Drug Investigation

, Volume 5, Issue 3, pp 141–153

Heart Failure and Ventricular Arrhythmias

Prognostic Indices of Mortality and Therapeutic Options
  • Sergio Morelli
  • Francesco Cardoni
  • Claudio Ferri
  • Vincenzo Guido
  • Marianna Suppa
  • Claudio Perrone
  • Paolo De Marzio
Review Article

Summary

Patients with chronic heart failure show a high incidence of complex ventricular ectopic activity and high mortality, with an average sudden death rate of 46%. Given the close relationship between ventricular ectopic activity and left ventricular function, it is difficult to determine whether the ventricular ectopic activity has independent prognostic significance in patients with chronic heart failure. Notwithstanding, several large scale clinical studies have shown that left ventricular dysfunction is the first independent prognostic index in patients with ischaemic or dilative idiopathic cardiomyopathy. Therefore, potentially reversible causes of arrhythmia should be diagnosed and if necessary corrected. Electrophysiological testing and noninvasive techniques are used for evaluating arrhythmia mechanisms and establishing drug efficacy. Empirical therapy of potentially malignant ventricular arrhythmias in patients with ischaemic or dilative idiopathic cardiomyopathy has proved unsatisfactory because of both the inadequate control obtained and the increasing evidence that antiarrhythmic drugs are arrhythmogenic. In selected groups of patients, however, empirical therapy with amiodarone may reduce the frequency and complexity of the ventricular ectopic activity and incidence of sudden death. The use of drugs with an indirect antiarrhythmic action, such as β-blockers and angiotensin converting enzyme (ACE) inhibitors, has been shown to decrease the mortality and incidence of sudden cardiac death in some groups of patients with chronic heart failure. A further step forward in the treatment of patients at high risk of sudden death is represented by nonpharmacological therapy, i.e. excision of aneurysm, surgical or electrical ablation of arrhythmogenic foci, and use of automatic implantable cardioverter defibrillators.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abrahm AS, Rosenmann D, Kramer M, Balkin J, Zion MM, et al. Magnesium in the prevention of lethal arrhythmias in acute myocardial infarction. Archives of Internal Medicine 147: 753–755, 1987Google Scholar
  2. Anderson J, Lutz JR, Gilbert EM, Sorenson SG, Yanowitz FG, et al. A randomized trial of low dose β blockade therapy for idiopathic dilated cardiomyopathy. American Journal of Cardiology 55: 471–475, 1985PubMedGoogle Scholar
  3. Aronow WS, Mercando AD, Epstein S, Kronzon I. Effect of quinidine or procainamide versus no antiarrhythmic drug on sudden cardiac death, total cardiac death and total death in elderly patients with heart disease and complex ventricular arrhythmias. American Journal of Cardiology 66: 423–428, 1990PubMedGoogle Scholar
  4. Arons RS. Afterpotentials and triggered activity in hypertrophied myocardium from rat renal hypertension. Circulation Research 48: 720–727, 1981Google Scholar
  5. Bauman JL, Berk SI, Herman RJ. Amiodarone for sustained ventricular tachycardia: efficacy, safety and factors influencing long-term outcome. American Heart Journal 114: 1436–1444, 1987PubMedGoogle Scholar
  6. Bigger Jr JT. Why patients with congestive heart failure die: arrhythmias and sudden cardiac death. Circulation 75 (Suppl. IV): 28–35, 1987Google Scholar
  7. Bigger Jr JT, Fleiss JL, Kleiger R, Miller JP, Rolnitzky LM, and the Multicenter Post-Infarction Research Group. The relationship among ventricular arrhythmias, left ventricular dysfunction and mortality in the two years after myocardial infarction. Circulation 69: 250–258, 1984PubMedGoogle Scholar
  8. Bigger Jr JT, Fleiss JL, Roldnitzky LM, Merab JB, Ferrick KJ. Effect of digitalis treatment on survival after acute myocardial infarction. American Journal of Cardiology 55: 623–630, 1985PubMedGoogle Scholar
