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Definition and EtiologyTop
Idiopathic ventricular fibrillation (IVF) is a life-threatening arrhythmia that occurs in individuals without an identified structural heart disease, genetic arrhythmic disorder, or other obvious cause (eg, drug overdose). IVF is responsible for ~5% of cases of cardiac arrest. It is usually associated with closely coupled premature ventricular complexes (a premature ventricular contraction [PVC] that is close to the prior QRS).
Exclude structural heart disease on the basis of history (including family history), physical examination, laboratory studies, electrocardiography, and echocardiography. Cardiac magnetic resonance imaging may be a useful tool to rule out subtle structural disease. Ischemic cardiomyopathy should be excluded taking into consideration the clinical presentation and risk factors (consider exercise testing, coronary computed tomography scan, and cardiac catheterization with coronary angiography). Exclude the administration of drugs causing long-QT syndrome, electrolyte disturbances, alcohol, and drugs of abuse. Electrophysiologic study is of no prognostic value and is not routinely recommended. If closely coupled PVCs are documented, sometimes ablation is attempted, but insertion of an implantable cardioverter-defibrillator (ICD) would be still recommended.
Placement of an ICD is recommended in all survivors.