However, some emergency physicians advocate a trial of defibrillation in case the rhythm is actually fine ventricular fibrillation otherwise indistinguishable from asystole, although little evidence exists to support the practice. Asystole is one of the conditions required for a medical practitioner to certify death. Asystole is usually a confirmation of death as opposed to a heart rhythm to be treated, although a small minority of patients are successfully resuscitated if the underlying cause is identified and treated immediately. Generally, after a minute and a half to five or so minutes, the heart will not respond to defibrillation or injections of epinephrine and atropine and the patient is then declared dead or brain-dead. In asystole, the heart will generally not respond to defibrillation because it is already depolarized. In medicine, asystole is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. When a patient displays asystole, the treatment of choice is an injection of epinephrine and atropine and chest compressions.
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