  9. Boullin DJ. The action of extracellular cations on the release of the sympathetic transmitter from peripheral nerves. Journal of Physiology 189: 85–99, 1967PubMedGoogle Scholar
  10. Breithardt G, Borggrefe M. Recent advances in the identification of patients at risk of ventricular tachyarrhythmias: role of late ventricular potentials. Circulation 75: 1091–1096, 1987PubMedGoogle Scholar
  11. Brown MJ, Brown DC, Murphy MB. Hypokalemia from β2-receptor stimulation by circulating epinephrine. New England Journal of Medicine 309: 1414–1419, 1983PubMedGoogle Scholar
  12. Burkart F, Pfisterer M, Kiowski W, Follath F, Burckhardt D. Effect of antiarrhythmic therapy on mortality in survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias: Basel Antiarrhythmic Study of Infarct Survival (BASIS). Journal of American College of Cardiology 16: 1711–1718, 1990Google Scholar
  13. Campbell RWF, Achuff SC, Pottage A, Murray A, Prescott LF, et al. Mexiletine in the prophylaxis of the ventricular arrhythmias during acute myocardial infarction. Journal of Cardiovascular Pharmacology 1: 43–52, 1979PubMedGoogle Scholar
  14. Captopril-Digoxin Multicenter Research Group. Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure. Journal of the American Medical Association 59: 539–544, 1988Google Scholar
  15. Cardiac Arrhythmia Suppression Trial (CAST) Investigators Preliminary report: Effect of encainide and flecainide on mortality in randomized trial of arrhythmia suppression after myocardial infarction. New England Journal of Medicine 321: 406–412, 1989Google Scholar
  16. Cardiac Arrhythmia Suppression Trial (CAST) II Investigators. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. New England Journal of Medicine 327: 227–233, 1992Google Scholar
  17. Ceremuzynsky L, Kleczar E, Krzeminska-Pakula M, Kuch J, Nartowicz E. Effect of amiodarone on mortality after myocardial infarction: a double-blind, placebo-controlled, pilot study. Journal of American College of Cardiology 20: 1056–1062, 1992Google Scholar
  18. Chadda K, Ballas M, Bodenheimer MM. Efficacy of magnesium replacement in patients with hypomagnesemia and cardiac arrhythmia. Abstract. Circulation 70 (Suppl.): 11–444, 1984Google Scholar
  19. Chadda K, Goldstein S, Byington S, Curb JD. The effect of propranolol therapy following acute myocardial infarction in patients with congestive heart failure. Circulation 73: 503–510, 1986PubMedGoogle Scholar
  20. Chakko CS, Gheorghiade M. Ventricular arrhythmias in severe heart failure: incidence, significance and effectiveness of antiarrhythmic therapy. American Heart Journal 109: 497–504, 1985PubMedGoogle Scholar
  21. Chamberlain DA, Julian DJ, Boyle D McC, Jewitt DE, Campbell RWS, et al. Oral mexiletine in high-risk patients after myocardial infarction. Lancet 2: 1324–1327, 1980PubMedGoogle Scholar
  22. Chew CYC, Hecht HS, Collect JT. Influence of severity of ventricular dysfunction on haemodynamic responses to intravenously administered verapamil in ischemic heart disease. American Journal of Cardiology 47: 917–922, 1981PubMedGoogle Scholar
  23. Cleland JGF, Dargie HJ, Hodsman GP, Ball SG, Robertson JIS, et al. Captopril in heart failure. A double-blind controlled trial. British Heart Journal 52: 530–535, 1984PubMedGoogle Scholar
  24. Cleland JGF, Dargie HJ, Findlay IN, Wilson JT. Clinical, haemodynamic effects of long-term treatment with amiodarone of patients in heart failure. British Heart Journal 57: 436–445, 1987PubMedGoogle Scholar
  25. Cohn JN, Levine TB, Olivari MT, Garberg W, Lura D, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. New England Journal of Medicine 311: 819–823, 1984PubMedGoogle Scholar
  26. Collaborative Group. Phenytoin after recovery from myocardial infarction, controlled trial in 568 patients. Lancet 2: 1055–1057, 1971Google Scholar
