Ventricular arrhythmias in heart failure and cardiomyopathy
- Philip J Podrid, MD, FACC
Philip J Podrid, MD, FACC
- Professor of Medicine, Professor of Pharmacology and Experimental Therapeutics
- Boston University School of Medicine
- Lecturer, Harvard Medical School
- Leonard I Ganz, MD, FHRS, FACC
Leonard I Ganz, MD, FHRS, FACC
- Section Editor — Cardiac Arrhythmias
- Director of Cardiac Electrophysiology
- Heritage Valley Health System
Ventricular arrhythmias, ranging from asymptomatic ventricular premature beats (VPBs) to ventricular fibrillation (VF), are common in patients with heart failure (HF) and cardiomyopathy [1-3]. These arrhythmias fall into two broad categories:
●Malignant or potentially lethal arrhythmias, including sustained ventricular tachycardia (VT) and VF.
●Nonsustained or hemodynamically tolerated arrhythmias, including VPBs, nonsustained ventricular tachycardia (NSVT), and accelerated idioventricular rhythm (AIVR). The clinical significance of these arrhythmias is largely based upon whether or not they predict future malignant arrhythmias and sudden cardiac death (SCD).
The prognostic significance of VPBs and NSVT varies with the etiology of the cardiomyopathy. In patients with left ventricular (LV) systolic dysfunction due to prior myocardial infarction (MI), VPBs and NSVT are associated with an increased risk of SCD. In contrast, in most other forms of cardiomyopathy (eg, nonischemic cardiomyopathy or valve disease), these arrhythmias do not appear to predict SCD . (See "Prophylaxis against ventricular arrhythmias during and after acute myocardial infarction".)
The types of ventricular arrhythmias in patients with HF or cardiomyopathy, the effect of HF therapy on these arrhythmias, and the role of electrophysiologic testing will be reviewed here. The secondary and primary prevention of SCD in these patients, including a review of the causes of death in HF, and the importance of ventricular arrhythmias in other causes of cardiomyopathy, such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy, are discussed separately. (See "Secondary prevention of sudden cardiac death in heart failure and cardiomyopathy" and "Hypertrophic cardiomyopathy: Assessment and management of ventricular arrhythmias and sudden cardiac death risk" and "Arrhythmogenic right ventricular cardiomyopathy: Treatment and prognosis".)
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- TYPE OF ARRHYTHMIA
- Ventricular premature beats
- Nonsustained ventricular tachycardia
- Accelerated idioventricular rhythm
- Sustained VT or VF
- - Electrical storm
- IMPACT OF SLEEP DISORDERED BREATHING
- ICD therapy
- EFFECT OF HF THERAPY ON VENTRICULAR ARRHYTHMIA
- Beta blockers
- ACE inhibitors and ARBs
- Aldosterone antagonists
- Digoxin and other inotropes
- Cardiac resynchronization therapy
- ROLE OF EP TESTING
- Risk stratification
- PREVENTION OF SCD
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Types of ventricular arrhythmia
- - VPBs
- - Nonsustained VT
- - AIVR
- - Sustained ventricular arrhythmias
- Significance of syncope
- HF therapy
- EP testing