01/07/2026
๐ฃ๐๐๐๐๐ง๐ฅ๐๐ ๐ฉ-๐ง๐๐๐ ๐๐ก๐ ๐ฉ-๐๐๐ ๐๐ซ
๐ช๐๐ฌ ๐ฌ๐ข๐จ ๐ฅ๐๐ฅ๐๐๐ฌ ๐ฆ๐๐ ๐ง๐๐๐ , ๐๐ก๐ ๐ช๐๐ฌ โ๐๐ง ๐๐ข๐ข๐๐ฆ ๐๐๐๐ ๐ฉ-๐๐๐โ ๐จ๐ฆ๐จ๐๐๐๐ฌ ๐ ๐๐๐ก๐ฆ ๐๐ง ๐๐ฆ ๐ก๐ข๐ง โ ๏ธ
You see a wide or chaotic rhythm on a pediatric monitor. Someone says โThatโs V-fibโ or โThatโs V-tach.โ
Pause. Look again. In kids, that call deserves a higher bar.
๐ฆ๐๐ ๐ฃ๐๐ ๐ง๐๐๐๐๐ช๐๐ฌ ๐๐๐ฅ๐ฆ๐ง ๐ถ
โข Ventricular tachycardia is uncommon in children
โข Ventricular fibrillation is even less common
โข Most pediatric arrests are hypoxic or metabolic
โข Ugly rhythms in kids are often organized if you slow down and look
If you shock every scary pediatric rhythm, you will shock a lot of hearts that still have perfusion.
๐ช๐๐ฌ ๐ฉ-๐ง๐๐๐ ๐๐ฆ ๐ฅ๐๐ฅ๐ ๐๐ก ๐ฃ๐๐๐๐๐ง๐ฅ๐๐๐ฆ ๐ง
Simple version.
โข Kids lack ischemic scar
โข They rarely have chronic ventricular disease
โข Their myocardium conducts more uniformly
โข Arrest usually starts with hypoxia, not coronary occlusion
Detailed version.
Sustained ventricular tachycardia requires scar, fibrosis, or an abnormal ventricular substrate that supports re-entry or automaticity. Adults accumulate this over decades. Most children do not. Large registry data show fewer than 10 percent of pediatric cardiac arrests present with shockable rhythms. Bradycardia, PEA, and asystole dominate because hypoxia and acidosis drive the arrest physiology.
๐ช๐๐ฌ ๐๐ง ๐๐ข๐ข๐๐ฆ ๐๐๐๐ ๐ฉ-๐๐๐ ๐ช๐๐๐ก ๐๐ง ๐๐ฆ ๐ก๐ข๐ง ๐
Simple version.
โข SVT with aberrancy looks wide and ugly
โข Fast sinus tachycardia plus artifact looks chaotic
โข CPR and motion exaggerate noise
โข Poor lead contact lies to you
Detailed version.
Pediatric heart rates are high. SVT at 220 with bundle branch aberrancy can look indistinguishable from VT at a glance. Add motion, CPR artifact, shivering, or loose electrodes and the tracing can resemble ventricular fibrillation. True VF has no organization. If you can find a pattern, it is not VF.
๐๐ข๐ช ๐ง๐ข ๐๐ข๐ข๐ ๐๐ข๐ฅ ๐ข๐ฅ๐๐๐ก๐๐ญ๐๐ ๐๐๐ง๐๐ฉ๐๐ง๐ฌ ๐
Quick checklist you can run in seconds.
โข Is there a repeating pattern
โข Do complexes look similar beat to beat
โข Can you identify a rate
โข Does the rhythm change with oxygen or ventilation
โข Does motion make it worse
If you can predict the next deflection, you are not looking at VF.
Practical steps.
โข Check two leads
โข Press the electrodes and stabilize cables
โข Look at pleth, arterial line, or ETCOโ if present
โข Briefly pause motion when safe
๐ช๐๐๐ง ๐ฌ๐ข๐จ ๐ก๐๐๐ ๐ง๐ข ๐๐๐๐ ๐ฉ-๐๐๐ โก
โข Completely disorganized electrical activity
โข No identifiable QRS complexes
โข No repeating morphology
โข No pulse or perfusion
If any organized electrical activity exists, it does not meet criteria for VF.
