Paroxysmal Ventricular Fibrillation Producing Adams-Stokes Syndrome

INCREASING interest in the relative importance of paroxysmal ventricular fibrillation, as opposed to ventricular standstill, as the cause of Adams-Stokes seizures has encouraged us to report another case and to review the present concepts concerning various features of the condition, including etiology, prognosis, prevention, and treatment. Interest in this problem is justified particularly since efforts toward prevention of attacks and rational treatment of Adams-Stokes seizures depend upon the identification of the basic underlying mechanism, namely, paroxysmal rapid heart action (including ventricular tachycardia, prefibrillary ventricular tachycardia, and ventricular fibrillation) or ventricular standstill. Our interest in the problem has been stimulated by a case which we have had the opportunity to observe and study. REPORT OF CASE Present History .—A physician, 64 years of age, was admitted to the hospital March 20, 1947, because of an attack of syncope four days before entry. Upon falling in his bathroom, he had struck his