-II: substudies and their implications. Card Electrophysiol Rev. Dec 2003;7(4):430-3. [Medline]. 98. Moss AJ, Brown MW, Cannom DS, Daubert JP, Estes M, Foster E. Multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT): design and clinical protocol. Ann Noninvasive Electrocardiol. Oct 2005;10(4 Suppl):34-43. [Medline]. 99. Multiple Risk Factor Intervention Trial Research Group. Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial. Am J Cardiol. Jan 1 1985;55(1):1-15. [Medline]. 100. Murphy JG, Gersh BJ, Mair DD, et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med. Aug 26 1993;329(9):593-9. [Medline]. 101. Myerburg RJ, Conde C, Sheps DS, et al. Antiarrhythmic drug therapy in survivors of prehospital cardiac arrest: comparison of effects on chronic ventricular arrhythmias and recurrent cardiac arrest. Circulation. May 1979;59(5):855-63. [Medline]. 102. Myerburg RJ, Conde CA, Sung RJ, et al. Clinical, electrophysiologic and hemodynamic profile of patients resuscitated from prehospital cardiac arrest. Am J Med. Apr 1980;68(4):568-76. [Medline]. 103. Myerburg RJ, Kessler KM, Kimura S. Life-threatening ventricular arrhythmias: the link between epidemiology and pathophysiology. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 3rd ed. Philadelphia: WB Saunders Co; 2000:521-590. 104. Myerburg RJ, Kessler KM, Kimura S, et al. Life-threatening ventricular arrhythmias: the link between epidemiology and pathophysiology. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 2nd ed. Philadelphia: WB Saunders Co; 1995:723. 105. Myerburg RJ, Kessler KM, Zaman L, et al. Factors leading to decreasing mortality among patients resuscitated from out-of-hospital cardiac arrest. In: Brugada P, Wellens HJ, eds. Cardiac Arrhythmias: Where to Go from Here?. Mt. Kisko, NY: Futura Publishing; 1987:505-525. 106. Myerburg RJ, Kessler KM, Zaman L, et al. Survivors of prehospital cardiac arrest. JAMA. Mar 12 1982;247(10):1485-90. [Medline]. 107. Myerburg RJ, Mitrani R, Interian A Jr, Castellanos A. Interpretation of outcomes of antiarrhythmic clinical trials: design features and population impact. Circulation. Apr 21 1998;97(15):1514-21. [Medline]. 108. Myerburg RJ, Mitrani R, Interian A Jr, Castellanos A. Identification of risk of cardiac arrest and sudden cardiac death in athletes. In: Estes NA, Salem DN, Wang PJ, eds. Sudden Cardiac Death in the Athlete. Armonk, NY: Futura Publishing; 1996:25. 109. Myerburg RJ, Zaman L. Indications for intracardiac electrophysiologic studies in survivors of prehospital cardiac arrest. Circulation. 1987;75:151. 110. Nalos PC, Ismail Y, Pappas JM, et al. Intravenous amiodarone for short-term treatment of refractory ventricular tachycardia or fibrillation. Am Heart J. Dec 1991;122(6):1629-32. [Medline]. 111. Nasir N Jr, Doyle TK, Wheeler SH, Pacifico A. Usefulness of Holter monitoring in predicting efficacy of amiodarone therapy for sustained ventricular tachycardia associated with coronary artery disease. Am J Cardiol. Mar 15 1994;73(8):554-8. [Medline]. 112. ORourke RA. Role of myocardial revascularization in sudden cardiac death. Circulation. Jan 1992;85(1 Suppl):I112-7. [Medline]. 113. Olgin, Jeffrey E; Zipes, Douglas P. Specific Arrhythmias: Diagnosis and Treatment. In: Zipes, Douglas P; Libby, Peter; Bonow, Robert O; Braunwald, Eugene. Heart Disease: A Textbook of Cardiovascular9 of 11 9/3/2011 8:21 AM
