Paramedics respond to a fitness center for a 58 year-old male with dispatch complaint of seizure. On their arrival the patient is awake and alert although slightly confused. Staff at the fitness center claim to have performed CPR and applied the AED which delivered one shock. Patient complains of chest pain at the site where compressions were performed.

Vital signs:  BP: 146/86, HR: 96, RR: 24, SpO2: 96% on room air

The patient loses consciousness as a 12-lead ECG is being performed.  The ECG is shown below.

 

What is your interpretation of this ECG? 

Rate:         Zero

Rhythm:     Ventricular Fibrillation (VFib); Likely Torsades de Pointe (left) degenerating into VFib (right)

 

Note from the author:

This ECG is more than a decade old. A 12-lead ECG is performed over six seconds. We all now know that we wouldn’t be watching Torsades or VFib on an ECG in the field — for an unstable patient with Torsades or for VFib we would either charge and defibrillate, or initiate compressions while charging the defibrillator, before we got to the end of the six seconds. Either of those actions would disrupt the quality of the ECG. It’s likely that this was initially Torsades de Pointes (on the left) that degenerated into VFib (on the right). Either way, from a historical context, it’s interesting to see what VFib and/or Torsades looks like on a 12-lead ECG.