  27. CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). New England Journal of Medicine 316: 1429–1435, 1987Google Scholar
  28. Costanzo-Nordin MR, O’Connell JB, Engelmeier RS, Moran JF, Scanlon PJ. Dilated cardiomyopathy: functional status, hemodynamics, arrhythmias and prognosis. Catheterization and Cardiovascular Diagnosis 11: 445–453, 1985PubMedGoogle Scholar
  29. Cox JL. The status of surgery of cardiac arrhythmias. Circulation 71: 413–418, 1985PubMedGoogle Scholar
  30. Dargie HJ, Cleland JGF, Leckie BJ, Inglis CG, East BW, et al. Relation of arrhythmias and electrolyte abnormalities to survival in patients with severe chronic heart failure. Circulation 75 (Suppl. IV): 98–107, 1987Google Scholar
  31. Di Bianco R, Shabetai R, Kostuk W, Moran J, Schlant R, et al. A comparison of oral milrinone, digoxin and their combination in the treatment of patients with chronic heart failure. New England Journal of Medicine 320: 677–683, 1989Google Scholar
  32. Dyckner T, Wester PO. Diuretic treatment and magnesium loss. Acta Medica Scandinavica 647 (Suppl.): 145–152, 1981PubMedGoogle Scholar
  33. Echt DS, Armstrong K, Schmidt P, Oyer PE, Stinson EB, et al. Clinical experience, complications and survival in 70 patients with the automatic implantable cardioverter-defibrillator. Circulation 71: 289–296, 1985PubMedGoogle Scholar
  34. Engelmeier RS, O’Connell JB, Walsh R, Rad N, Scanlon PF, et al. Improvement in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: a doubleblind randomized, placebo-controlled trial. Circulation 72: 536–546, 1985PubMedGoogle Scholar
  35. ESVEM Investigation. The ESVEM Trial. Electrophysiologic study versus electrocardiographic monitoring for selection of antiarrhythmic therapy of ventricular tachyarrhythmias. Circulation 79: 1354–1360, 1989Google Scholar
  36. Fenoglio Jr GG, Pham TD, Harken AH, Horowitz LN, Josephson ME, et al. Recurrent sustained ventricular tachycardia: structure and ultrastructure of subendocardial regions in which tachycardia originates. Circulation 68: 518–533, 1983PubMedGoogle Scholar
  37. Ferrick KJ, Fein SA, Ferrick AM, Doyle JT. Effect of milrinone on ventricular arrhythmias in congestive heart failure. American Journal of Cardiology 65: 431–434, 1990Google Scholar
  38. Figulla HR, Rechenberg JV, Wiegand V, Soballa R, Krenger H. Beneficial effects of long-term diltiazem treatment in dilated cardiomyopathy. Journal of American College of Cardiology 13: 653–658, 1989Google Scholar
  39. Flink EB. Hypomagnesemia in patients receiving digitalis. Archives of Internal Medicine 145: 625–626, 1985PubMedGoogle Scholar
  40. Follansbee WP, Michelson EL, Morganroth J. Nonsustained ventricular tachycardia in ambulatory patients: characteristics and association with sudden cardiac death. Annals of Internal Medicine 92: 741–747, 1980PubMedGoogle Scholar
  41. Franciosa JA, Wilen M, Ziesche S, Cohn JN. Survival in men with severe chronic left ventricular failure due to either coronary heart disease or idiopathic dilated cardiomyopathy. American Journal of Cardiology 51: 831–836, 1983PubMedGoogle Scholar
  42. Francis GS. Development of arrhythmias in the patient with congestive heart failure: pathophysiology, prevalence and prognosis. American Journal of Cardiology 57: 3B–7B, 1986PubMedGoogle Scholar
  43. Frommer PL, Furber C. β-Blocking drugs in the prevention of sudden cardiac death. In Morganroth & Horowitz (Eds) Sudden Cardiac Death, pp. 249–256, Grune and Stratton, Orlando, USA, 1985Google Scholar
  44. Gilbert EM, Anderson JL, Deitchman D, Yanowitz FG, O’Connell JB, et al. Long-term β-blocker vasodilator therapy improves cardiac function in idiopathic dilated cardiomyopathy: a doubleblind, randomized study of bucindolol versus placebo. American Journal of Medicine 88: 223–239, 1990PubMedGoogle Scholar
