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Ventricular fibrillation

(VFib)

Overview

Ventricular fibrillation is a type of irregular heart rhythm (arrhythmia). In a typical heart rhythm, electrical signals travel from the heart's upper chambers (atria) to the heart's lower chambers (ventricles), causing the ventricles to contract and pump blood. In ventricular fibrillation, rapid, irregular electrical signals cause the ventricles to quiver uselessly instead of pumping blood.

Ventricular fibrillation is an emergency that requires immediate medical attention. It's the most frequent cause of sudden cardiac death.

Emergency treatment for ventricular fibrillation includes cardiopulmonary resuscitation (CPR) and shocks to the heart with a device called an automated external defibrillator (AED). Medications, implanted devices or surgery may be recommended to prevent episodes of ventricular fibrillation.

Ventricular fibrillation may also be called VFib, V-fib or VF.

Types of Vfib?

Coarse ventricular fibrillation

Ventricular fibrillation can be divided into two types based on the way it appears on an imaging test called an electrocardiogram (ECG or EKG). An EKG reading depicts your heart's electrical activity as high and low points (peaks and valleys). With coarse VFib, the peaks go higher and the valleys go lower.

Fine ventricular fibrillation

With fine ventricular fibrillation, there's not as much difference between the peaks and valleys on your EKG reading. While both types are very serious, this is considered the most dangerous form.

Symptoms

Collapse and loss of consciousness are the most common symptoms of ventricular fibrillation.

Before a ventricular fibrillation episode, you may have symptoms of an irregularly fast or erratic heartbeat (arrhythmia). You may have:

Chest pain (angina)

Very fast heartbeat (tachycardia)

Heart palpitations (where you become unpleasantly aware of your own heartbeat)

Dizziness or lightheadedness

Nausea

Shortness of breath

Racing or erratic pulse (including other types of arrhythmia)

When you lose consciousness because of VFib, you don't respond when someone touches or speaks to you. You also have serious problems breathing (gasping for air or not breathing at all).

Ventricular fibrillation vs. ventricular tachycardia

Both are very serous types of arrhythmia. With ventricular tachycardia or V-tach, your heart beats quickly but isn't as irregular as it is with VFib. V-tach can lead to ventricular fibrillation.

What is ventricular flutter?

Ventricular flutter is an extreme type of ventricular tachycardia in which your heart beats 150-300 times a minute. If not treated, it usually becomes ventricular fibrillation.

Ventricular fibrillation vs. atrial fibrillation

Atrial fibrillation, or AFib, affects the upper chambers of the heart (atria) rather than the lower ones. It causes a very fast heartbeat. Blood can pool in your atria and make them stretch out, but it can still circulate to the rest of your body. Atrial fibrillation isn't considered a medical emergency, but it raises your risk for blood clots and stroke.

When to see a doctor

Make an appointment with a heart doctor (cardiologist) if you have an unexplained fast or pounding heartbeat.

If you see someone collapse, seek emergency medical help immediately. Follow these steps:

Call 911 or your local emergency number.

If the person is unconscious, check for a pulse.

If no pulse, begin cardiopulmonary resuscitation (CPR) to help keep blood flowing through the body until an automated external defibrillator (AED) is available. The American Heart Association recommends hands-only CPR. Push hard and fast on the person's chest — about 100 to 120 times a minute. It's not necessary to check the person's airway or deliver rescue breaths. Continue until emergency medical help arrives.

Use an automated external defibrillator (AED) as soon as it's available. Deliver a shock following the prompts on the device.

Ventricular Fibrillation Causes and Risk Factors

Causes

You get VFib because there's a problem with your heart's electrical properties or with the blood supply to your heart muscle.

Doctors don’t always know what causes this. But they do know some conditions and situations are linked to ventricular fibrillation. For instance, it happens most often during or right after a heart attack. That may be because your heart’s electrical signals become unstable when there's not enough blood flow.

