01/07/2026
𝗣𝗘𝗗𝗜𝗔𝗧𝗥𝗜𝗖 𝗩-𝗧𝗔𝗖𝗛 𝗔𝗡𝗗 𝗩-𝗙𝗜𝗕 🚑🫀
𝗪𝗛𝗬 𝗬𝗢𝗨 𝗥𝗔𝗥𝗘𝗟𝗬 𝗦𝗘𝗘 𝗧𝗛𝗘𝗠, 𝗔𝗡𝗗 𝗪𝗛𝗬 “𝗜𝗧 𝗟𝗢𝗢𝗞𝗦 𝗟𝗜𝗞𝗘 𝗩-𝗙𝗜𝗕” 𝗨𝗦𝗨𝗔𝗟𝗟𝗬 𝗠𝗘𝗔𝗡𝗦 𝗜𝗧 𝗜𝗦 𝗡𝗢𝗧 ⚠️
You see a wide or chaotic rhythm on a pediatric monitor. Someone says “That’s V-fib” or “That’s V-tach.”
Pause. Look again. In kids, that call deserves a higher bar.
𝗦𝗜𝗠𝗣𝗟𝗘 𝗧𝗔𝗞𝗘𝗔𝗪𝗔𝗬 𝗙𝗜𝗥𝗦𝗧 👶
• Ventricular tachycardia is uncommon in children
• Ventricular fibrillation is even less common
• Most pediatric arrests are hypoxic or metabolic
• 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.
𝗪𝗛𝗬 𝗩-𝗧𝗔𝗖𝗛 𝗜𝗦 𝗥𝗔𝗥𝗘 𝗜𝗡 𝗣𝗘𝗗𝗜𝗔𝗧𝗥𝗜𝗖𝗦 🧠
Simple version.
• Kids lack ischemic scar
• They rarely have chronic ventricular disease
• Their myocardium conducts more uniformly
• 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.
𝗪𝗛𝗬 𝗜𝗧 𝗟𝗢𝗢𝗞𝗦 𝗟𝗜𝗞𝗘 𝗩-𝗙𝗜𝗕 𝗪𝗛𝗘𝗡 𝗜𝗧 𝗜𝗦 𝗡𝗢𝗧 📉
Simple version.
• SVT with aberrancy looks wide and ugly
• Fast sinus tachycardia plus artifact looks chaotic
• CPR and motion exaggerate noise
• 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.
𝗛𝗢𝗪 𝗧𝗢 𝗟𝗢𝗢𝗞 𝗙𝗢𝗥 𝗢𝗥𝗚𝗔𝗡𝗜𝗭𝗘𝗗 𝗔𝗖𝗧𝗜𝗩𝗜𝗧𝗬 👀
Quick checklist you can run in seconds.
• Is there a repeating pattern
• Do complexes look similar beat to beat
• Can you identify a rate
• Does the rhythm change with oxygen or ventilation
• Does motion make it worse
If you can predict the next deflection, you are not looking at VF.
Practical steps.
• Check two leads
• Press the electrodes and stabilize cables
• Look at pleth, arterial line, or ETCO₂ if present
• Briefly pause motion when safe
𝗪𝗛𝗔𝗧 𝗬𝗢𝗨 𝗡𝗘𝗘𝗗 𝗧𝗢 𝗖𝗔𝗟𝗟 𝗩-𝗙𝗜𝗕 ⚡
• Completely disorganized electrical activity
• No identifiable QRS complexes
• No repeating morphology
• No pulse or perfusion
If any organized electrical activity exists, it does not meet criteria for VF.
𝗪𝗛𝗔𝗧 𝗬𝗢𝗨 𝗡𝗘𝗘𝗗 𝗧𝗢 𝗖𝗔𝗟𝗟 𝗩-𝗧𝗔𝗖𝗛 ⚠️
• Wide complex rhythm
• Consistent ventricular morphology
• Rate usually over 120 to 150 in children
• AV dissociation, capture beats, or fusion beats if visible
• Often associated with poor perfusion
Wide and fast does not automatically mean VT. In pediatrics, assume supraventricular until proven otherwise.