  10. 10. Ventricular Fibrillation Medicine. 7th. Philadelphia, PA: Elsevier Saunders; 2005:803-863. 114. Perry JC, Knilans TK, Marlow D, et al. Intravenous amiodarone for life-threatening tachyarrhythmias in children and young adults. J Am Coll Cardiol. Jul 1993;22(1):95-8. [Medline]. 115. Pogwizd SM. Focal mechanisms underlying ventricular tachycardia during prolonged ischemic cardiomyopathy. Circulation. Sep 1994;90(3):1441-58. [Medline]. 116. Primo J, Geelen P, Brugada J, et al. Hypertrophic cardiomyopathy: role of the implantable cardioverter- defibrillator. J Am Coll Cardiol. Apr 1998;31(5):1081-5. [Medline]. 117. Prystowsky EN, Nisam S. Prophylactic implantable cardioverter defibrillator trials: MUSTT, MADIT, and beyond. Multicenter Unsustained Tachycardia Trial. Multicenter Automatic Defibrillator Implantation Trial. Am J Cardiol. Dec 1 2000;86(11):1214-5, A5. [Medline]. 118. Rahimtoola SH. Valvular heart disease: a perspective. J Am Coll Cardiol. Jan 1983;1(1):199-215. [Medline]. 119. Roden DM, George AL Jr, Bennett PB. Recent advances in understanding the molecular mechanisms of the long QT syndrome. J Cardiovasc Electrophysiol. Nov 1995;6(11):1023-31. [Medline]. 120. Roelke M, Ruskin JN. Dilated cardiomyopathy: ventricular arrhythmias and sudden death. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 2nd ed. Philadelphia: WB Saunders Co; 1994:774-753. 121. Roy D, Waxman HL, Kienzle MG, et al. Clinical characteristics and long-term follow-up in 119 survivors of cardiac arrest: relation to inducibility at electrophysiologic testing. Am J Cardiol. Nov 1 1983;52(8):969-74. [Medline]. 122. Schatzkin A, Cupples LA, Heeren T, et al. Sudden death in the Framingham Heart Study. Differences in incidence and risk factors by sex and coronary disease status. Am J Epidemiol. Dec 1984;120(6):888-99. [Medline]. 123. Schatzkin A, Cupples LA, Heeren T, et al. The epidemiology of sudden unexpected death: risk factors for men and women in the Framingham Heart Study. Am Heart J. Jun 1984;107(6):1300-6. [Medline]. 124. Senges JC, Becker R, Schreiner KD, Bauer A, Weretka S, Siegler K. Variability of Holter electrocardiographic findings in patients fulfilling the noninvasive MADIT criteria. Multicenter Automatic Defibrillator Implantation Trial. Pacing Clin Electrophysiol. Feb 2002;25(2):183-90. [Medline]. 125. Sharma B, Asinger R, Francis GS, et al. Demonstration of exercise-induced painless myocardial ischemia in survivors of out-of-hospital ventricular fibrillation. Am J Cardiol. Apr 1 1987;59(8):740-5. [Medline]. 126. Sheps DS, Conde CA, Mayorga-Cortes A, et al. Primary ventricular fibrillation. Some unusual features. Chest. Aug 1977;72(2):235-8. [Medline]. 127. Singh B, al Shahwan SA, Habbab MA, et al. Idiopathic long QT syndrome: asking the right question. Lancet. Mar 20 1993;341(8847):741-2. [Medline]. 128. Stewart JT, McKenna WJ. Management of arrhythmias in hypertrophic cardiomyopathy. Cardiovasc Drugs Ther. Feb 1994;8(1):95-9. [Medline]. 129. Sueta CA, Clarke SW, Dunlap SH, et al. Effect of acute magnesium administration on the frequency of ventricular arrhythmia in patients with heart failure. Circulation. Feb 1994;89(2):660-6. [Medline]. 130. Surawicz B. Ventricular fibrillation. J Am Coll Cardiol. Jun 1985;5(6 Suppl):43B-54B. [Medline]. 131. Tanno K, Miyoshi F, Watanabe N, Minoura Y, Kawamura M, Ryu S. Are the MADIT II criteria for ICD implantation appropriate for Japanese patients?. Circ J. Jan 2005;69(1):19-22. [Medline]. 132. Teerlink JR, Jalaluddin M, Anderson S, et al. Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death. PROMISE (Prospective Randomized Milrinone Survival Evaluation) Investigators. Circulation. Jan 4-11 2000;101(1):40-6. [Medline]. 133. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular10 of 11 9/3/2011 8:21 AM
