Sudden Cardiac Death Risk Stratification in Patients with Heart Failure

Addo, Kamel N.; Chodosh, Adam; Iyer, Venkat; Lum, Jeremy J.; Buxton, Alfred E.

doi:10.1016/j.hfc.2010.12.001

Cited by 16 publications

(9 citation statements)

References 121 publications

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“…This is similar to findings of the greater risk of ventricular arrhythmias in HF subjects when compared with normal controls by Lasisi et al 24 This has been attributed to a multiplicity of mechanisms, the exact nature of which is important to unravel in order to be able to better risk stratify these patients to avoid sudden death. 25 These mechanisms include early autonomic and repolarization abnormalities, afterdepolarizations, re-entry, and enhanced automaticity. 25 , 26 In addition to these, other factors that play modifying roles to reduce the threshold for arrhythmogenesis in HF include electrolyte abnormalities, scar and fibrosis formation, valvular disease, complications of medical management (eg, digoxin toxicity and abnormal electrophysiologic predispositions [QT abnormalities and impaired vagal tone]).…”

Section: Discussionmentioning

confidence: 99%

Pattern of arrhythmias among Nigerians with congestive heart failure

Ajayi¹,

Abiodun²,

Akintomide³

et al. 2015

IJGM

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BackgroundIn patients with heart failure, death is often sudden due to life-threatening arrhythmias. This work was carried out to evaluate the pattern of arrhythmias in Nigerians with heart failure.Materials and methodsThirty subjects with congestive heart failure (CHF), 30 subjects with hypertensive heart disease, and 15 normal subjects with no obvious features of heart disease were evaluated with resting and 24-hour electrocardiographic monitoring and transthoracic echocardiography. Data were analyzed with one-way analysis of variance with post hoc Duncan’s analysis, Fisher’s exact test, and linear regression analysis using SPSS version 16.ResultsCHF subjects had more instances of supraventricular tachycardia (P=0.005), ventricular extrasystoles (P<0.001), bigeminy (P<0.001), trigeminy (P<0.001), couplets (P<0.001), triplets (P<0.001), and nonsustained ventricular tachycardia (VT) (P=0.003) than the other two control groups. They also showed a significantly longer VT duration (4.6±5.6 seconds) compared with the other groups (P<0.001). Linear regression analysis showed a significant direct relationship between VT and the maximum number of ventricular extrasystoles per hour (P=0.001).ConclusionCardiac arrhythmias are common in subjects with CHF and are more frequent when compared with patients with hypertensive heart disease and normal subjects.

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Section: Discussionmentioning

confidence: 99%

Pattern of arrhythmias among Nigerians with congestive heart failure

Ajayi¹,

Abiodun²,

Akintomide³

et al. 2015

IJGM

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“…Numerous clinical and demographic variables have been associated with an increased risk of arrhythmic death, and many electrophysiological approaches have been proposed and evaluated in an attempt to better identify the patient population at highest risk of future arrhythmic death (1,2). However, despite multiple large clinical trials performed during the last 30 years, left ventricular ejection fraction (LVEF) remains the only parameter clinically used to distinguish high- and low-risk groups.…”

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confidence: 99%

“…Nevertheless, the majority of patients never require device therapy to prevent a lethal ventricular arrhythmia. The ability to identify risk of arrhythmic death independently of LVEF could better target therapy among current ICD candidates, as well as identify patients with LVEF >35% who are at high risk of SCA (1,2). Although the latter population has a lower rate of arrhythmic death, it actually accounts for a larger number of arrhythmic events (6).…”

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confidence: 99%

Regional Myocardial Sympathetic Denervation Predicts the Risk of Sudden Cardiac Arrest in Ischemic Cardiomyopathy

Fallavollita

Heavey

Luísi

et al. 2014

Journal of the American College of Cardiology

359

293

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Objectives The PAREPET (Prediction of ARrhythmic Events with Positron Emission Tomography) study sought to test the hypothesis that quantifying inhomogeneity in myocardial sympathetic innervation could identify patients at highest risk for sudden cardiac arrest (SCA). Background Left ventricular ejection fraction (LVEF) is the only parameter identifying patients at risk of SCA who benefit from an implantable cardiac defibrillator (ICD). Methods We prospectively enrolled 204 subjects with ischemic cardiomyopathy (LVEF ≤35%) eligible for primary prevention ICDs. Positron emission tomography (PET) was used to quantify myocardial sympathetic denervation (11C-meta-hydroxyephedrine [11C-HED]), perfusion (13N-ammonia) and viability (insulin-stimulated 18F-2-deoxyglucose). The primary endpoint was SCA defined as arrhythmic death or ICD discharge for ventricular fibrillation or ventricular tachycardia >240 beats/min. Results After 4.1 years follow-up, cause-specific SCA was 16.2%. Infarct volume (22 ± 7% vs. 19 ± 9% of left ventricle [LV]) and LVEF (24 ± 8% vs. 28 ± 9%) were not predictors of SCA. In contrast, patients developing SCA had greater amounts of sympathetic denervation (33 ± 10% vs. 26 ± 11% of LV; p = 0.001) reflecting viable, denervated myocardium. The lower tertiles of sympathetic denervation had SCA rates of 1.2%/year and 2.2%/year, whereas the highest tertile had a rate of 6.7%/year. Multivariate predictors of SCA were PET sympathetic denervation, left ventricular end-diastolic volume index, creatinine, and no angiotensin inhibition. With optimized cut-points, the absence of all 4 risk factors identified low risk (44% of cohort; SCA <1%/year); whereas ≥2 factors identified high risk (20% of cohort; SCA ~12%/year). Conclusions In ischemic cardiomyopathy, sympathetic denervation assessed using 11C-HED PET predicts cause-specific mortality from SCA independently of LVEF and infarct volume. This may provide an improved approach for the identification of patients most likely to benefit from an ICD. (Prediction of ARrhythmic Events With Positron Emission Tomography [PAREPET]; NCT01400334)

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“…Determining suitable factors for identifying high risk heart failure patients is necessary. Heart rate variability (HRV) [3] was previously demonstrated to predict sudden cardiac death in heart failure patients, though findings have been inconsistent [4]. …”

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confidence: 99%