Ventricular fibrillation is caused by either:

A problem in the heart's electrical properties

A disruption of the blood supply to the heart muscle

Ventricular fibrillation

In a typical heart rhythm, electrical signals travel from the heart's upper chambers (atria) to the heart's lower chambers (ventricles), causing the ventricles to contract and pump blood. In ventricular fibrillation, rapid, irregular electrical signals cause the ventricles to quiver uselessly instead of pumping blood.
Sometimes, the cause of ventricular fibrillation is unknown.

To understand more about how ventricular fibrillation occurs, it may be helpful to know how the heart typically beats.
The heartbeat

The typical heart has four chambers — two upper chambers (atria) and two lower chambers (ventricles). Within the upper right chamber of the heart (right atrium) is a group of cells called the sinus node. The sinus node is the heart's natural pacemaker. It produces the signals that start each heartbeat.

These electrical signals move across the atria, causing the heart muscles to squeeze (contract) and pump blood into the ventricles.

Next, the signals arrive at a cluster of cells called the atrioventricular (AV) node, where they slow down. This slight delay allows the ventricles to fill with blood. When the signals reach the ventricles, the lower heart chambers contract and pump blood to the lungs or to the rest of the body.

In a typical heart, this heart signaling process usually goes smoothly, resulting in a typical resting heart rate of 60 to 100 beats a minute. But in ventricular fibrillation, rapid, irregular electrical signals cause the lower heart chambers to quiver uselessly instead of pumping blood.

Risk factors

Often, people who get ventricular fibrillation don't have heart disease. But they may have conditions that put them at risk for heart disease, like high blood pressure or diabetes. Other things that raise your chances of VFib include:

Weakened heart muscle (cardiomyopathy)

A previous episode of ventricular fibrillation

Other arrhythmias (abnormal electrical rhythms) or arrhythmia-causing conditions

Hypoxemia (low oxygen in your blood)

A previous heart attack

Acidosis (too much acid in your body)

Certain genetic diseases (present at birth) heart issues like Brugada syndrome

Certain heart medicines

An imbalance of electrolytes in your blood (too much or too little potassium or magnesium in your blood)

Very low blood pressure (shock)

Electrical shock

Drowning

Problems with your main artery (aorta)

Drug misuse, especially with cocaine or methamphetamine

Serious system-wide infection (sepsis)

Commotio cordis (the result of getting hit in the chest with a small, fast-moving object like a baseball or hockey puck)

Complications

If you don't get treatment for ventricular fibrillation right away, it can be fatal in a matter of minutes. When your heart can't pump blood, a condition called cardiac arrest, your blood pressure falls very quickly.

The longer your body is deprived of blood, the higher the chances that you'll end up with serious damage to your kidneys, liver, and nervous system. Depending on how serious this damage is, it may be reversible or permanent. You may go into a coma.

Once you recover from VFib, you may have more episodes in which you pass out or almost pass out. One episode of ventricular fibrillation increases the risk that you'll have another one.

Complications of ventricular fibrillation rhythm include:

Sudden cardiac arrest and death.

Coma.

Brain damage.

Heart muscle damage.

Kidney failure.

Liver failure.

Diagnosis

Ventricular fibrillation is always diagnosed in an emergency situation. If sudden cardiac death has occurred, a pulse check will reveal no pulse.

Tests to diagnose and determine the cause of ventricular fibrillation include:

Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results. An electrocardiogram (ECG) can show if the heart is beating too fast or too slowly. If you're having an episode of ventricular fibrillation, the ECG usually shows a heartbeat of about 300 to 400 beats a minute.

Blood tests. Blood tests can be done to check for proteins (enzymes) that leak into the bloodstream when the heart is damaged by a heart attack.

Chest X-ray. This imaging test lets your doctor see the shape and size of your heart. It can also show them what your heart's blood vessels look like.

Echocardiogram. This noninvasive test uses sound waves to create images of the heart in motion. It can show the heart's size and structure.

Coronary catheterization (angiogram). This test helps health care providers see blockages in the heart arteries. A long, thin flexible tube (catheter) is inserted in a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.

