Which patient factor on the telemetry floor indicates the highest risk for sudden cardiac death based on the described scenario?

• A. Uncontrolled atrial fibrillation at a rapid rate.
• B. Symptomatic sinus bradycardia with a pacemaker.
• C. Multifocal premature ventricular contractions.
• D. Supraventricular tachycardia at a rate of 110 bpm.

Answer: (C)

The key concept is recognizing ventricular electrical instability as a threat for sudden cardiac death on telemetry. When multiple ventricular ectopic foci are firing—multifocal premature ventricular contractions—it shows the ventricles are irritable from more than one site. That pattern strongly suggests a substrate for malignant ventricular arrhythmias, such as ventricular tachycardia or ventricular fibrillation, which are common causes of sudden death.

In contrast, rapid atrial fibrillation, while it raises concerns like hemodynamic strain or stroke risk, does not carry the same imminent risk of sudden death as a ventricular rhythm problem. Symptomatic sinus bradycardia with a pacemaker points to a conduction/pace-related issue that’s managed with pacing and isn’t typically a direct predictor of sudden death. Supraventricular tachycardia at 110 bpm is uncomfortable and can cause symptoms, but SVT originates above the ventricles and is less likely to lead to sudden death on its own.

Thus, multifocal PVCs best indicate the highest risk for sudden cardiac death in this telemetry scenario.