  11. 11. Ventricular Fibrillation arrhythmias. N Engl J Med. Nov 27 1997;337(22):1576-83. [Medline]. 134. Torp-Pedersen C, Kober L, Elming H, et al. Classification of sudden and arrhythmic death. Pacing Clin Electrophysiol. Oct 1997;20(10 Pt 2):2545-52. [Medline]. 135. Tung RT, Shen WK, Hammill SC, Gersh BJ. Idiopathic ventricular fibrillation in out-of-hospital cardiac arrest survivors. Pacing Clin Electrophysiol. Aug 1994;17(8):1405-12. [Medline]. 136. Turitto G, Ahuja RK, Caref EB, el-Sherif N. Risk stratification for arrhythmic events in patients with nonischemic dilated cardiomyopathy and nonsustained ventricular tachycardia: role of programmed ventricular stimulation and the signal-averaged electrocardiogram. J Am Coll Cardiol. Nov 15 1994;24(6):1523-8. [Medline]. 137. Vincent GM. Hypothesis for the molecular physiology of the Romano-Ward long QT syndrome. J Am Coll Cardiol. Aug 1992;20(2):500-3. [Medline]. 138. Vorobiof G, Goldenberg I, Moss AJ, Zareba W, McNitt S. Effectiveness of the implantable cardioverter defibrillator in blacks versus whites (from MADIT-II). Am J Cardiol. Nov 15 2006;98(10):1383-6. [Medline]. 139. Waller BF. Exercise-related sudden death in young (age 30 years) and old (age>30 years) conditioned subjects. In: Wengor NK, ed. Exercise and the Heart. Philadelphia:. FA Davis;1985:9-73. 140. Warnes CA, Roberts WC. Sudden coronary death: relation of amount and distribution of coronary narrowing at necropsy to previous symptoms of myocardial ischemia, left ventricular scarring and heart weight. Am J Cardiol. Jul 1 1984;54(1):65-73. [Medline]. 141. Wever EF, Hauer RN, Oomen A, et al. Unfavorable outcome in patients with primary electrical disease who survived an episode of ventricular fibrillation. Circulation. Sep 1993;88(3):1021-9. [Medline]. 142. White RD, Hankins DG, Bugliosi TF. Seven years experience with early defibrillation by police and paramedics in an emergency medical services system. Resuscitation. Dec 1998;39(3):145-51. [Medline]. 143. Wilson AC, Kostis JB. The prognostic significance of very low frequency ventricular ectopic activity in survivors of acute myocardial infarction. BHAT Study Group. Chest. Sep 1992;102(3):732-6. [Medline]. 144. Young D, Mark H. Fate of the patient with the Eisenmenger syndrome. Am J Cardiol. Dec 1971;28(6):658-69. [Medline]. 145. Zareba W, Moss AJ. Noninvasive risk stratification in postinfarction patients with severe left ventricular dysfunction and methodology of the MADIT II noninvasive electrocardiology substudy. J Electrocardiol. 2003;36 Suppl:101-8. [Medline]. 146. Zheutlin TA, Steinman RT, Mattioni TA, Kehoe RF. Long-term arrhythmic outcome in survivors of ventricular fibrillation with absence of inducible ventricular tachycardia. Am J Cardiol. Dec 1 1988;62(17):1213-7. [Medline]. 147. Zwanziger J, Hall WJ, Dick AW, Zhao H, Mushlin AI, Hahn RM. The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. J Am Coll Cardiol. Jun 6 2006;47(11):2310-8. [Medline].11 of 11 9/3/2011 8:21 AM