Cardiac computerized tomography (CT). A computed tomography (CT) scan uses X-rays to create cross-sectional images of specific parts of your body.

Cardiac magnetic resonance imaging (MRI). This test uses a magnetic field and computer-generated radio waves to create detailed images of blood flow in the heart.

Treatment

Ventricular fibrillation requires emergency medical treatment to prevent sudden cardiac death. The goal of emergency treatment is to restore blood flow as quickly as possible to prevent organ and brain damage.

Emergency treatment for ventricular fibrillation includes:

Cardiopulmonary resuscitation (CPR). cardiopulmonary resuscitation (CPR) mimics the pumping motion of the heart. It keeps blood flowing through the body.

Stay calm and call 911 or your local emergency number.

Begin CPR: Chest compressions are an essential, lifesaving step, especially until someone finds and uses an automated external defibrillator (AED) or until first responders arrive (whichever happens first).

Use an AED: Ventricular fibrillation is one of the “shockable” arrhythmias, meaning an AED can help return your heart’s rhythm to a normal one. When someone uses an AED in the first three minutes after a person collapses because of v-fib, the survival rate of ventricular fibrillation can be as high as 95%

Defibrillation. This treatment is also called cardioversion. An automated external defibrillator (AED) delivers shocks through the chest wall to the heart. It can help restore a regular heart rhythm. As soon as an automated external defibrillator (AED) is available, apply it and follow the prompts. If you're not trained to use an AED, a 911 operator or another emergency medical operator may be able to give you instructions. Public-use automated external defibrillators (AEDs) are programmed to recognize ventricular fibrillation and send a shock only when needed.

Other treatments for ventricular fibrillation are given to prevent future episodes and reduce the risk of arrhythmia-related symptoms. Treatment for ventricular fibrillation includes medications, medical devices and surgery.
Medications

Drugs to control the heart rhythm (anti-arrhythmics) are used for emergency or long-term treatment of ventricular fibrillation. If you're at risk of ventricular fibrillation or sudden cardiac death, your provider may prescribe medications to slow and control your heartbeat.
Surgery or other procedures

Surgery or medical procedures to treat ventricular fibrillation include:

Implantable cardioverter-defibrillator (ICD). An implantable cardioverter-defibrillator (ICD) is a battery-powered unit that's implanted under the skin near the collarbone — similar to a pacemaker. The ICD continuously monitors the heart rhythm. If the device detects an episode of ventricular fibrillation, it sends shocks to stop it and reset the heart's rhythm, you may experience pain or shock.

Cardiac ablation. This procedure uses heat or cold energy to create tiny scars in the heart to block the irregular heart signals that cause ventricular fibrillation. It's most often done using thin, flexible tubes called catheters inserted through the veins or arteries. It may also be done during heart surgery.

Coronary angioplasty and stent placement. If ventricular fibrillation is caused by a heart attack, this procedure may reduce the risk of future episodes of ventricular fibrillation.

The health care provider inserts a long, thin tube (catheter) through an artery, usually in the groin, to a blocked artery in the heart. A balloon on the tip of the catheter briefly inflates to widen the artery. This restores blood flow to the heart. A metal mesh stent may be placed into the artery to help it stay open.

Coronary bypass surgery. This open-heart surgery redirects blood around a section of a blocked or partially blocked artery in the heart. It may be done if ventricular fibrillation is caused by coronary artery disease. During bypass surgery, the surgeon takes a healthy blood vessel from the leg, arm or chest. It's connected below and above the blocked artery or arteries in the heart. This creates a new pathway for blood flow.

Prevention & Self care

Can ventricular fibrillation be prevented?

Most cases of v-fib start out as another type of ventricular arrhythmia. If you show symptoms of an abnormal heart rhythm in your lower heart chambers, a provider can monitor your rhythms. Finding these issues early can help prevent you from developing ventricular fibrillation.