𝗪𝗢𝗨𝗟𝗗 𝗔 𝟭𝟮-𝗟𝗘𝗔𝗗 𝗛𝗘𝗟𝗣 📟
Short answer. Yes, when the child is perfusing.
A 12-lead can:
• Show organized ventricular activation
• Help separate VT from SVT with aberrancy
• Reveal long QT, Brugada pattern, or myocarditis clues
• Guide receiving team decisions
It should never delay airway, oxygenation, or defibrillation in confirmed pulseless VF or VT.
𝗧𝗛𝗘 𝗙𝗘𝗪 𝗖𝗢𝗡𝗗𝗜𝗧𝗜𝗢𝗡𝗦 𝗧𝗛𝗔𝗧 𝗧𝗥𝗨𝗟𝗬 𝗖𝗔𝗨𝗦𝗘 𝗣𝗘𝗗𝗜𝗔𝗧𝗥𝗜𝗖 𝗩-𝗧𝗔𝗖𝗛 🧬
𝗖𝗼𝗻𝗴𝗲𝗻𝗶𝘁𝗮𝗹 𝗵𝗲𝗮𝗿𝘁 𝗱𝗶𝘀𝗲𝗮𝘀𝗲
• Surgical scars create re-entry circuits
𝗠𝘆𝗼𝗰𝗮𝗿𝗱𝗶𝘁𝗶𝘀
• Inflamed myocardium becomes electrically unstable
• Tachycardia out of proportion to fever is a clue
𝗖𝗵𝗮𝗻𝗻𝗲𝗹𝗼𝗽𝗮𝘁𝗵𝗶𝗲𝘀
• Long QT, CPVT, Brugada
• Catecholamines can worsen arrhythmias
• Magnesium matters in torsades physiology
𝗘𝗹𝗲𝗰𝘁𝗿𝗼𝗹𝘆𝘁𝗲 𝗮𝗻𝗱 𝘁𝗼𝘅𝗶𝗰𝗼𝗹𝗼𝗴𝘆 𝗰𝗮𝘂𝘀𝗲𝘀
• Hyperkalemia widens QRS
• Sodium channel blockade mimics VT
𝗪𝗛𝗔𝗧 𝗬𝗢𝗨 𝗦𝗛𝗢𝗨𝗟𝗗 𝗗𝗢 𝗜𝗡 𝗧𝗥𝗔𝗡𝗦𝗣𝗢𝗥𝗧 ✈️
• Assume hypoxia first
• Ventilate early and effectively
• Correct acidosis and electrolytes
• Look for organization before shocking
• Use a 12-lead in perfusing patients
In pediatrics, oxygen fixes more rhythms than electricity.
𝗧𝗔𝗞𝗘𝗛𝗢𝗠𝗘 🧠
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.
𝗥𝗘𝗙𝗘𝗥𝗘𝗡𝗖𝗘𝗦 📚
Lasa JJ et al. Part 8: Pediatric Advanced Life Support. 2025 AHA Guidelines. Circulation. 2025. doi:10.1161/CIR.0000000000001368
Somma V et al. Epidemiology of pediatric out-of-hospital cardiac arrest. Heart Rhythm. 2023;20(11):1525–1531. doi:10.1016/j.hrthm.2023.06.010
Law YM et al. Diagnosis and management of myocarditis in children. Circulation. 2021;144(6):e123–e135. doi:10.1161/CIR.0000000000001001
Wilde AAM et al. Diagnosis and management of congenital long QT syndrome. Heart. 2022;108(5):332–338. 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
Kafalı HC, Ergül Y. Common supraventricular and ventricular arrhythmias in children. Turk Arch Pediatr. 2022;57(5):476–488. doi:10.5152/TurkArchPediatr.2022.22099
