Asystole is often the terminal rhythm in which scenario?

• A. In patients with pulseless ventricular tachycardia responding to defibrillation
• B. In patients with brisk cardiac output after CPR
• C. In patients with ventricular fibrillation already converted to sinus rhythm
• D. In untreated pulseless ventricular tachycardia or ventricular fibrillation

Answer: (D)

Asystole represents the end stage of many cardiac arrests and is most likely to occur when a shockable rhythm like pulseless ventricular fibrillation or pulseless ventricular tachycardia is left untreated. When VF or VT is not treated with timely defibrillation and Advanced Cardiac Life Support interventions, the electrical activity eventually ceases, resulting in asystole. This rhythm is non‑shockable, so the focus shifts to high‑quality CPR and medications (like epinephrine) while addressing reversible causes, hoping for any chance of return of spontaneous circulation.

That’s why the scenario with untreated pulseless VT or VF is the best fit for asystole. If a patient has been defibrillated and responds, or if VF has converted to a rhythm with a pulse or restored perfusion after CPR, asystole wouldn’t be the expected terminal rhythm. Similarly, with a patient who has brisk cardiac output after CPR or VF converted to sinus rhythm, you wouldn’t classify the situation as asystole.