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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sudden death is common in patients with severe heart failure, but antiarrhythmic drug therapy has potential risks as well as benefits. Programmed electrical stimulation may offer a means of identifying lower risk patients who are less likely to benefit from antiarrhythmic therapy and who could potentially be spared the risk of adverse drug effects. Therefore 72 consecutive patients referred for management of severe heart failure (left ventricular ejection fraction 0.18 +/- 0.06) were studied. The mean age was 47 +/- 12 years; 45 (61%) patients had idiopathic dilated cardiomyopathy and 24 (33%) had coronary artery disease. Fifty-eight (82%) patients had nonsustained ventricular tachycardia. Following adjustment of vasodilators and diuretics, programmed stimulation was performed from the right ventricular apex with one, two, and three extrastimuli. Sustained ventricular tachycardia was initiated in nine (13%) patients and all received chronic antiarrhythmic drug therapy. During follow-up of 176 +/- 187 days, 1 of 13 patients treated for inducible ventricular tachycardia and 13 of 63 noninducible patients died suddenly (p = 0.20). The actuarial risk of sudden death in the noninducible patients was 13% at 6 weeks and 30% at 6 months. The only independent predictors of sudden death were pulmonary artery systolic pressure greater than 55% mm Hg and a pulmonary capillary wedge pressure with vasodilator therapy greater than 16 mm Hg. Of the 63 noninducible patients, 11 (17%) received long-term antiarrhythmic agents due to atrial fibrillation or referring physician preference, and antiarrhythmic therapy was not associated with a lower risk of sudden death in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Inducible ventricular arrhythmias and sudden death during vasodilator therapy of severe heart failure. 319 28

Sustained ventricular tachycardia or fibrillation that develops during the early recovery period after acute myocardial infarction is a common clinical problem whose management remains controversial. Fifty-three patients who survived an initial episode of sustained ventricular tachycardia or fibrillation occurring between 3 and 60 days (mean +/- SD 21 +/- 16) after myocardial infarction were evaluated. Most of these patients had had a large (peak creatine kinase = 1,729 +/- 882 IU) complicated infarction. Forty-two (79%) of the 53 patients had had repetitive sustained ventricular arrhythmias and the condition of 19 of these could not be stabilized with drug therapy. Twenty-eight patients received medical therapy only. Twenty-four survived and were discharged from the hospital. Twenty-five patients underwent infarctectomy or aneurysmectomy either on an emergency basis (16 patients) or electively because of coexistent heart failure or angina (9 patients). Intraoperative mapping was attempted in these patients but was completely successful in only 13 (52%). Operative mortality was 16% with all deaths occurring in patients who were in shock before surgery. Five of 21 surgically treated survivors required long-term antiarrhythmic therapy. Twenty-one of 24 patients medically treated remain alive and well after 15 +/- 10 months of follow-up. Nineteen of 21 surgically treated patients remain alive and well after 17.9 +/- 11 months. One of these patients required reoperation for severe mitral regurgitation. These results confirm the poor medical prognosis of sustained ventricular tachyarrhythmias that present during the first 2 months after myocardial infarction but demonstrate that an acceptable rate of survival can be achieved with a combined medical and surgical approach to therapy.
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PMID:Sustained ventricular tachyarrhythmias within 2 months of acute myocardial infarction: results of medical and surgical therapy in patients resuscitated from the initial episode. 403 Dec 90

Sudden death accounts for about 35% of the mortality of cardiac failure and its incidence does not decrease with the use of angiotensin converting enzyme inhibitors. Non-sustained ventricular tachycardia on Holter monitoring, late ventricular potentials and tachycardia induced by programmed ventricular stimulation have no formal predictive value of sudden death, underlining the varied character of the mechanisms underlying sudden death during cardiac failure. Sustained ventricular tachycardia degenerating to ventricular fibrillation is only one of the rhythmic factors implicated together with inaugural ventricular fibrillation, bradyarrhythmias and electromechanical dissociation. The underlying cardiac disease plays a role in the initiation of the fatal arrhythmia. In coronary artery disease, recurrent acute ischaemia is the principal trigger factor in patients who often have triple vessel disease. This explains the fact that classic markers of arrhythmia in the post-infarction period, which are only the reflection of the arrhythmogenic substrate of ventricular tachycardia, usually due to reentry around the fibrous scar of the infarct, are not valid in patients with progressive ischaemic cardiomyopathy. The most effective antiarrhythmic treatment in this type of patient is the prevention of ischaemia, when possible. In primary dilated cardiomyopathy, the mechanism underlying sudden death could be different at each stage. In NYHA Stages I and II, ventricular tachyarrhythmias could play a major part in unexpected sudden death in patients whose stable haemodynamic status suggested a more prolonged survival. The value of an implantable defibrillator would seem to be proved in this group of patients, at least in secondary prevention. In Stages III and IV, ventricular arrhythmias only indicate the degree of ventricular dysfunction and sudden death may follow bradyarrhythmias and electromechanical dissociation due to the precarious haemodynamic status.
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PMID:[Sudden death and chronic cardiac insufficiency]. 989 14