If someone in your family has a type of arrhythmia that families can pass down to each other, ask about genetic testing. Testing people who may be at risk can help them take steps to prevent dangerous heart rhythms.

Since heart attacks are the top cause of ventricular fibrillation, preventing a heart attack can prevent v-fib, as well.

Lifestyle changes that help keep the heart as healthy as possible include the following:

Eat a heart-healthy diet. Heart-healthy foods include fruits, vegetables and whole grains, as well as lean protein sources such as soy, beans, nuts, fish, skinless poultry and low-fat dairy products. Avoid added salt (sodium), added sugars and saturated fats.

Exercise. Physical activity helps you achieve and maintain a healthy weight. Regular exercise helps control diabetes, high cholesterol and high blood pressure — all risk factors for heart disease. With your provider's OK, aim for 30 to 60 minutes of physical activity most days of the week. Talk to your health care provider about the amount and type of exercise that's best for you.

Manage weight. Being overweight increases the risk of heart disease. Talk with your care provider to set realistic goals for body mass index (BMI) and weight.

Don't smoke. Smoking is a major risk factor for heart disease, especially atherosclerosis. Quitting is the best way to reduce the risk of heart disease and its complications. If you need help quitting, talk to your provider.

Manage blood pressure and cholesterol. Get regular health checkups to monitor blood pressure and cholesterol. Take medications as prescribed to manage high blood pressure or high cholesterol.

Limit alcohol. Too much alcohol can damage the heart. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.

Get regular checkups. Take your medications as prescribed. Have regular follow-up appointments with your health care provider. Tell your provider if your symptoms worsen.

Practice good sleep habits. Poor sleep may increase the risk of heart disease and other chronic conditions. Adults should aim to get 7 to 9 hours of sleep daily. Kids often need more. Go to bed and wake at the same time every day, including on weekends. If you have trouble sleeping, talk to your provider about strategies that might help.

Prognosis

What can I expect if I have ventricular fibrillation?

Your outlook with ventricular fibrillation depends on how quickly someone helps you. With quick treatment, up to 50% of people can survive. Without immediate treatment, a ventricular fibrillation rhythm is fatal. For each minute you wait for defibrillation, your chance of survival drops by 7% to 10%.

Defibrillation only works on 30% of people who have heart failure. Heart failure is often fatal, even for those who have a successful defibrillation.

Coping and support

Some irregular heart rhythms (arrhythmias) can be triggered by emotional stress. Taking steps to ease stress and anxiety can help keep the heart healthy. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to reduce and manage stress. If you have anxiety or depression, talk to your provider about strategies to help.

Some types of complementary and alternative therapies may help reduce stress, such as:

Yoga

Meditation

Relaxation or mindfulness techniques

Getting support from loved ones may also be helpful.

VFib FAQs

How long can you live with ventricular fibrillation?

VFib is fatal within about 3-5 minutes unless someone resuscitates you.

What happens when you have ventricular fibrillation?

When you have VFib, the electrical signals in your heart go haywire. The lower chambers of your heart (ventricles) quiver instead of pumping like they should. This keeps blood from being pumped out to the rest of your body.

What is the range of heart rate for ventricular fibrillation?

When you have ventricular fibrillation, the lower chambers of your heart beat over 300 times a minute.

What is the mortality rate for ventricular fibrillation?

With quick and effective treatment, up to 50% of those with ventricular fibrillation survive. If you have VFib when you're not in a hospital, the odds that it can be reversed go down by 5% to 10% for each minute you wait for defibrillation.

Takeaways

You may find it hard to talk about ventricular fibrillation and sudden cardiac arrest, especially if you continue to have health issues from them. Your healthcare provider can give you guidance that can help you better understand your situation. Don’t be afraid to ask questions or ask for help as you focus on living your best life.

Ventricular fibrillation is a fast, irregular heart rhythm that keeps your heart from pumping blood out to your body. It's the most common cause of sudden cardiac death. If someone you're with has symptoms of VFib, call 911 right away, start CPR, and use a defibrillator if one is available.

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