From the Guidelines
Ventricular standstill is a life-threatening cardiac emergency where the ventricles of the heart completely stop contracting, resulting in no cardiac output, and is characterized by the absence of electrical activity in the ventricles, leading to absence of QRS complexes on an electrocardiogram (ECG) while atrial activity (P waves) may continue 1. This condition requires immediate treatment, which includes cardiopulmonary resuscitation (CPR), administration of epinephrine, and consideration of pacing, as outlined in the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. Some key points to consider in the management of ventricular standstill include:
- The importance of high-quality CPR, with minimal pauses and a compression rate of at least 100 per minute 1
- The use of epinephrine (1 mg IV every 3-5 minutes) and atropine (1 mg IV) if bradycardia precedes the standstill 1
- The potential role of pacing, including transcutaneous and transvenous pacing, in the management of ventricular standstill 1
- The use of bedside ultrasonography to guide further resuscitative efforts and determine the presence of cardiac contractility 1 Common causes of ventricular standstill include severe heart block, myocardial infarction, electrolyte disturbances, drug toxicity, and end-stage heart disease. Without immediate intervention, ventricular standstill rapidly leads to death as the brain and other vital organs are deprived of blood flow. Patients who survive require permanent pacemaker implantation to prevent recurrence. It is essential to note that the prognosis for ventricular standstill is generally poor, with a high mortality rate, especially if true cardiac standstill is confirmed on bedside echocardiography 1.
From the Research
Definition of Ventricular Standstill
- Ventricular standstill is an electrophysiologic phenomenon characterized by the absence of ventricular activity or contraction 2.
- It is the result of the lack of impulse formation in ventricles (absence of idioventricular automaticity) or the failure of impulse transmission to ventricles (conduction disturbance) 2.
- Ventricular standstill is considered a ventricular fibrillation equivalent and is associated with a high mortality rate 3.
Causes and Treatment
- The condition can be caused by various factors, including profound vagal tone 4.
- There are no set guidelines on the treatment of ventricular standstill, and swift and sound clinical judgment is required 2.
- Treatment should be focused on resolving the precipitating factors and may involve the use of medications such as norepinephrine and lidocaine 5.
- In some cases, the use of extracorporeal cardiopulmonary resuscitation (E-CPR) may be effective in managing refractory ventricular fibrillation 6.
Prognosis and Outcomes
- The longer the duration of ventricular standstill, the poorer the prognosis 3.
- The overall survival rate for patients with ventricular standstill is generally low, but can be improved with aggressive treatment and the use of E-CPR 6.
- Patients who receive prompt and effective treatment may have a better chance of survival and recovery 2, 3, 6.