๐ช๐๐๐ง ๐ฌ๐ข๐จ ๐ก๐๐๐ ๐ง๐ข ๐๐๐๐ ๐ฉ-๐ง๐๐๐ โ ๏ธ
โข Wide complex rhythm
โข Consistent ventricular morphology
โข Rate usually over 120 to 150 in children
โข AV dissociation, capture beats, or fusion beats if visible
โข Often associated with poor perfusion
Wide and fast does not automatically mean VT. In pediatrics, assume supraventricular until proven otherwise.
๐ช๐ข๐จ๐๐ ๐ ๐ญ๐ฎ-๐๐๐๐ ๐๐๐๐ฃ ๐
Short answer. Yes, when the child is perfusing.
A 12-lead can:
โข Show organized ventricular activation
โข Help separate VT from SVT with aberrancy
โข Reveal long QT, Brugada pattern, or myocarditis clues
โข Guide receiving team decisions
It should never delay airway, oxygenation, or defibrillation in confirmed pulseless VF or VT.
๐ง๐๐ ๐๐๐ช ๐๐ข๐ก๐๐๐ง๐๐ข๐ก๐ฆ ๐ง๐๐๐ง ๐ง๐ฅ๐จ๐๐ฌ ๐๐๐จ๐ฆ๐ ๐ฃ๐๐๐๐๐ง๐ฅ๐๐ ๐ฉ-๐ง๐๐๐ ๐งฌ
๐๐ผ๐ป๐ด๐ฒ๐ป๐ถ๐๐ฎ๐น ๐ต๐ฒ๐ฎ๐ฟ๐ ๐ฑ๐ถ๐๐ฒ๐ฎ๐๐ฒ
โข Surgical scars create re-entry circuits
๐ ๐๐ผ๐ฐ๐ฎ๐ฟ๐ฑ๐ถ๐๐ถ๐
โข Inflamed myocardium becomes electrically unstable
โข Tachycardia out of proportion to fever is a clue
๐๐ต๐ฎ๐ป๐ป๐ฒ๐น๐ผ๐ฝ๐ฎ๐๐ต๐ถ๐ฒ๐
โข Long QT, CPVT, Brugada
โข Catecholamines can worsen arrhythmias
โข Magnesium matters in torsades physiology
๐๐น๐ฒ๐ฐ๐๐ฟ๐ผ๐น๐๐๐ฒ ๐ฎ๐ป๐ฑ ๐๐ผ๐
๐ถ๐ฐ๐ผ๐น๐ผ๐ด๐ ๐ฐ๐ฎ๐๐๐ฒ๐
โข Hyperkalemia widens QRS
โข Sodium channel blockade mimics VT
๐ช๐๐๐ง ๐ฌ๐ข๐จ ๐ฆ๐๐ข๐จ๐๐ ๐๐ข ๐๐ก ๐ง๐ฅ๐๐ก๐ฆ๐ฃ๐ข๐ฅ๐ง โ๏ธ
โข Assume hypoxia first
โข Ventilate early and effectively
โข Correct acidosis and electrolytes
โข Look for organization before shocking
โข Use a 12-lead in perfusing patients
In pediatrics, oxygen fixes more rhythms than electricity.
๐ง๐๐๐๐๐ข๐ ๐ ๐ง
True pediatric V-tach and V-fib exist. They are uncommon. Most scary pediatric rhythms are organized if you slow down and look. Your job is to treat physiology, protect perfusion, and shock only when criteria are clearly met.
๐ฅ๐๐๐๐ฅ๐๐ก๐๐๐ฆ ๐
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Law YM et al. Diagnosis and management of myocarditis in children. Circulation. 2021;144(6):e123โe135. doi:10.1161/CIR.0000000000001001
Wilde AAM et al. Diagnosis and management of congenital long QT syndrome. Heart. 2022;108(5):332โ338. doi:10.1136/heartjnl-2020-318259
Balestra E et al. Congenital long QT syndrome in children. Children (Basel). 2024;11(5):582. doi:10.3390/children11050582
Abbas M et al. Catecholaminergic polymorphic ventricular tachycardia. Arrhythm Electrophysiol Rev. 2022;11:e20. doi:10.15420/aer.2022.09
Aggarwal A et al. Catecholaminergic polymorphic ventricular tachycardia. J Clin Med. 2024;13(6):1781. doi:10.3390/jcm13061781
Lavonas EJ et al. 2023 AHA guideline update for life-threatening poisoning. Circulation. 2023. doi:10.1161/CIR.0000000000001161
Kafalฤฑ HC, Ergรผl Y. Common supraventricular and ventricular arrhythmias in children. Turk Arch Pediatr. 2022;57(5):476โ488. doi:10.5152/TurkArchPediatr.2022.22099
