Skip to main content
SpringerLink
Log in

Nonpharmacologic Therapy for Malignant Ventricular Tachyarrhythmias in Patients with Congestive Heart Failure

  • Conference paper
Heart Failure and Arrhythmias

  • 45 Accesses

Abstract

Malignant ventricular tachyarrhythmias constitute an important cause of sudden cardiac death in patients with congestive heart failure [25]. It is increasingly recognized that despite effective treatment of congestive heart failure, life-threatening ventricular tachyarrhythmias may abbreviate patient survial. The frequency of this complication impacts significantly on the overall clinical outcome of these patients. In some instances, the therapeutic agent chosen for the treatment of congestive heart failure, for example, certain inotropic agents, may actually aggravate the ventricular tachyarrhythmia [23]. Surgical therapy in patients with congestive heart failure is also not immune to this complication. It is well-established that patients who have undergone aortic valve replacement for severe aortic valvular stenosis may experience postoperative sudden cardiac death. Clinical studies have suggested an association with the presence of complex ventricular tachyarrhythmias and nonsustained ventricular tachycardia (VT) on Holter monitoring. Similarly, patients who have undergone visually guided resection of a ventricular aneurysm or non-map-guided surgical resection of ventricular myocardium have a higher risk of recurrent postoperative ventricular tachyarrhythmias than patients who have undergone map-directed operations [40]. Finally, the presence of complex ventricular tachyarrhythmias or nonsustained VT in patients with left ventricular dysfunction due to a variety of anatomic abnormalities is an independent predictor of sudden cardiac death.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. An H, Saksena S, Janssen M, Osypka P (1989) Radiofrequency ablation of ventricular myocardium using active fixation and passive contact catheter delivery systems. Am Heart J 118: 69

    Article  PubMed  CAS  Google Scholar 

  2. Bach SM, Barstad J, Harper N et al. (1989) Initial clinical experience: Endotak-implantable transvenous defibrillator system. J Am Coll Cardiol 13: 65A

    Google Scholar 

  3. Borggrefe M, Budde T, Martinez-Rubio A et al. (1988) Radiofrequency catheter ablation for drug resistant supraventricular tachycardia. Circulation 78 [Suppl II]: 11–305

    Google Scholar 

  4. Borggrefe M, Podczeck A, Ostermeyer J et al. (1987) Long term results of electrophysiolog- ically guided tachycardia surgery in ventricular tachyarrhythmias. A collaborative report on 665 patients. In: Breithardt G, Borggrefe M, Zipes DP (eds) Non-pharmacological therapy of tachyarrhythmias. Futura, Mount Kisco, p 109

    Google Scholar 

  5. Branyas NA, Cain ME, Cassidy DM (1989) Transmural ventricular activation during consecutive cycles of sustained ventricular tachycardia. J Am Coll Cardiol 13: 167A

    Google Scholar 

  6. Calvo RA, Saksena S, Pantopoulos D (1988) Sequential transvenous pacing and shock therapy for termination of sustained ventricular tachycardia. Am Heart J 115: 569

    Article  PubMed  CAS  Google Scholar 

  7. Camm AJ, Ward DE, Spurell RAJ et al. (1980) Cryothermal mapping and cryoablation in the treatment of refractory cardiac arrhythmias. Circulation 62: 67

    PubMed  CAS  Google Scholar 

  8. CASS principal investigators and their associates (1983) Coronary artery surgery study (CASS): A randomized trial of coronary artery bypass surgery survival data. Circulation 68: 939

    Article  Google Scholar 

  9. Ciccone JM, Saksena S, Shah Y et al. (1985) A prospective, randomized study of the clinical efficacy and safety of transvenous cardioversion for ventricular tachycardia termination. Circulation 71: 571

    Article  PubMed  CAS  Google Scholar 

  10. DePaola AAV, Horowitz LN, Morganroth J, Senior S, Spielman SR, Greenspan AM, Kay HR (1987) Influence of left ventricular dysfunction on flecainide therapy. J Am Coll Cardiol 9: 163

    Article  CAS  Google Scholar 

  11. Downar E, Mickleborough LL, Harris L et al. (1986) Mapping of endocardial activation during ventricular tachycardia - a “closed heart” procedure. J Am Coll Cardiol 7: 234

    Article  Google Scholar 

  12. ESVEM Investigators (1989) The ESVEM trial: electrophysiologic study versus electrocardiographic monitoring for selection of antiarrhythmic therapy of ventricular tachyarrhythmias. Circulation 79: 1354

    Article  Google Scholar 

  13. Evans GT Jr, Scheinman MM (1987) The percutaneous cardiac mapping and ablation registry: summary of results. PACE 10: 1395

