Tachyarrhythmias and Heart Failure

Journal of Clinical and Basic Cardiology 2001; 4 (2): 115-122

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Keywords: Arrhythmie,  Herzinsuffizienz,  implantierbarer Kardioverter-Defibrillator,  Mortalität,  Proarrhythmie,  arrhythmia,  heart failure,  implantable cardioverter defibrillator,  mortality,  proarrhythmia

Cardiac arrhythmias are a frequent finding in those with congestive heart failure regardless of aetiology. Atrial fibrillation is common in the natural history of heart failure and is associated with considerable morbidity. The likelihood of potentially lethal ventricular tachyarrhythmias is highest in those with a substrate for arrhythmia propagation and potential trigger factors for initiation. Those with poor left ventricular function secondary to myocardial ischaemia are particularly at risk. The severity of heart failure, both in terms of functional capacity and ejection fraction, has been uniformly found to be a strong independent predictor of mortality. Clinical trials show that pharmacological suppression of arrhythmias in heart failure is associated with disappointing long term results that highlight the potential of proarrhythmia. Non-pharmacological management strategies improve morbidity and mortality. Implantable cardioverter defibrillators have a pivotal role in the treatment of ventricular tachycardia and ventricular fibrillation in this setting.