How to Document Cause of Death in Ventricular Tachycardia Followed by Seizure
The primary cause of death should be listed as ventricular tachycardia (or ventricular fibrillation if documented), with the seizure documented as a secondary or contributing event, since the cardiac arrhythmia represents the terminal mechanism of circulatory arrest. 1
Understanding the Clinical Sequence
The critical distinction here is identifying which event was the primary lethal mechanism versus which was a secondary manifestation:
When VT Causes Seizure (Most Common Scenario)
- Ventricular tachycardia causing hemodynamic collapse leads to cerebral hypoperfusion, which can manifest as seizure-like activity (convulsive syncope). 1
- In this sequence, the seizure is a consequence of the cardiac arrest, not the cause of death. 1
- Death certificate should list:
- Immediate cause: Cardiac arrest due to ventricular tachycardia/ventricular fibrillation
- Underlying cause: The structural heart disease or condition predisposing to VT (e.g., ischemic heart disease, cardiomyopathy, channelopathy) 1
When Seizure Triggers Fatal Arrhythmia (Less Common)
- Seizures, particularly generalized tonic-clonic seizures, can rarely trigger fatal ventricular arrhythmias through excessive catecholamine release and sympathetic activation. 2, 3
- Ventricular fibrillation occurring after convulsive seizures has been documented in near-SUDEP (Sudden Unexpected Death in Epilepsy) cases. 4
- However, even in these cases, the terminal mechanism of death is still the cardiac arrhythmia (ventricular fibrillation/tachycardia), not the seizure itself. 4, 5
Proper Death Certificate Documentation
Primary Cause of Death Line
List "Cardiac arrest due to ventricular tachycardia" or "Ventricular fibrillation" as the immediate cause. 1
Underlying Causes (Part I)
Document the chain of events leading to the terminal arrhythmia:
- Line (a): Ventricular tachycardia/fibrillation
- Line (b): The underlying cardiac condition (e.g., "Ischemic cardiomyopathy," "Acute myocardial infarction," "Hypertrophic cardiomyopathy," "Long QT syndrome") 1, 6
Contributing Conditions (Part II)
- If the seizure preceded and potentially triggered the arrhythmia, list "Epilepsy" or "Seizure disorder" as a contributing condition in Part II. 4, 2
- This acknowledges the seizure's role without incorrectly identifying it as the primary cause of death. 5
Critical Pitfalls to Avoid
Do Not List Seizure as Primary Cause
- Even if a seizure was witnessed first, the actual mechanism of death in cardiac arrest is the cessation of effective circulation, which occurs due to the ventricular arrhythmia, not the seizure. 1
- Seizures themselves do not directly cause death unless associated with status epilepticus, aspiration, or trauma—none of which apply when VT/VF is documented. 2
Distinguish from SUDEP
- In documented SUDEP cases, the typical fatal cascade involves primary central apnea after a tonic-clonic seizure, followed secondarily by bradyarrhythmia and terminal asystole—not ventricular tachycardia. 2
- If VT/VF was the documented rhythm, this is not SUDEP but rather sudden cardiac death that may have been seizure-triggered. 4, 5
Document What Was Actually Observed
- If ventricular fibrillation was the documented rhythm on monitor or defibrillator, list "ventricular fibrillation" specifically rather than the more general "ventricular tachycardia." 1
- If the specific arrhythmia was not documented but cardiac arrest occurred, "cardiac arrest" with the underlying cardiac condition is appropriate. 1
Example Documentation Scenarios
Scenario 1: Patient with known cardiomyopathy has VT → loses consciousness with convulsive movements → progresses to VF
- Immediate cause: Ventricular fibrillation
- Due to: Ventricular tachycardia
- Due to: Dilated cardiomyopathy
- Contributing: None (the convulsive movements were convulsive syncope from cerebral hypoperfusion)
Scenario 2: Epileptic patient has witnessed tonic-clonic seizure → develops VT documented on monitor → cardiac arrest