    Article  PubMed  Google Scholar 

  14. Fisher JD, Kim SG, Matos JA et al. (1983) Comparative effectiveness of pacing techniques for termination of well-tolerated sustained ventricular tachycardia. PACE 6: 915

    Article  PubMed  CAS  Google Scholar 

  15. Follansbee WP, Michelson EL, Morganroth J (1980) Nonsustained ventricular tachycardia in ambulatory patients: characteristics and association with sudden cardiac death. Ann Intern Med 92: 741

    PubMed  CAS  Google Scholar 

  16. Gallagher JJ, Svenson RH, Kasell JH et al. (1982) Catheter technique for closed chest ablation of the atrioventricular conduction system. A therapeutic alternative for the treatment of refractory supraventricular tachycardia. N Engl J Med 306: 194

    Article  PubMed  CAS  Google Scholar 

  17. Huang SK, Bharati S, Graham AR etal. (1987) Closed chest catheter desiccation of the atrioventricular junction using radiofrequency energy - a new method of catheter ablation. J Am Coll Cardiol 9: 349

    Article  PubMed  CAS  Google Scholar 

  18. Josephson ME, Horowitz LN, Farshid A (1978) Recurrent sustained ventricular tachycardia. 2. Endocardial mapping. Circulation 57: 440

    Google Scholar 

  19. Josephson ME, Harken AH, Horowitz LN (1979) Endocardial excision: a new surgical technique for the treatment of recurrent ventricular tachycardia. Circulation 60: 1430

    PubMed  CAS  Google Scholar 

  20. La very S, Saksena S (1987) Management of refractory sustained ventricular tachycardia with amiodarone: a reappraisal. Am Heart J 113: 49

    Article  PubMed  CAS  Google Scholar 

  21. Lindsay BD, Saksena S, Rothbart ST etal. (1987) Prospective evaluation of a sequential pacing and high-energy bidirectional shock algorithm for transvenous cardioversion in patients with ventricular tachycardia. Circulation 76: 601

    Article  PubMed  CAS  Google Scholar 

  22. Miller JM, Kienzle MG, Harken AH et al. (1984) Subendocardial resection for ventricular tachycardia: predictors of surgical success. Circulation 70: 624

    Article  PubMed  CAS  Google Scholar 

  23. Milrinone Multicenter Trial Group (1989) A comparison of oral milrinone, digoxin, and their combination in the treatment of patients with chronic heart failure. N Engl J Med 320: 677

    Article  Google Scholar 

  24. Mirowski M, Reid PR, Mower MM et al. (1980) Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 303: 322

    Article  PubMed  CAS  Google Scholar 

  25. Packer M (1985) Sudden unexpected death in patients with congestive heart failure: a second frontier. Circulation 72: 681

    Article  PubMed  CAS  Google Scholar 

  26. Saksena S (1989) Catheter ablation of tachycardias with laser energy: issues and answers. PACE 12: 196

    Article  PubMed  CAS  Google Scholar 

  27. Saksena S, An HL (1990) Clinical efficacy of dual electrode systems for endocardial cardioversion of ventricular tachycardia: a prospective randomized crossover trial. Am Heart J 119: 15

    Article  PubMed  CAS  Google Scholar 

  28. Saksena S, Calvo R (1985) Transvenous cardioversion and defibrillation of ventricular tachyarrhythmias: current status and future directions. PAGE 8: 715

    CAS  Google Scholar 

  29. Saksena S, Gadhoke A (1986) Laser therapy for tachyarrhythmias: a new frontier. PACE 9: 531

    Article  PubMed  CAS  Google Scholar 

  30. Saksena S, Gielchinsky I (1988) Intraoperative selection of laser ablation site in patients with sustained ventricular tachycardia. PACE 11: 528

    Google Scholar 

  31. Saksena S, Parsonnet V (1988) Implantation of a cardioverter/defibrillator without thoracotomy using a triple electrode system. JAMA 259: 69

    Article  PubMed  CAS  Google Scholar 

  32. Saksena S, Chandran P, Shah Y et al. (1985) Comparative efficacy of transvenous cardioversion and pacing in patients with sustained ventricular tachycardia: a prospective randomized crossover study. Circulation 72: 153

    Article  PubMed  CAS  Google Scholar 

  33. Saksena S, Ciccone J, Chandran P et al. (1986) Laser ablation of normal and diseased human ventricle. Am Heart J 112: 52

    Article  PubMed  CAS  Google Scholar 

  34. Saksena S, Hussain SM, Wasty N et al. (1986) Long-term efficacy of subendocardial resection in refractory ventricular tachycardia: relationship to site of arrhythmia origin. Ann Thorac Surg 42: 685

    Article  PubMed  CAS  Google Scholar 

  35. Saksena S, Calvo RA, Pantopoulos D et al. (1987) A prospective evaluation of single and dual current pathways for transvenous cardioversion in rapid ventricular tachycardia. PACE 10: 1130

