Pulseless electrical activity (PEA) is a type of irregular heart rhythm, meaning it’s a malfunction of your heart’s electrical system. When this happens, your heart’s electrical activity is too weak to make your heart pump, which causes your heart to stop (cardiac arrest). Without medical attention, PEA and cardiac arrest are deadly in minutes.
Pulseless electrical activity (PEA) is a condition where your heart stops because the electrical activity in your heart is too weak to make your heart beat. When your heart stops, you go into cardiac arrest, and you don’t have a pulse.
PEA is a “nonshockable” heart rhythm, meaning a defibrillator won’t correct it. If not treated quickly, PEA causes sudden cardiac death within minutes.
At the beginning of every heartbeat, a cluster of cells (the sinoatrial node) near the top of your heart creates an electrical current, which then spreads to other areas of your heart. As the current passes through the heart muscle, the muscle reacts by flexing. That causes your heart to squeeze and pump blood.
That electrical current is detectable with a diagnostic test called an electrocardiogram (ECG or EKG). With PEA, your heart does have a detectable electrical current, but your heart isn’t strong enough to pump blood to the body.
PEA can take two different forms:
PEA is a common irregular heart rhythm (arrhythmia) that happens in connection to cardiac arrest. When you go into cardiac arrest, you are “clinically dead.”
When your heart stops, there are still some treatments that may be able to save your life. That’s why modern medicine distinguishes the types of death. The types are:
Because there’s about five minutes after your heart stops before your brain cells begin to die, that window means there’s a small chance that life-saving measures like CPR can revive you. For that reason, time is critical to help someone who goes into cardiac arrest. Unfortunately, even with measures like CPR, most people don’t survive cardiac arrest if it happens outside of a hospital setting.
PEA and asystole (also known as “flat-lining”) can lead to cardiac arrest. The difference is that with PEA, your heart still has some detectable electrical activity. With asystole, there’s no electrical activity to detect.
The causes of PEA fall into two distinct categories.
This happens because of a problem with your heart itself. It usually has a connection with cardiac arrest, or cardiac arrest causes it directly.
This is PEA from a distinct outside cause rather than from a problem with your heart itself. The most likely causes of secondary PEA are:
PEA occurs in about 20% of sudden heart-related deaths outside of hospitals. Inside hospitals, it accounts for about 10% of heart-related deaths.
The only way to know if a stopped heart involves PEA is with an electrocardiogram, which isn’t always available outside of a hospital setting. Fortunately, the treatment for cardiac arrest is always the same, regardless of whether or not PEA is involved.
Immediate, effective CPR should always be the top priority when cardiac arrest happens, especially outside of a hospital setting. CPR should continue until emergency services or first responders arrive.
If PEA happens inside a hospital, the following treatments are likely:
Certain malfunctions in your heart’s electrical system that create arrhythmias are “shockable.” That means defibrillation (an electric shock) can stop those rhythms by restoring your heart to a normal rhythm.
The two shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia. Both of those can turn into PEA, but PEA itself isn’t shockable. However, CPR for pulseless electrical activity can sometimes get your heart to switch to a shockable rhythm. If that happens, then defibrillation can happen, which has a chance of restoring your heart to a normal rhythm.
PEA doesn’t happen predictably, and it’s a common part of the normal dying process. That means it’s not preventable. While it might be possible to revive someone who has PEA, this isn’t always the case.
Cardiac arrest is always a medical emergency that needs immediate care. You should always call 911 (or the local emergency services number in your area) and start CPR. If you don’t know CPR, 911 operators can often instruct you over the phone on how to give CPR.
The main symptoms of cardiac arrest are:
A note from Cleveland Clinic
Pulseless electrical activity usually happens along with cardiac arrest, a very dangerous condition. Fortunately, modern medicine’s understanding of PEA and similar conditions has grown tremendously over the past few decades. However, the first few moments are especially critical, especially when cardiac arrest happens outside of a hospital. That means effective CPR and quick medical attention can make a big difference and improve the chances of survival.
Last reviewed by a Cleveland Clinic medical professional on 06/03/2022.
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