Ventricular arrhythmias in severe heart failure

Incidence, significance, and effectiveness of antiarrhythmic therapy

C. Simon Chakko, Mihai Gheorghiade

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

Forty-three patients receiving maximal medical therapy for severe chronic heart failure from dilated cardiomyopathies (28 ischemic, 15 idiopathic) and ventricular premature beats (VPBs) on the 12-lead ECG had baseline 24-hour ambulatory ECG monitoring. Complex VPBs (multiform, repetitive-couplets, R on T phenomenon) and asymptomatic, nonsustained ventricular tachycardia were present in 38 patients (88%) and 22 patients (51%), respectively. Twenty-three patients (group I) were placed on long-term antiarrhythmic therapy (20 patients received procainamide and the remaining quinidine). Twenty patients (group II) did not receive antiarrhythmic therapy. At baseline, no significant differences between the two groups were noted for age, functional class, type of cardiomyopathy, medical therapy for heart failure, cardiothoracic ratio, radionuclide ejection fraction, or rate and complexity of the ventricular arrhythmias on the 24-hour ambulatory ECG tracings. At a mean follow-up period of 16 months (range 1 to 37), there were 16 deaths, 10 (62%) of which were sudden and unexpected. No significant differences in the incidence of sudden death and overall mortality were noted between the two groups. Among patients with nonsustained ventricular tachycardia, those who died suddenly had a lower mean left ventricular ejection fraction (0.15 ± 0.01) when compared to the survivors (0.23 ± 0.02; p < 0.01). It is concluded that (1) patients with severe heart failure have a high mortality from both sudden and nonsudden cardiac death, (2) incidence of complex VPBs is very high, (3) sudden death is more common when the left ventricular function is severely compromised, and (4) apparently, therapeutic plasma levels of conventional antiarrhythmic drugs do not protect this group of patients from dying.

Original languageEnglish
Pages (from-to)497-504
Number of pages8
JournalAmerican Heart Journal
Volume109
Issue number3 PART 1
DOIs
StatePublished - Jan 1 1985
Externally publishedYes

Fingerprint

Cardiac Arrhythmias
Heart Failure
Incidence
Ventricular Premature Complexes
Electrocardiography
Therapeutics
Ventricular Tachycardia
Sudden Death
Procainamide
Ambulatory Monitoring
Quinidine
Mortality
Anti-Arrhythmia Agents
Sudden Cardiac Death
Dilated Cardiomyopathy
Cardiomyopathies
Left Ventricular Function
Radioisotopes
Stroke Volume
Survivors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ventricular arrhythmias in severe heart failure : Incidence, significance, and effectiveness of antiarrhythmic therapy. / Chakko, C. Simon; Gheorghiade, Mihai.

In: American Heart Journal, Vol. 109, No. 3 PART 1, 01.01.1985, p. 497-504.

Research output: Contribution to journalArticle

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