Management of Arrhythmias in Heart Failure

Abstract

Heart failure patients are predisposed to develop arrhythmias. Supraventricular arrhythmias can exacerbate the heart failure symptoms by decreasing the effective cardiac output and their control require pharmacological, electrical, or catheter-based intervention. In the setting of atrial flutter or atrial fibrillation, anticoagulation becomes paramount to prevent systemic or cerebral embolism. Patients with heart failure are also prone to develop ventricular arrhythmias that can present a challenge to the managing clinician. The management strategy depends on the type of arrhythmia, the underlying structural heart disease, the severity of heart failure, and the range from optimization of heart failure therapy to catheter ablation. Patients with heart failure, irrespective of ejection fraction are at high risk for developing sudden cardiac death, however risk stratification is a clinical challenge and requires a multiparametric evaluation for identification of patients who should undergo implantation of a cardioverter defibrillator. Finally, patients with heart failure can also develop symptomatic bradycardia, caused by sinus node dysfunction or atrio-ventricular block. The treatment of bradycardia in these patients with pacing is usually straightforward but needs some specific issue.

Impact of Left Ventricular Ejection Fraction on Recurrent Ventricular Tachyarrhythmias in Recipients of Implantable Cardioverter Defibrillators

“…Nevertheless, LVEF remains a reliable predictor of SCD in patients with structural heart disease, irrespective of the underlying aetiology [32]. However, there are still relevant limitations regarding the adequate identification of patients at risk.…”

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

“…Although there are a large number of risk factors identified for sudden cardiac death in heart failure, developing a comprehensive risk stratification strategy remains a clinical challenge that requires the analysis of multiple parameters. 22,29 Currently, there is no combination of tests that can definitively predict arrhythmic events. However, a depressed ejection fraction and symptoms of heart failure are the most consistent predictors of sudden cardiac death.…”

“…However, a depressed ejection fraction and symptoms of heart failure are the most consistent predictors of sudden cardiac death. 29 Indeed, many international guidelines suggest that an ejection fraction <30% in NYHA class I, or <35% in class II and III, is an indication for ICD implantation in heart failure patients. 29 Other parameters that may be useful in risk stratification include T wave alternans, signal-averaged ECG, autonomic tone, and electrophysiology studies or ischaemic substrates.…”

Laser-Doppler flow (LDF) and Heart rate intervals (R-R) as stochastic processes

“…В обоих случаях спектры разбиваются на интервалы, и частоты из этих интервалов, считается, генерируются управляющими воздействиями. Гуморальные, нейрогенные и другие для ЛДФ [1-7], симпатические и парасимпатические нервы для R-R [8][9][10][11][12][13].…”