Ventricular fibrillation is one of the most serious cardiac arrhythmias: let's find out about it

By Cristiano Antonino On May 4, 2023

When ventricular fibrillation occurs, the contraction movements of the ventricles become so rapid and irregular that the muscle cannot perform its function, with consequences that include cardiac compromise, cardiac arrest and death

In particular, during an episode of ventricular fibrillation, the heart muscle does not respect the different phases of the physiological cycle, shortening the systole and diastole (i.e. contraction and relaxation) times and reducing the output.

As a result, the influx of oxygenated blood changes and the organs do not receive enough of it.

The heart itself receives less oxygen and is no longer able to perform its activity properly

If not enough oxygen reaches the heart (anoxia), the muscle can stop working, leading to cardiovascular arrest: the heart stops and the blood no longer circulates.

Ventricular fibrillation turns out to be one of the most frequently fatal arrhythmias, because it quickly leads to cardiac arrest (estimates are around one death per thousand each year).

Men are at greater risk than women, and the age group most affected is between 50-70 years of age: in most cases, these are people who have already suffered from heart disease in the past.

Ventricular fibrillation, the symptoms

Ventricular fibrillation is a pathology that appears suddenly, most often without presenting any prodrome.

Although the list presented is not exhaustive, it is good to know the symptoms with which it manifests itself in order to recognise it at an early stage and go immediately to a doctor or emergency room.

The symptoms presented may also appear in other pathological conditions, as they are not specific, but further investigations should be carried out to avert the risk of potentially fatal medical conditions.

The symptoms should not be underestimated because ventricular fibrillation is a serious and often fatal condition if not detected and treated in time.

The symptoms, which appear suddenly, require very rapid treatment.

The increased heart rate due to ventricular fibrillation is usually associated with palpitations and chest pain or discomfort.

The individual also complains of fatigue and tiredness.

In the early stages of fibrillation, dyspnoea, i.e. difficulty breathing, may appear, with the individual, who, not being sufficiently oxygenated, most often appears pale or cyanotic.

It is also possible for blood pressure to drop so low that the patient enters a state of shock and loss of consciousness.

The heartbeat is no longer detectable on palpation of the peripheral pulses and the pupils are dilated.

If action is not taken in a timely manner, the condition leads to irreversible deterioration of body tissue, with the inability to restore vital functions.

Already within five minutes, brain damage and death can occur because the brain is no longer supplied with blood.

Within a short time, the rest of the organs also collapse.

Typical causes of ventricular fibrillation

Ventricular fibrillation is the subject of constant study in order to be able to identify all possible causes and enable medical personnel to take preventive action.

It has been noted that the primary cause is heart disease, which impairs cardiac activity and function and increases the risk of developing severe arrhythmias such as ventricular fibrillation.

Causes also include dysplasias and congenital malformations affecting the heart muscle and blood vessels, as well as the presence of certain syndromes that can impact heart function:

All conditions that cause hypoxia: heart disease and coronary artery disease, cardiac ischaemia.
Myocarditis and endocarditis.
Valvular dysfunction.
Drowning is one of the circumstances most frequently leading to ventricular fibrillation.
Electrolyte imbalances conditions that alter the concentration of certain body components such as hydrogen ions (pH), calcium, potassium, chlorine and magnesium. These substances, present in the right quantities, ensure the body functions properly, an alteration in them can predispose to cardiac arrhythmias.
Cardiac and thoracic trauma following accidents or invasive surgery.
Inhalation and ingestion of gases or toxic substances.
Electrical discharges.
Repeated intake of certain drugs, especially those that affect cardiac rhythm.
Intake of narcotics usually used to treat anxiety and depression or drugs such as cocaine. Ventricular fibrillation is often the effect of excessive use of stimulants.
Systemic diseases such as hyperthyroidism.
Blood pressure that is too low for a long time, which can degenerate into shock and loss of consciousness.
The presence of certain syndromes that can increase the risk of arrhythmias (long QT syndrome, Brugada syndrome).
There is also a type of ventricular fibrillation known as idiopathic, which affects healthy but predisposed individuals and for which the specific causes are unknown, making it even more difficult to carry out proper prevention

Ventricular fibrillation: the importance of early diagnosis

As already mentioned, ventricular fibrillation is a cardiac arrhythmia that appears, more often than not, suddenly and without showing the slightest warning signs.

This makes it impossible to diagnose the condition once it emerges, as any delay in intervention puts the subject at risk.

To reduce the risk of developing this sudden condition, it is advisable, once one is over 50 (or earlier, if there is cardiovascular disease in the family), to carry out an annual cardiological examination and, if necessary, a series of tests to assess the health of the cardiovascular system, in order to catch even the smallest cardiac abnormalities in their early stages.

Diagnostic tests usually performed as a preventive measure include an electrocardiogram, echocardiogram, chest X-ray and coronary angiography.

The electrocardiogram, or ECG, is a diagnostic test that assesses the heart’s electrical activity.

When ventricular fibrillation is present, the waves are rapid and irregular.

During the test, electrodes are placed in the upper chest to measure atrial activity, while others are placed lower down to measure ventricular activity.

The echocardiogram is a technique that evaluates the cardiac structure, investigating any alterations in the different components (atria, ventricles, valves).

Thanks to this test, abnormalities and malformations in them can be detected.

A chest X-ray can show any alterations in the heart and lungs.

This is very useful because some lung abnormalities may predispose to ventricular fibrillation.

Coronary angiography is a more invasive test than the previous ones: a catheter-probe is inserted directly into the vessels to study them and assess their state of health.

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As well as assessing the health of the vessels, the investigation also makes it possible to intervene to restore the patency of those vessels that are excessively obstructed.

Ventricular fibrillation: early treatment

The treatment of an episode of ventricular fibrillation is based on cardiopulmonary resuscitation manoeuvres and defibrillation, as well as the administration of certain drugs to stabilise the heart rhythm once the physiological rhythm is restored.

Cardiopulmonary resuscitation (CPR) is necessary to circulate blood within the cardiovascular system when the heart pump is stopped.

The blood thus reaches the lungs, brain and all other organs, which can resume proper function.

The procedure includes cardiac massage and mouth-to-mouth breathing.

Defibrillation is a procedure that involves the use of a special device called a defibrillator whose pads, once placed on the patient’s chest, are able to deliver an electric shock in order to restore heart rhythm.

A common defibrillator consists of two paddles to be positioned at the level of the left flank (at chest level) and below the right clavicle.

The new instruments (semi-automatic defibrillators) autonomously detect the heart rhythm and are able to determine whether an electric shock can help to restore the physiological rhythm.

During cardiopulmonary resuscitation manoeuvres, the doctor may decide to administer certain drugs to control arrhythmias.

These act on the heart rhythm and keep it in normal rhythm once the correct one has been restored.

The most popular drugs to date are lidocaine and amiodarone.

Since the risk of recurrence is high, in patients who have suffered ventricular fibrillation and survived, an attempt is made to act on the risk factors by treating possible triggers.

Subsequently, an artificial cardiac defibrillator is implanted through surgery.

The patient remains in hospital and under observation for a more or less long period, in order to have constant control of the heart rhythm and to verify his or her effective and stable recovery.

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