    Article  PubMed  CAS  Google Scholar 

  36. Saksena S, Hussain SM, Gielchinsky I et al. (1987) Intraoperative mapping-guided argon laser ablation of malignant ventricular tachycardia. Am J Cardiol 59: 78

    Article  PubMed  CAS  Google Scholar 

  37. Saksena S, Lindsay BD, Parsonnet V (1987) Development of future implantable cardioverters and defibrillators. PACE 10: 1342

    Article  PubMed  CAS  Google Scholar 

  38. Saksena S, Pantopoulos D, Hussain SM et al. (1987) Mechanisms of ventricular tachycardia termination and acceleration during transvenous cardioversion as determined by cardiac mapping in man. Am Heart J 113: 1495

    Article  PubMed  CAS  Google Scholar 

  39. Saksena S, Tarjan PP, Bharati S et al. (1987) Low energy transvenous ablation of the atrioventricular conduction system using a suction electrode catheter. Circulation 76: 394

    Article  PubMed  CAS  Google Scholar 

  40. Saksena S, Hussain SM, Gielchinsky I (1988) Surgical ablation of tachyarrhythmias: reflections for the third decade (editorial). PACE 11: 103

    Article  PubMed  CAS  Google Scholar 

  41. Saksena S, Gielchinsky I, Tullo NG (1989) Argon laser ablation of malignant ventricular tachycardia associated with coronary artery disease. Am J Cardiol 64: 1298

    Article  PubMed  CAS  Google Scholar 

  42. Saksena S, Scott S, Accorti P et al. (1989) Improved pacing and internal defibrillation using a porous electrode catheter with biphasic unidirectional and bidirectional shocks. PACE 12 (1): 663

    Article  Google Scholar 

  43. Saksena S, Tullo NG, Krol RB etal. (1989) Initial clinical experience with endocardial defibrillation using an implantable cardioverter/defibrillator with a triple electrode system. Arch Intern Med 149: 2333

    Article  PubMed  CAS  Google Scholar 

  44. Scheinman MM, Morady F, Hess DS et al. (1982) Catheter induced ablation of the atrioventricular junction to control refractory supraventricular arrhythmias. JAMA 248: 851

    Article  PubMed  CAS  Google Scholar 

  45. Thomas A, Moser SA, Smutka ML et al. (1988) Implantable defibrillation: eight year clinical experience. PACE 11: 2053

    Article  PubMed  CAS  Google Scholar 

  46. Tullo NG, An H, Saksena S (1989) Ablation using radiofrequency current and low energy D.C. shocks. In: Saksena S, Goldschlager N (eds) Textbook of electrical therapy for cardiac arrhythmias. Saunders, Philadelphia

    Google Scholar 

  47. Vedel J, Frank R, Fontaine G et al. (1979) Bloc auriculo-ventriculaire intra-Hisien définitif induit au cours d’une exploration endoventriculaire droite. Arch Mal Coeur 72: 107

    PubMed  CAS  Google Scholar 

  48. Veltri EP, Reid PR, Platia EV, Griffith LSC (1985) Amiodarone in the treatment of life- threatening ventricular tachycardia: role of Holter monitoring in predicting long-term clinical efficacy. J Am Coll Cardiol 6: 806

    Article  PubMed  CAS  Google Scholar 

  49. Warm JF, Hassaguerre M, Lemetayer P et al. (1988) Catheter ablation of accessory pathways with a direct approach. Circulation 78: 800

    Article  Google Scholar 

  50. Wilber DJ, Garan H, Finkelstein D et al. (1988) Out of hospital cardiac arrest: use of electrophysiologic testing in the prediction of long-term outcome. N Engl J Med 38: 19

    Article  Google Scholar 

  51. Zipes DP, Jackman WM, Heger JJ (1982) Clinical transvenous cardioversion of recurrent life-threatening tachyarrhythmias: low energy synchronized cardioversion of ventricular tachycardia and termination of ventricular fibrillation in patients using a catheter electrode. Am Heart J 103: 789

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. S. Saksena
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Internal Medicine III, Cardiology, Medizinische Universitätsklinik, Bergheimer Str. 58, 6900, Heidelberg, Germany

    Johannes Brachmann MD , Rainer Dietz MD  & Wolfgang Kübler MD ,  & 

Rights and permissions

Reprints and permissions

Copyright information

© 1990 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Saksena, S. (1990). Nonpharmacologic Therapy for Malignant Ventricular Tachyarrhythmias in Patients with Congestive Heart Failure. In: Brachmann, J., Dietz, R., Kübler, W. (eds) Heart Failure and Arrhythmias. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-75326-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-75326-8_16

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-75328-2

  • Online ISBN: 978-3-642-75326-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation