Incidence, predictive factors and prognostic significance of supraventricular tachyarrhythmias in congestive heart failure

Mathew, Jason; Hunsberger, Sally; Fleg, J. L.; Sherry, F.; Williford, WO; Yusuf, S.

doi:10.1016/s0735-1097(98)81588-x

Cited by 11 publications

(15 citation statements)

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“…8 Although tachyarrhythmias are often considered benign, they confer an increased risk of embolic strokes and sudden death in susceptible cardiac patients. 9 At the time of regulatory approval, tiotropium was known to be associated with mild decreased heart rate variability, 10 which is a known risk factor for cardiac mortality and sudden cardiac death. 11 The Lung Health Study investigators reported a RR for hospitalisations due to supraventricular tachycardia of 4.5 (95% CI 0.97 to 20.8) associated with use of short-acting inhaled ipratropium versus placebo.…”

Section: Introductionmentioning

confidence: 99%

Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications

Singh

Loke

Enright

et al. 2012

Thorax

104

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The majority of deaths in COPD are from cardiovascular causes. Several large randomized controlled trials demonstrate that inhaled anticholinergic agents ipratropium and tiotropium increase the risk of serious cardiovascular events, including cardiovascular mortality. Tiotropium Respimat is associated with a statistically significant increased risk of mortality (RR 1.52; 95% CI 1.06 to 2.16) and cardiovascular death (RR 2.05; 95% CI 1.06 to 3.99) compared with placebo in a metaanalysis of clinical trials. In the largest study, the subgroup of patients with COPD in the Respimat group with known rhythm and cardiac disorders at baseline had an especially high risk for cardiac death (RR 8.6; 95% CI 1.1 to 67.2). Although there was no significantly increased risk of mortality (HR 0.89; 95% CI 0.79 to 1.02) or myocardial infarction (MI) (RR 0.73; 95% CI 0.53 to 1.00) with tiotropium handihaler in the Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) trial, the reported excess of angina (RR 1.44; 95% CI 0.91 to 2.26), imbalance in strokes related to ischaemia and rates of supraventricular tachyarrhythmias are consistent with the pro-ischemic and pro-arrhythmic effects. The subjects at greatest risk of cardiovascular death, such as those with a recent history of MI, unstable or life-threatening cardiac arrhythmias or hospitalisation with heart failure, were excluded from the UPLIFT trial. The Prevention of Exacerbations with Tiotropium in COPD trial showed an excess of serious coronary ischaemic events of angina, myocardial ischaemia and MI with the tiotropium Handihaler compared with salmeterol. The authors urge caution in prescribing inhaled anticholinergics for patients with pre-existing arrhythmias or cardiac disorders.

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Section: Introductionmentioning

confidence: 99%

Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications

Singh

Loke

Enright

et al. 2012

Thorax

104

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“…The Danish Investigations of Arrhythmia and Mortality on Dofetilide‐Congestive Heart Failure (DIAMOND‐CHF) 11 and The Veterans Affairs (VA) Congestive Heart Failure Survival Trial of Antiarrhythmic Therapy (CHF‐STAT) 23 trials (Figure) included patients with reduced left ventricular function, and more patients had clinical symptoms than patients in the SOLVD prevention trial. In the Digitalis Investigation Group (DIG) trial, which compared digoxin with placebo in heart failure patients with sinus rhythm at baseline, 11% developed supraventricular tachyarrhythmias during the follow‐up period 24 . The study by Crijns et al, 25 from the Prospective Randomized Study of Ibopamine on Mortality and Efficacy II (PRIME II), has questioned the relation between heart failure and development of AF.…”

Section: Prevalence Of Af In Heart Failure Patientsmentioning

confidence: 99%

“…However, within the past decade a number of larger trials in heart failure patients has extended our knowledge in this field and given further information to evaluate the impact of AF on mortality (Table I). Three trials reported no increase in mortality 25,41 while three showed AF to be an independent risk factor 24,42–44 …”

