“be still my beating heart”: ventricular standstill occurring in different age groups

Ventricular standstill is an uncommon yet potentially fatal arrhythmia, which requires urgent recognition and treatment. As the name suggests, the ventricles come to a standstill with an almost immediate cessation of cardiac output. If this persists for more than a few seconds the patient will lose consciousness and no pulse will be palpable. Recommended treatment includes prompt initiation of cardiopulmonary resuscitation, and if return of circulation is achieved, pacemaker insertion is usually required. Case report: Four case reports are presented which highlight the ECG features of ventricular standstill and that this arrhythmia can occur across a wide range of ages. Conclusion: Ventricular standstill can occur at any age. It can be difficult to diagnose with many cases only evident on pre-hospital ECG recordings. It may present as recurring episodes of loss of consciousness yet the patient may be well in the intervening period. During episodes of ventricular standstill failure to palpate the pulse and/or over reliance on cardiac monitoring and automated ECG analysis programmes to determine the heart rate, may result in dramatic overestimation of the heart rate and may lead to delays in initiation of cardiopulmonary resuscitation and pacing if required.