Which telemetry patient is most at risk for sudden cardiac death?

• A. The client with uncontrolled Atrial Fibrillation at 136 bpm.
• B. The client with symptomatic sinus bradycardia who has a pacemaker.
• C. The client with multifocal premature ventricular contractions.
• D. The client with Supraventricular Tachycardia at 110 bpm.

Answer: (C)

The key idea is ventricular irritability leading to malignant rhythms. Multifocal premature ventricular contractions mean there are multiple ventricular escape sites firing ectopically. That signals a myocardium that’s highly irritable and capable of degenerating into dangerous rhythms such as ventricular tachycardia or ventricular fibrillation. Because several foci raise the likelihood of an impulse triggering a rapid or chaotic ventricular rhythm, this pattern carries the greatest potential for sudden cardiac death among the options.

In comparison, uncontrolled atrial fibrillation at a high rate is serious and requires urgent rate and rhythm management, but it does not inherently carry the same immediate risk of a rapid ventricular death rhythm unless the situation worsens. A symptomatic sinus bradycardia with a pacemaker is protected by pacing, reducing risk. Supraventricular tachycardia at a moderate rate is usually stable and far less likely to precipitate sudden death than multifocal PVCs, unless there are other compromising factors.

If you see multifocal PVCs on telemetry, investigate reversible causes (electrolyte imbalances, ischemia, hypoxia), ensure the patient is hemodynamically stable, and prepare for potential advanced arrhythmia management.