Sudden and Unexpected Ventricular Standstill in Acute Myocardial Infarction

¹ Department of Medicine, Sinai Hospital of Baltimore, Inc., Baltimore

Sudden and prolonged ventricular standstill developed in two patients with acute myocardial infarction. Ventricular standstill of 20 seconds duration occurred on the fourth day in one patient with an acute inferior wall myocardial infarction. In the second patient with a nontransmural anterior wall myocardial infarction, ventricular standstill occurred on the second day. Both episodes occureed during sleep and were not preceded by lengthening of the P-R interval, widened QRS complexes, or obvious axis shifts. Prompt restoration to sinus rhythm occurred with chest thumping and intravenously administered atropine sulfate and both patients were successfully paced; however, the first patient died four days later in cardiogenic shock. It is suggested that ventricular standstill is one of the mechanisms of sudden death in acute myocardial infarction and can occur suddenly and unexpectedly.