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Ventricular fibrillation most commonly occurs within diseased hearts, and, in the vast majority of cases, is a manifestation of underlying ischemic heart disease. Ventricular fibrillation is also seen in those with cardiomyopathy, myocarditis, and other heart pathologies.
Cardiac cells have two refractory periods, the first from the beginning of phase 0 until part way through phase 3; this is known as the absolute refractory period during which it is impossible for the cell to produce another action potential. This is immediately followed, until the end of phase 3, by a relative refractory period, during which a ...
This period of time is referred to as the refractory period, which is 250ms in duration and helps to protect the heart. In the classical sense, the cardiac refractory period is separated into an absolute refractory period and a relative refractory period. During the absolute refractory period, a new action potential cannot be elicited.
Right after the ventricles contract, the cells enter into a refractory period, where they can’t be stimulated to contract again, and during the upslope of the T wave, some cells are starting to come out of refractory, so those cells might be ready to go again, whereas other cells might still be in a refractory phase.
Timing the shock to the R wave prevents the delivery of the shock during the vulnerable period (or relative refractory period) of the cardiac cycle, which could induce ventricular fibrillation. If the patient is conscious, various drugs are often used to help sedate the patient and make the procedure more tolerable.
Ibutilide is a Class III antiarrhythmic agent that is indicated for acute cardioconversion of atrial fibrillation and atrial flutter of a recent onset to sinus rhythm. It exerts its antiarrhythmic effect by induction of slow inward sodium current, which prolongs action potential and refractory period of myocardial cells.
The drug was used in emergency medicine, cardiology, and other specialties throughout the 1980s-1990s for the acute management of ventricular tachycardia and ventricular fibrillation refractory to other first line treatments such as defibrillation or lidocaine.
There are two major classes of cardiac fibrillation: atrial fibrillation and ventricular fibrillation. Atrial fibrillation is an irregular and uncoordinated contraction of the cardiac muscle of atria. It can be a chronic condition, usually treated with anticoagulation and sometimes with conversion to normal sinus rhythm.