Approach to reduction of ventricular arrhythmias and implantable cardioverter-defibrillator therapies in patients with heart failure

Sengupta, Jay; Abdelhadi, Raed

doi:10.1097/hco.0b013e3283604420

Cited by 4 publications

(10 citation statements)

References 35 publications

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“…Increased end-stage heart failure survival increases the chance of suffering from arrhythmic complications, a phenomenon previously reported in other heart failure studies [20].…”

Section: Alcohol Abuse and Ventricular Arrhythmiasmentioning

confidence: 94%

Malignant ventricular arrhythmias in alcoholic cardiomyopathy

Guzzo-Merello

Domínguez

González-López

et al. 2015

International Journal of Cardiology

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“…Increased end-stage heart failure survival increases the chance of suffering from arrhythmic complications, a phenomenon previously reported in other heart failure studies [20].…”

Section: Alcohol Abuse and Ventricular Arrhythmiasmentioning

confidence: 94%

Malignant ventricular arrhythmias in alcoholic cardiomyopathy

Guzzo-Merello

Domínguez

González-López

et al. 2015

International Journal of Cardiology

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“…Ventricular arrhythmias should be managed with treatment of the underlying cardiomyopathy, addressing reversible factors, and optimising heart failure status. 41 ICD provide the best protection against sudden cardiac death from ventricular arrhythmias; however, recurrent ICD shocks are associated with long-term morbidity and mortality. 41 Consequently,…”

Section: Management Strategiesmentioning

confidence: 99%

“…41 ICD provide the best protection against sudden cardiac death from ventricular arrhythmias; however, recurrent ICD shocks are associated with long-term morbidity and mortality. 41 Consequently,…”

Section: Management Strategiesmentioning

confidence: 99%

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A Clinical Review of Ventricular Arrhythmias in Patients with Congestive Heart Failure

Boyle¹

2019

EMJ Cardiol

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Heart failure is an increasingly prevalent condition, which is associated with ventricular arrhythmias. The reduction in cardiac pumping efficiency leads to the activation of several compensatory mechanisms. These mechanisms eventually lead to cardiac remodelling and a decline in haemodynamic status, contributing to the formation of a substrate conducive to arrhythmias, including increased automaticity, triggered activity, and, most commonly, re-entry circuits. In turn, ventricular arrhythmias can lead to the worsening of heart failure. A diagnosis of heart failure and ventricular arrhythmias is obtained using the patient’s history, examination findings, and investigation results. A key tool in this is echocardiogram imaging, which visualises the cardiac chambers, determines ventricular ejection fraction, and identifies structural abnormalities. A reduction in ejection fraction is a significant risk factor for the development of ventricular arrhythmias. Arrhythmias are diagnosed by ECG, Holter monitoring, and telemetry or event monitoring, and should initially be treated by optimising the medical management of heart failure. Anti-arrhythmic drugs, including beta-blockers, are usually the first-line therapy. Sudden cardiac death is a significant cause of mortality in heart failure patients, and implantable cardioverter defibrillator devices are used in both primary and secondary prevention. Anti-arrhythmic drugs and catheter ablation are important adjunctives for minimising shock therapy. In addition, autonomic modulation may offer a novel method of controlling ventricular arrhythmias. The objective of this review is to provide a practical overview of this rapidly developing field in relation to current evidence regarding the underlying pathophysiology, burden of disease, and management strategies available.

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“…The introduction of Implantable Cardioverter-Defibrillator (ICD) therapies in the 1990s represented a major step forward for improving long-term survival after HF [7]. ICD devices correct left ventricular arrhythmias, lowering the risk of SCD in patients with HF with reduced Ejection Fraction (HFrEF) due to ischemic or non-ischemic heart disease [8,9].…”

Section: Introductionmentioning

confidence: 99%

Primary Prevention of Sudden Cardiac Death in Patients with Heart Failure: How Effective is Current Pharmacologic Therapy?

Gavira¹,

García‐Bolao²,

Dı́ez³

2016

Cardiovasc Pharm Open Access

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Sudden cardiac death is the most common cause of death in the early stages of heart failure. Implantable cardioverter-defibrillator therapies substantially reduce sudden cardiac death but incur morbidity and are expensive, so are recommended only after failure of optimal medical therapy. Guidelines recommend simultaneous first-line therapy with an angiotensin converting enzyme inhibitor and a beta blocker for heart failure with reduced ejection fraction, with diuretic therapy for symptom relief. The all-cause mortality benefit of angiotensin converting enzyme inhibitors (or angiotensin receptor blockers) in this setting is largely attributable to reduced deaths related to disease progression. Addition of a beta blocker improves both all-cause survival and rates of sudden cardiac death. Where symptoms persist, introduction of a mineralocorticoid receptor antagonist is recommended and can reduce sudden cardiac death. If symptoms continue, substitution of the angiotensin converting enzyme inhibitor with the angiotensin receptor neprilysin inhibitor sacubitril/valsartan significantly reduces all-cause mortality, with the benefit arising from fewer deaths from both sudden cardiac death and worsening heart failure. Further medical interventions should be instituted in specific situations as required. Disappointingly, despite evidence-led guidelines, approximately a quarter of patients who have heart failure with reduced ejection fraction do not receive standard therapy with an angiotensin converting enzyme inhibitor and beta blocker. It remains to be seen if recent guidelines for successive interventions in the event of non-response to standard therapy are more effectively adopted.

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Approach to reduction of ventricular arrhythmias and implantable cardioverter-defibrillator therapies in patients with heart failure

Cited by 4 publications

References 35 publications

Malignant ventricular arrhythmias in alcoholic cardiomyopathy

Malignant ventricular arrhythmias in alcoholic cardiomyopathy

A Clinical Review of Ventricular Arrhythmias in Patients with Congestive Heart Failure

Primary Prevention of Sudden Cardiac Death in Patients with Heart Failure: How Effective is Current Pharmacologic Therapy?

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