  45. Gomes JAC, Hariman RI, Kang PS, El-Sherif N, Chowdry I, et al. Programmed electrical stimulation in patients with high-grade ventricular ectopy: electrophysiologic findings and prognosis for survival. Circulation 70: 43–51, 1984PubMedGoogle Scholar
  46. Gomes JA, Winters SL, Stuart D, Horowitz S, Milner M, et al. A new non invasive index to predict sustained ventricular tachycardia and sudden death in the first year after myocardial infarction: based on signal-averaged electrocardiogram, radionuclide ejection fraction and Holter monitoring. Journal of the American College of Cardiology 10: 349–357, 1987PubMedGoogle Scholar
  47. Gottlieb SH, Achuff SC, Mellits ED. Prophylactic antiarrhythmic therapy of high risk survivors of myocardial infarction: lower mortality at 1 month but not at 1 year. Circulation 75: 792–799, 1987PubMedGoogle Scholar
  48. Graboys TB, Lown B, Podrid PJ, De Silva R. Long-term survival of patients with malignant ventricular arrhythmias treated with antiarrhythmia drugs. American Journal of Cardiology 50: 437–443, 1982PubMedGoogle Scholar
  49. Hamer AWF, Arkles LB, Johns JA. Beneficial effects of low dose amiodarone in patients with congestive cardiac failure: a placebo-controlled trial. Journal of the American College of Cardiology 14: 1768–1774, 1989PubMedGoogle Scholar
  50. Heger JJ, Prystowsky EN, Jackman WM, Naccarelli GV, Warfel KA, et al. Clinical efficacy and electrophysiology during long-term therapy for recurrent ventricular tachycardia of ventricular fibrillation. New England Journal of Medicine 305: 539–545, 1981PubMedGoogle Scholar
  51. Hjalmarson A, Herlitz J, Malek I, Ryden L, Vedin A, et al. Effect on mortality of metoprolol in acute myocardial infarction. Lancet 2: 823–827, 1981PubMedGoogle Scholar
  52. Holmes J, Kubo SH, Cody RJ, Kligfield P. Arrhythmias in ischemic and non ischemic dilated cardiomyopathy: prediction of mortality by ambulatory electrocardiography. American Journal of Cardiology 55: 146–151, 1985PubMedGoogle Scholar
  53. Huang SK, Messer JW, Denes P. Significance of ventricular tachycardia in dilated cardiomyopathy: observations in 35 patients. American Journal of Cardiology 51: 507–512, 1983PubMedGoogle Scholar
  54. Hugenholtz PG, Hagemeijer F, Lubsen J, Glazer B, Van Durme JP, et al. One-year follow-up in patients with persistent ventricular dysrhythmias after myocardial infarction treated with aprindine or placebo. In Sandoe et al. (Eds) Management of ventricular tachycardia. Role of mexiletine, pp. 572–578, Excerpta Medica, Amsterdam-Oxford, 1978Google Scholar
  55. IMPACT Research Group. I. Report on arrhythmia and other findings. Journal of American College of Cardiology 4: 1148–1163, 1984Google Scholar
  56. Iseri LT, Freed J, Bures AR. Magnesium deficiency and cardiac disorders. American Journal of Medicine 58: 837–846, 1975PubMedGoogle Scholar
  57. Jennings G, Jones MBS, Besterman EMM, Model DG, Turner PP, et al. Oral disopyramide in prophylaxis of arrhythmias following myocardial infarction. Lancet 1: 51–54, 1976PubMedGoogle Scholar
  58. Johannsson BW. Hypokalemia in cardiac decompensation. Acta Pharmacologica et Toxicologica 54 (Suppl. I): 103–106, 1984Google Scholar
  59. Josephson ME, Harken AH, Horowitz LN. Long-term results of endocardial resection for sustained ventricular tachycardia in coronary disease patients. American Heart Journal 104: 5157, 1982Google Scholar
  60. Kostis JB, Bayington R, Friedman LM, Golstein S, Furberg C and the Beta Blocker Heart Attack Trial (BHAT) Study Group. Prognostic significance of ventricular ectopic activity in survivors of acute myocardial infarction. Journal of the American College of Cardiology 10: 231–242, 1987PubMedGoogle Scholar
  61. Lab MJ. Brief reviews: contraction-excitation feed back in myocardium: physiological basis and clinical relevance. Circulation Research 50: 757–766, 1982PubMedGoogle Scholar
