Ventricular Standstill



Ventricular standstill is an uncommon yet potentially fatal arrhythmia, which requires urgent
recognition and treatment. As the name suggests, the ventricles come to a standstill with an
almost immediate cessation of cardiac output. The SA node continues to conduct without any
ventricular response due to an advanced complete heart block. If this sustains for more than
a few seconds the patient will lose consciousness and no pulse will be palpable. Sustained
ventricular standstill is a non-shockable rhythm, and is considered 10 times more deadly than
a patient in V-Fib. With this emergent rhythm, treatment includes immediate initiation of
cardiopulmonary resuscitation, and if the return of circulation is achieved, pacemaker insertion
is usually required.


Paroxysmal Ventricular standstill; This strip shows SR with a beat of 2nd degree type II,
going into a long pause (paroxysmal run of ventricular standstill), then going to JR.

    Causes:
  • hypoxia
  • non-cardiac: acidosis, hypokalemia, hyperkalemia, hypothermia, massive pulmonary embolism
  • cardiac diseases: post-advanced (high degree) atrioventricular heart block and failed treatment attempts
  • certain drugs: cocaine overdose
    Treatment:
  • CPR
  • identify and treat the cause
  • epinephrine


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