What is the treatment for Ventricular Fibrillation (V Fib)?

From the Guidelines

Ventricular fibrillation (V-fib) requires immediate defibrillation as the primary treatment, with CPR and defibrillation being the only therapies associated with improved survival, as noted in the 2018 American Heart Association guidelines update 1. The treatment approach involves delivering an unsynchronized shock as soon as possible, followed by immediate resumption of CPR for 2 minutes before reassessing the rhythm. Key points to consider in the management of V-fib include:

• Delivering an unsynchronized shock at 200 joules biphasic (or 360 joules monophasic) for witnessed V-fib
• Alternating shocks with 2-minute CPR cycles if V-fib persists
• Administering epinephrine 1 mg IV/IO every 3-5 minutes throughout resuscitation
• Considering either amiodarone or lidocaine for shock-refractory VF/pVT, with amiodarone 300 mg IV/IO bolus given after the second shock, and lidocaine 1-1.5 mg/kg IV/IO as an alternative if amiodarone is unavailable, as per the updated treatment recommendations in the 2018 ACLS guidelines focused update 1 The goal of treatment is to restore organized electrical activity, achieve return of spontaneous circulation, and identify and treat the underlying cause of V-fib, which may include acute coronary syndrome, electrolyte abnormalities, drug toxicity, or hypothermia. Post-resuscitation care should include targeted temperature management, hemodynamic support, and consideration for cardiac catheterization if indicated, with the aim of improving survival and neurological outcomes, as emphasized in the 2018 guidelines update 1.

From the FDA Drug Label

Amiodarone hydrochloride injection is indicated for initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation (VF) and hemodynamically unstable ventricular tachycardia (VT) in patients refractory to other therapy. The recommended starting dose is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: • Initial Load: 150 mg in 100 mL (in D 5W) infused over 10 minutes • Followed by: 1 mg/min for 6 hours • Followed by: 0.5 mg/min thereafter For breakthrough episodes of VF or hemodynamically unstable VT, repeat the Initial Load

The treatment for Ventricular Fibrillation (V Fib) is amiodarone (IV), with a recommended starting dose of about 1000 mg over the first 24 hours of therapy, delivered by a specific infusion regimen 2, 3.

• Initial Load: 150 mg in 100 mL (in D 5W) infused over 10 minutes
• Followed by: 1 mg/min for 6 hours
• Followed by: 0.5 mg/min thereafter For breakthrough episodes of VF, repeat the Initial Load 3.

From the Research

Treatment for Ventricular Fibrillation (V Fib)

The treatment for Ventricular Fibrillation (V Fib) involves several steps, including:

• Defibrillation: This is the most common treatment for V Fib, and it involves the use of a defibrillator to deliver an electric shock to the heart to restore a normal heartbeat 4, 5, 6.
• Medications: Medications such as amiodarone, lidocaine, and epinephrine may be used to help restore a normal heartbeat and prevent further episodes of V Fib 4, 7, 8.
• Cardiopulmonary resuscitation (CPR): CPR may be performed to help maintain blood circulation and oxygenation to the brain and other vital organs until the heart can be restored to a normal rhythm 7.
• Double sequence defibrillation: This is a technique that involves delivering two consecutive defibrillation shocks in rapid succession, and it may be used in cases where standard defibrillation is not effective 6.
• Double simultaneous defibrillators: This is a technique that involves using two defibrillators to deliver simultaneous shocks to the heart, and it may be used in cases where standard defibrillation is not effective 5.

Refractory Ventricular Fibrillation

Refractory Ventricular Fibrillation is a type of V Fib that is resistant to treatment, and it may require additional interventions, such as:

• High-energy defibrillation: This involves delivering higher-energy shocks to the heart in an attempt to restore a normal rhythm 5.
• Esmolol: This is a medication that may be used to help slow the heart rate and improve the effectiveness of defibrillation 8.
• Beta blockers: These medications may be used to help slow the heart rate and improve the effectiveness of defibrillation, especially in cases where ischemic heart disease is suspected as the cause of V Fib 4.
• Magnesium: This medication may be used to help improve the effectiveness of defibrillation, especially in cases where hypomagnesemia is suspected as the cause of V Fib 4.