Pennsylvania Democratic Senator John Fetterman (Photo courtesy of Senator John Fetterman)
Officials say the cause was a heart condition Thursday’s fall of Pennsylvania Sen. John Fetterman According to cardiologists, it could have been fatal if not treated immediately. The first-term Democrat’s life was probably saved by an implant implanted after a stroke more than three years ago.
According to announcement posted on Fetterman’s Senate account on Xformerly known as Twitter, Fetterman experienced a “recurrence of ventricular fibrillation” on Thursday while walking, a spokesman said. As a result of the incident, Fetterman “felt dizzy, fell to the ground and hit his face, sustaining minor injuries.”
Fetterman’s office provided no additional details about his condition or prognosis. But Dr. Justin Lee, a cardiac electrophysiologist at the Cleveland Clinic, said ventricular fibrillation, or v-fib, is a “dangerous heart rhythm” that causes an raise in voltage in the lower chamber of the heart. If the person is not given a shock soon after the incident to restore the heart rhythm, he or she will die, he added.
The heart “instead of pumping, it starts to quiver. And when that happens, the blood flow just stops and the person can just collapse within seconds,” he said. “This is the leading cause of sudden cardiac arrest and the only way to treat it at this time is to give an electric shock to the heart.”
Fetterman likely experienced such shock because of the treatment he received afterward suffered a stroke and was hospitalized during his May 2022 Senate campaign. He said at the time that the stroke was caused by a clot in the heart that had developed two days earlier during an episode of atrial fibrillation – a different and less immediately unsafe form of cardiac arrhythmia. He later underwent surgery to have a pacemaker and defibrillator implanted to control the disease.
Lee noted that implanted defibrillators can save lives by protecting people at high risk of developing v-fib, especially since v-fib can occur suddenly. The device monitors a person’s heart rhythm and delivers a shock if they fall into a v-fib state.
“Think of it like a sprinkler system connected to a fire alarm. It detects a fire and the sprinkler system activates to put out the fire,” Lee said. Without such immediate intervention, he warned, “the death rate from v-vib — we can put it at 100 percent. It’s the rhythm of death. That’s why urgent defibrillation for ventricular fibrillation is very important.”
Lee said a fall like the one Fetterman’s office described wouldn’t be a surprising outcome in such a case: “Because there’s no blood flow, that would mean a fall. And then the defibrillator would go off so that the atrial fibrillation doesn’t progress any further.”
On Thursday, Fetterman’s office said he was “undergoing routine monitoring at the hospital” so doctors could “fine-tune his medications.”
Dr. Nikos Pappan, cardiologist at St. Hospital Clair, Allegheny County, said it’s essential to pay attention to the effects of medications and that some medications used to treat atrial fibrillation may raise the risk of atrial fibrillation.
“What they do is they can sometimes prolong myocardial repolarization” — when the heart recovers from a resting state — “which makes people more prone to going into v-fib,” he said. “That’s why we continue to monitor these patients on these particular medications and conduct very close surveillance and monitoring.”
A v-fib incident most often occurs when arteries become blocked, Lee said. Other triggers, such as heart failure or genetic diseases, can also trigger a v-fib event. According to the Cleveland ClinicIt is estimated that between 180,000 and 450,000 sudden cardiac deaths occur each year in the United States. Of these, a significant proportion may be due to v-fib or other types of ventricular arrhythmias.
Lee said that even if a defibrillator saves heart patients, they should go to the hospital immediately after experiencing v-fib – in much the same way that fire trucks rush to the scene of a fire even after the sprinkler system is activated. You may need to check them for blockages or check the implanted device itself. Patients may also be at risk of an “electric storm” during which their body repeatedly goes into a v-fib state.
The need to respond immediately to a v-fib event places automatic external defibrillators, or AEDs, in areas where gigantic numbers of people gather, such as schools and airports.
Pappan stressed the importance of knowing the location of the AED in a specific building or workplace and learning how to exploit it.
“People are not prepared for something like this, for someone to fall,” he said. “Go open it and familiarize yourself with the specific AED you have in your workplace. Because if that time ever comes, this is not the time to be wondering how to use it.”
Papan said there are very few early warning signs of v-fib, which is one reason why patients at high risk of heart disease should see a cardiologist to find out if they need further treatment or lifestyle changes before such an event can occur.
“For patients who have coronary artery disease, high blood pressure, family history of sudden cardiac death,” he said, “those are the types of patients where it’s really important to see a cardiologist for preventive care.”
