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Asystole (New Latin, from Greek privative a "not, without" + systolē "contraction" [1] [2]) is the absence of ventricular contractions in the context of a lethal heart arrhythmia (in contrast to an induced asystole on a cooled patient on a heart-lung machine and general anesthesia during surgery necessitating stopping the heart).
In medicine, an agonal heart rhythm is a variant of asystole. Agonal heart rhythm is usually ventricular in origin. Occasional P waves and QRS complexes can be seen on the electrocardiogram. The complexes tend to be wide and bizarre in morphological appearance. [1]
Flatlined ECG lead. A flatline is an electrical time sequence measurement that shows no activity and therefore, when represented, shows a flat line instead of a moving one. It almost always refers to either a flatlined electrocardiogram, where the heart shows no electrical activity [1] (), or to a flat electroencephalogram, in which the brain shows no electrical activity (brain death).
If these fail to respond to atropine or there is a potential risk of asystole, transvenous pacing is indicated. The risk factors for asystole include 1) previous asystole, 2) complete heart block with wide complexes, and 3) ventricular pause for > 3 seconds. Mobitz Type 2 AV block is another indication for pacing.
On ECG, the PR interval is unchanged from beat to beat, but there is a sudden failure to conduct the signal to the ventricles, and resulting in random skipped beat. [4] The risks and possible effects of Mobitz II are much more severe than Mobitz I in that the risk of progression to complete heart block or asystole are significant. [5] [6]
Pulseless electrical activity (PEA) is a form of cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse, but does not.Pulseless electrical activity is found initially in about 20% of out-of-hospital cardiac arrests [1] and about 50% of in-hospital cardiac arrests.
Sudden cardiac death is the cause of about half of deaths due to cardiovascular disease and about 15% of all deaths globally. [12] About 80% of sudden cardiac death is the result of ventricular arrhythmias. [12] Arrhythmias may occur at any age but are more common among older people. [4]
In contrast, asystole is desired and induced during cardiopulmonary bypass through a cardioplegia solution containing very high amounts of potassium. One additional example is the use of high potassium in lethal injection that results in asystole, cardiac arrest, and then death.