Section: Prognosis Of Af In Heart Failure Patientsmentioning

confidence: 99%

“…In multivariate analyses, AF remained significantly associated with all‐cause mortality (relative risk [RR], 1.34; 95% confidence interval [CI], 1.12–1.62; p =0.002). In the DIG trial, 24 866 patients (11.1%) developed supraventricular tachycardia, which was associated with a greater risk of total mortality (RR, 2.45; p =0.0001) and stroke (RR, 2.37; p =0.0001). Finally, Wyse et al 45 indicated that AF was an independent risk factor ( p =0.019) for increased mortality among the 2848 patients (718 with AF) of the Antiarrhythmics Versus Implantable Defibrillators (AVID) study.…”

Section: Prognosis Of Af In Heart Failure Patientsmentioning

confidence: 99%

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Prevalence, Prognostic Significance, and Treatment of Atrial Fibrillation in Congestive Heart Failure With Particular Reference to the DIAMOND‐CHF Study

Pedersen

Brendorp

Køber

et al. 2003

Congestive Heart Failure

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Atrial fibrillation is a growing health problem and the most common cardiac arrhythmia, affecting 5% of persons above the age of 65 years. The number of hospital discharges for atrial fibrillation has more than doubled in the past decade. It occurs very often in patients with congestive heart failure and the prevalence increases with the severity of the disease. These two conditions seem to be linked together, and congestive heart failure may either be the cause or the consequence of atrial fibrillation. The prognosis of atrial fibrillation is controversial, but studies indicate that atrial fibrillation is a risk factor in congestive heart failure patients. In the last 10-15 years, significant advances in the treatment of heart failure have improved survival, whereas effective management of atrial fibrillation in heart failure patients still awaits similar progress. Empirically, two strategies have evolved for treatment of atrial fibrillation: 1) rhythm control, which means conversion to sinus rhythm and maintenance of sinus rhythm; and 2) rate control, which means reduction of heart rate to an acceptable frequency. It is unknown whether one of these strategies is better than the other. In this review the authors discuss the prevalence, impact, and treatment of atrial fibrillation in heart failure patients.

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“…Although tachyarrhythmias are often considered benign, they confer an increased risk of embolic strokes and sudden death in susceptible cardiac patients 9. At the time of regulatory approval, tiotropium was known to be associated with mild decreased heart rate variability,10 which is a known risk factor for cardiac mortality and sudden cardiac death 11.…”

Section: Introductionmentioning

confidence: 99%

Republished: Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications

Singh

Loke

Enright

et al. 2014

Postgraduate Medical Journal

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The majority of deaths in COPD are from cardiovascular causes. Several large randomized controlled trials demonstrate that inhaled anticholinergic agents ipratropium and tiotropium increase the risk of serious cardiovascular events, including cardiovascular mortality. Tiotropium Respimat is associated with a statistically significant increased risk of mortality (RR 1.52; 95% CI 1.06 to 2.16) and cardiovascular death (RR 2.05; 95% CI 1.06 to 3.99) compared with placebo in a meta-analysis of clinical trials. In the largest study, the subgroup of patients with COPD in the Respimat group with known rhythm and cardiac disorders at baseline had an especially high risk for cardiac death (RR 8.6; 95% CI 1.1 to 67.2). Although there was no significantly increased risk of mortality (HR 0.89; 95% CI 0.79 to 1.02) or myocardial infarction (MI) (RR 0.73; 95% CI 0.53 to 1.00) with tiotropium handihaler in the Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) trial, the reported excess of angina (RR 1.44; 95% CI 0.91 to 2.26), imbalance in strokes related to ischaemia and rates of supraventricular tachyarrhythmias are consistent with the pro-ischemic and pro-arrhythmic effects. The subjects at greatest risk of cardiovascular death, such as those with a recent history of MI, unstable or life-threatening cardiac arrhythmias or hospitalisation with heart failure, were excluded from the UPLIFT trial. The Prevention of Exacerbations with Tiotropium in COPD trial showed an excess of serious coronary ischaemic events of angina, myocardial ischaemia and MI with the tiotropium Handihaler compared with salmeterol. The authors urge caution in prescribing inhaled anticholinergics for patients with pre-existing arrhythmias or cardiac disorders.

show abstract

Incidence, predictive factors and prognostic significance of supraventricular tachyarrhythmias in congestive heart failure

Cited by 11 publications

References 0 publications

Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications

Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications

Prevalence, Prognostic Significance, and Treatment of Atrial Fibrillation in Congestive Heart Failure With Particular Reference to the DIAMOND‐CHF Study

Republished: Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications

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