Patients With Valvular Heart Disease Presenting With Sustained Ventricular Tachyarrhythmias or Syncope

Abstract

Although programmed ventricular stimulation seems to predict adverse outcome, serial drug testing is unreliable in guiding therapy. The type of workload imposed on the ventricles influences outcome, being worse in patients with left ventricular volume overload. Therefore, implantation of a cardioverter-defibrillator should be considered early for the management of these patients.

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

“…[607] wykazali, że możliwość wywołania VT, w połączeniu z przeciążeniem objętościowym LV, pozwala przewidywać incydenty złośliwej arytmii u pacjentów z VT, VF lub omdleniem. Badanie elektrofizjologiczne ma dość duże znaczenie kliniczne u pacjentów, u których po operacji zastawki wystąpił VT. Nawet u 30% pacjentów VT (występujący najczęściej w ciągu miesiąca od operacji) wynikał z reentry w obrębie odnóg pęczka Hisa, a ten rodzaj arytmii jest potencjalnie wyleczalny za pomocą ablacji przezcewnikowej [608].…”

Task Force on Sudden Cardiac Death of the European Society of Cardiology

“…The degree of stenosis (systolic gradient, size of valve opening), amount of calcification and severity of left ventricular hypertrophy can be used to predict the speed of progression of stenosis requiring surgical intervention [389] . However, prediction of SCD based on the presence of frequent and/or complex ventricular arrhythmias, late potentials or reduced heart rate variability is still debated and not of sufficiently strong positive predictive accuracy to be used, e.g., for recommendation of aortic valve replacement [388,[390][391][392][393][394][395][396][397] . In patients with spontaneous sustained ventricular arrhythmias, Martinez-Rubio et al [397] pointed out that inducibility of ventricular tachycardia predicted a higher probability of recurrence of tachyarrhythmic events.…”

Valvuloarterial Impedance, But Not Aortic Stenosis Severity, Predicts Syncope in Patients With Aortic Stenosis

“…However, reports mention that other mechanisms of syncope development in AS exist, such as inappropriate reflex vasodilation, which is possibly mediated by a sudden rise in LV pressure and an increase in LV wall stress, [2][3][4] or primary cardiac arrhythmia. 20 The timing of syncope development and range of syncope history differ with each cause, depending on distinct pathophysiological conditions in the progress of AS. Interestingly, Ross and Braunwald 1 mentioned that the prognostic range of syncope was generally wide, although the average duration for death after syncope is 3 years.…”

“…12 Furthermore, a recent study reported that no correlation was found between AS severity and LV mass index, 21 although LV hypertrophy by itself is associated with sudden death and syncope. 20,22 This may also explain the lack of association between conventional parameters of AS severity and syncope.…”

“…[8][9][10] Patients with chronic pressure overload and LV hypertrophy have increased LV wall stress, subendocardial ischemia, and stimulation of LV baroreceptors, 20 which may lead to hypotension and arrhythmias. From the viewpoint of LV overload, it seems natural that Zva is closely associated with syncope.…”