  62. Lee WH, Packer M. Prognostic value of the serum sodium concentration in severe heart failure and its modification by converting enzyme inhibition. Circulation 70 (Suppl. II): 113, 1984Google Scholar
  63. Levine TB, Francis GS, Goldsmith S, Cohn JN. The neurohumoral and hemodynamic response to orthostatic tilt in patients with congestive heart failure. Circulation 67: 1070–1075, 1983PubMedGoogle Scholar
  64. Lun M, Stevenson WG, Warner Stevenson L, Baron K, Waiden J. Diverse mechanisms of unexpected cardiac arrest in advanced heart failure. Circulation 80: 1675–1680, 1989Google Scholar
  65. Madsen EB, Gilpin E, Henning H, Ahoore S, Le Winter M, et al. Prognostic importance of digitalis after acute myocardial infarction. Journal of the American College of Cardiology 3: 681–689, 1984PubMedGoogle Scholar
  66. Maron BJ, Savage DD, Wolfson JK, Epstein SE. Prognostic significance of 24-hour ambulatory electrographic monitoring in patients with hypertrophic cardiomyopathy: a prospective study. American Journal of Cardiology 48: 252–257, 1981PubMedGoogle Scholar
  67. Maskin CS, Siskind SJ, Lejemtel TH. High prevalence of nonsustained ventricular tachycardia in severe congestive heart failure. American Heart Journal 107: 896–901, 1984PubMedGoogle Scholar
  68. Massie B, Ports T, Chatterjee K, Parmely W, Ostland J, et al. Long term vasodilator therapy for heart failure: clinical response and its relationship to haemodynamic measurements. Circulation 63: 269–278, 1981PubMedGoogle Scholar
  69. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure. New England Journal of Medicine 285: 1441–1446, 1971PubMedGoogle Scholar
  70. Meinertz T, Hoffmann T, Kasper W, Treese N, Bechtold H, et al. Significance of ventricular arrhythmias in idiopathic dilated cardiomyopathy. American Journal of Cardiology 53: 902–907, 1984PubMedGoogle Scholar
  71. Meizlish JL, Berger HJ, Lankey M, Errico D, Levy W, et al. Functional left ventricular aneurysm formation after acute anterior transmural infarction: incidence, natural history and prognostic implications. New England Journal of Medicine 31: 1001–1006, 1984Google Scholar
  72. Milner PG, Platia EV, Reid PR, Griffith LSC. Ambulatory electrocardiographic recordings at the time of fatal cardiac arrest. American Journal of Cardiology 56: 588–592. 1985PubMedGoogle Scholar
  73. Moss AJ, Davis HT, Conrad DL, De Camilla JJ, Odoroff CL. Digitalis associated cardiac mortality after myocardial infarction. Circulation 64: 1150–1156, 1981PubMedGoogle Scholar
  74. Mukharji J, Rude RE, Pule K. Multicenter Investigation of the Limitation of Infarct Size (MILIS): Late sudden death following acute myocardial infarction: Importance of combined presence of repetitive ventricular ectopy and left ventricular dysfunction. Clinic Research 30: 108A, 1982Google Scholar
  75. Mukharji J, Rude RE, Pool WK, Gustafson N, Thomas Jr LJ, et al. and the MILIS Study Group. Risk factors for sudden death after acute myocardial infarction: two years follow-up. American Journal of Cardiology 54: 31–36, 1984PubMedGoogle Scholar
  76. Muller JE, Turi ZG, Stone PH, Rude RE, Raabe DS, et al. and the MILIS Study Group. Digoxin therapy and mortality after myocardial infarction. New England Journal of Medicine 314: 265–271, 1986PubMedGoogle Scholar
  77. Multicenter Diltiazem Postinfarction Research Group. The effect of diltiazem on mortality and reinfarction after myocardial infarction. New England Journal of Medicine 319: 358–392, 1988Google Scholar
  78. Multiple Risk Factor Intervention Trial Research Group. Multiple Risk Factor Intervention Trial (MRFIT): risk factor changes and mortality results. Journal of the American Medical Association 248: 1465–1477, 1982Google Scholar
  79. Neri M, Maestroni L, Salvi A, Pandullo C, Camerini F. Ventricular arrhythmias in dilated cardiomyopathy: efficacy of amiodarone. American Heart Journal 113: 707–715, 1987PubMedGoogle Scholar