Cardiac arrest can occur as a complication of acute myocardial infarction (AMI). To date, few studies have described factors associated with cardiac arrest occurrence and survival during hospitalization for treatment of AMI. We used data from a large national registry of hospitalized AMI patients to identify these factors. Data were collected from 1073 participating institutions, representing 14.4% of US hospitals. Hospital site coordinators conducted periodic chart reviews for AMI patients and data were submitted to an independent center for periodic review. Univariate analysis and multivariate logistic regression were used to identify factors associated with cardiac arrest. We found that cardiac arrest occurred in 4.8% (14,725/305,812) of hospitalized AMI patients. The survival rate to hospital discharge for these individuals was 29.4%. Sustained ventricular tachycardia or fibrillation (VT/VF) was present in 34.7% and was associated with a higher rate of survival to hospital discharge compared to cardiac arrest patients without a ventricular tachyarrhythmia (47.5 vs. 19.8%, P < 0.00001). Hypotension (initial systolic BP < 90 mmHg), q-wave AMI, old age, heart failure and initial heart rate abnormalities (bradycardia or tachycardia) were associated with a higher prevalence of cardiac arrest. A higher percentage of women compared to men experienced cardiac arrest (6.0 vs. 4.41%, P < 0.0001). Cardiac arrest prevalence was lower in patients with inferior wall infarction than in other types of ST-elevation infarction. Use of reperfusion therapy (PTCA or tPA) was associated with improved survival compared to hospitalized AMI patients who did not receive such therapy.
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PMID:Factors associated with the occurrence of cardiac arrest during hospitalization for acute myocardial infarction in the second national registry of myocardial infarction in the US. 1142 73

Heart failure is a major public health concern that is frequently complicated by ventricular arrhythmias. Sustained ventricular tachycardia is associated with an increased risk for progressive heart failure and sudden death. We summarize the current management strategies for ventricular tachycardia in heart failure patients, including implantable cardioverter-defibrillator therapy, pharmacologic therapy, catheter ablation techniques, ventricular assist device therapy, and heart transplantation.
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PMID:Treatment of ventricular tachycardia in patients with heart failure. 2144 60

Sustained ventricular tachycardia (VT) is an important cause of morbidity and sudden death in patients with dilated cardiomyopathy. Although ICD effectively terminate VT episodes and improve survival, shocks reduce quality of life, and episodes of VT predict increased risk of heart failure and death despite effective therapy. Patients suffering recurrent VT episodes remain a challenge. Antiarrhytmic therapy reduces VT episodes, but it is associated with serious adverse events, and disappointing efficacy. Catheter ablation has emerged as an important option to control recurrent VT, but major procedure-related complications, and even death, are still issues to concern. And even with these armamentaria, some patients still have recurrent VT episodes and ICD shocks. We report on a patient with non-ischemic dilated cardiomyopathy and recurrent ventricular tachycardia resistant to multiple antiarrhytmic agents, in whom dronedarone was effective in completely suppressing ventricular tachycardia episodes.
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PMID:Dronedarone for recurrent ventricular tachycardia: a real alternative? 2255 46

Lacosamide is a new-generation antiepileptic drug (AED) most commonly used adjunctively in the setting of partial-onset seizures refractory to traditional therapy. We describe the first case report, to our knowledge, of a patient who developed recurrent, sustained ventricular tachycardia with multiple administrations of lacosamide in an acute setting. A 70-year-old woman with a history significant for valvular heart disease was admitted to the inpatient cardiology service for worsening heart failure. On hospital day 7, she received a bioprosthetic aortic valve. Prior to surgery and immediately after, the patient's electrocardiogram (ECG) was normal. After developing multiple generalized tonic-clonic seizures refractory to levetiracetam, fosphenytoin, and valproic acid, the decision was made to initiate lacosamide. Two hours following the second lacosamide dose, the patient developed a wide complex QRS that transitioned into sustained ventricular tachycardia requiring electrical cardioversion. Sustained ventricular tachycardia occurred again, just hours after the third dose of lacosamide was given. Following cessation of lacosamide, the patient's QRS interval normalized and has since had no documented episodes of ventricular tachycardia. Clinicians should be aware of the potential for life-threatening rhythmic disturbances in patients initiated on lacosamide and the need for vigilant ECG, electrolyte, and drug-drug monitoring.
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PMID:Lacosamide-Induced Recurrent Ventricular Tachycardia in the Acute Care Setting. 2834 43