  80. Nicklas JM, Mickelson JK, Das SK, Morady F, Schort MA, et al. Prospective, randomized, double-blind, placebo-controlled trial of low dose amiodarone in patients with severe heart failure and frequent ventricular ectopy. Abstract. Circulation 78 (Suppl. II): 27, 1988Google Scholar
  81. Opherk D, Mall G, Zebech H, Schwarz F, Weihe F, et al. Reduction of coronary reserve: a mechanism for angina pectoris in patients with arterial hypertension and normal coronary arteries. Circulation 69: 1–7, 1984PubMedGoogle Scholar
  82. Packer M. Sudden unexpected death in patients with congestive heart failure: a second frontier. Circulation 72: 681–685, 1985PubMedGoogle Scholar
  83. Packer M, Gottlieb SS, Kessler PD. Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Basis of a new physiologic approach to control of arrhythmia. American Journal of Medicine 80: 23–29, 1986PubMedGoogle Scholar
  84. Packer M, Medina M, Yushak M. Haemodynamic and clinical limitations of long-term inotropic therapy with amrinone in patients with severe chronic heart failure. Circulation 70: 1038–1047, 1984PubMedGoogle Scholar
  85. Parmley W, Chatterjee K. Congestive heart failure and arrhythmias: an overview. American Journal of Cardiology 57: 34B–37B, 1986PubMedGoogle Scholar
  86. Peter T, Ross D, Duffield A. Effect on survival after myocardial infarction of long-term treatment with phenytoin. British Heart Journal 40: 1356–1360, 1978PubMedGoogle Scholar
  87. Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. New England Journal of Medicine 327: 669–677, 1992PubMedGoogle Scholar
  88. Pitt B. Evaluation of the patient with congestive heart failure and ventricular arrhythmias. American Journal of Cardiology 57: 19B–24B, 1986PubMedGoogle Scholar
  89. Podrid PJ. Aggravation of ventricular arrhythmia. A drug induced complication. Drugs 29 (Suppl. IV): 33–44, 1985PubMedGoogle Scholar
  90. Ravid S, Podrid PJ, Lampert S, Lown B. Congestive heart failure induced by six of the newer anthyarrhythmic drugs. Journal of American College of Cardiology 14: 1326–1330, 1989Google Scholar
  91. Renqvist N. Ventricular arrhythmias prior to discharge and one year after acute myocardial infarction. European Journal of Cardiology 4: 63–70, 1976Google Scholar
  92. Ryan TJ, Bailey KR, McCabe CH, Luk S, Fisher LD, et al. The effect of digitalis on survival in high-risk patients with coronary artery disease (CASS). Circulation 67: 735–742, 1983PubMedGoogle Scholar
  93. Ryden L, Amman K, Conradson TB, Ofvendhal S, Mortensen O, et al. Prophylaxis of ventricular tachyarrhythmias with intravenous and oral tocainide in patients with and recovering from acute myocardial infarction. American Heart Journal 100: 1006–1012, 1980PubMedGoogle Scholar
  94. Sakurai T, Kawai C. Sudden death in idiopathic cardiomiopathy. Japanese Circulation Journal 47: 581–585, 1983PubMedGoogle Scholar
  95. Savage DD, Seides SF, Maron BJ, Myers DJ, Epstein SE. Prevalence of arrhythmias during 24-hour electrocardiographic monitoring and exercise testing in patients with obstructive and non obstructive hypertrophic cardiomyopathy. Circulation 59: 866–875, 1979PubMedGoogle Scholar
  96. Schaeffer WA, Cobb LA. Recurrent ventricular fibrillation and modes of death in survivors of out-hospital ventricular fibrillation. New England Journal of Medicine 293: 259–262, 1974Google Scholar
  97. Scheinmann MM, Davis JC. Catheter ablation for treatment of tachyarrhythmias: present role and potential promise. Circulation 73: 10–13, 1986Google Scholar
  98. Schultze RA Jr, Rouleau J, Rigo P, Bowers S, Strauss HV, et al. Ventricular arrhythmias in the late hospital phase of acute myocardial infarction: relation of left ventricular function detected by gated cardiac blood pool scanning. Circulation 52: 1006–1011, 1975Google Scholar
  99. Skale BT, Miles WM, Heger JJ, Zipers DP, Prystowsky EN. Survivors of cardiac arrest: prevention of recurrence by drug therapy as predicted by electrophysiologic testing or electrocardiographic monitoring. American Journal of Cardiology 57: 113–119, 1986PubMedGoogle Scholar
  100. SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure. New England Journal of Medicine 325: 293–302, 1991Google Scholar
  101. SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. New England Journal of Medicine 327: 685–691, 1992Google Scholar
  102. Strasberg B, Kusniec J, Zlotiamien B, Mager A, Sclavorsky S. Long-term follow-up of postmyocardial infarction patients with ventricular tachycardia or ventricular fibrillation treated with amiodarone. American Journal of Cardiology 66: 673–678, 1990PubMedGoogle Scholar
  103. Strauss HV, Pitt B. Ventricular arrhythmias in the late hospital phase of acute myocardial infarction: relation of left ventricular function detected by gated cardiac blood pool scanning. Circulation 52: 1006–1011, 1975PubMedGoogle Scholar
  104. Swedberg K, Hjalmarson A, Waagstein F, Wallentin I. Prolongation of survival in congestive cardiomyopathy by β receptors blockade. Lancet 1: 1374–1386, 1979PubMedGoogle Scholar
  105. Torres V, Flowers D, Somberg JC. The arrhythmogenicity of antiarrhythmic agents. American Heart Journal 109: 1090–1097, 1985PubMedGoogle Scholar
  106. Unverferth DV, Magorien RD, Moeschberger ML, Baker PB, Fetters JK, et al. Factors influencing the one-year mortality of dilated cardiomyopathy. American Journal of Cardiology 54: 147–152, 1984PubMedGoogle Scholar
  107. Vasodilator-Heart Failure Veterans Affairs Cooperative Study Group (V-HeFT II). A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congest-ive heart failure. New England Journal of Medicine 325: 303–310, 1991Google Scholar
  108. Veterans Administration Study Group. Effect of vasodilator therapy on mortality in chronic congestive heart failure. New England Journal of Medicine 314: 1547–1552, 1986Google Scholar
  109. Von Olshausen K, Scafer K, Mehmel HC, Scwartz F, Seuges J, et al. Ventricular arrhythmias in idiopathic dilated cardiomyopathy. British Heart Journal 51: 195–201, 1984Google Scholar
  110. Waagstein F, Hjalmarson A, Varnauskas E, Wallentin I. Effect of chronic β-adrenergic receptors blockade in congestive cardiomyopathy. British Heart Journal 37: 1022–1036, 1975PubMedGoogle Scholar
  111. Webster MWI, Fitzpatrick MA, Nicholls MG, Ijram H, Weels JE. Effect of enalapril on ventricular arrhythmias in congestive heart failure. American Journal of Cardiology 56: 566–569, 1985PubMedGoogle Scholar
  112. Weser JK, Klein SW, Foo-Kanto LL, Kastor JA, De Sanctis RW. Antiarrhythmic prophylaxis with procainamide in acute myocardial infarction. New England Journal of Medicine 281: 1253–1260, 1969Google Scholar
  113. Whuang R, Aikawa JK. Magnesium deficiency and refractoriness to potassium repletion. Journal of Chronic Diseases 30: 65–68, 1977Google Scholar
  114. Wilson JR, Schwartz JS, Sutton MS, Ferraro N, Horowitz LN, et al. Prognosis in severe heart failure: relation to haemodynamic measurements and ventricular ectopic activity. Journal of the American College of Cardiology 2: 403–410, 1983PubMedGoogle Scholar
  115. Woolsley RL, Echt DS, Roder DM. Effects of congestive heart failure on the pharmacokinetics and pharmacodynamics of antiarrhythmic agents. American Journal of Cardiology 57: 25B–33B, 1986Google Scholar
  116. Yusuf S, Peto R, Lewis J, Collins R, Sleight P. Betablockade during and after myocardial infarction: an overview of the randomized trial. Progress in Cardiovascular Diseases 27: 335–371, 1985PubMedGoogle Scholar

Copyright information

© Adis International Limited 1993

Authors and Affiliations

  • Sergio Morelli
    • 1
  • Francesco Cardoni
    • 1
  • Claudio Ferri
    • 1
  • Vincenzo Guido
    • 1
  • Marianna Suppa
    • 1
  • Claudio Perrone
    • 1
  • Paolo De Marzio
    • 1
  1. 1.Istituto di I Clinica MedicaPoliclinico ‘Umberto I’RomeItaly

Personalised recommendations