Skip to main content
SpringerLink
Log in

Prognostic Significance of Asymptomatic Ventricular Arrhythmias in Heart Failure: Potential for Mortality Reduction by Pharmacologic Control

  • Conference paper
Book cover Heart Failure and Arrhythmias

  • 45 Accesses

Abstract

That patients surviving acute myocardial infarction incur an increased incidence of sudden death especially in the first 6 months to 1 year [1, 2] is well known. The highest risk is in patients with markedly reduced ejection fraction particularly in association with complex ventricular ectopy [3, 4]. Although not entirely certain, it appears that ventricular arrhythmias in this setting are associated with an enhanced mortality from sudden death independently of left ventricular dysfunction [3]. In recent years attention has turned towards the prognostic significance of asymptomatic ventricular arrhythmias in patients with overt cardiac failure [5, 6] especially in those with NYHA classes III and IV of functional disability. As in the case of survivors of acute infarction, they too appear to be markers of increased mortality from sudden death [6, 7–14]. The issue has become of major importance because the mortality rate for patients with congestive heart failure is extremely high, being about 50% in the 1st year following referral for treatment of patients with class III or IV functional disability [3]. About 40% of such deaths are sudden [15, 17].

Supported by the Medical Research Service of the Veterans Administration and the American Heart Association of the Greater Los Angeles Affiliate.

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.

References

  1. Ruberman W, Weinblatt E, Goldberg J (1977) Ventricular premature beats and mortality after acute myocardial infarction. N Engl J Med 293: 750–755

    Article  Google Scholar 

  2. Moss AJ, Davis HT, DeCamilla J (1977) Ventricular ectopic beats and their relation to sudden and non-sudden death after myocardial infarction. Circulation 60: 998–1004

    Google Scholar 

  3. Bigger JT Jr, Fleiss JL, Kleiger R, Miller JP, Rolnitzky LM (1984) The Multicenter Post-Infarction Group: the relationship between ventricular arrhythmias, left ventricular dysfunction and mortality in the two years after myocardial infarction. Circulation 69: 250

    Article  PubMed  Google Scholar 

  4. Mukharji J, Rude RE, Poole WK, Gustafson N, Thomas LJ Jr, Strauss HW, Jaffe AS, Muller JE, Roberts R, Raabe DS Jr, Croft CH, Passamani E, Braunwald E, Willerson JT, and the MILIS Study Group (1984) Risk factors for sudden death after acute myocardial infarction: two year follow-up. Am J Cardiol 54: 31–37

    Article  Google Scholar 

  5. McKenna WJ, England D, Doi YL, Deanfield JE, Oakley CM, Goodwin JF (1981) Arrhythmia in hypertrophy cardiomyopathy. Influence on prognosis. Br Heart J 46: 168–172

    Article  PubMed  CAS  Google Scholar 

  6. Maskin CS, Siskind SJ, LeJemptel TH (1984) High prevalence of nonsustained ventricular tachycardia in severe congestive heart failure. Am Heart J 107: 896–902

    Article  PubMed  CAS  Google Scholar 

  7. Wilson JR, Schwartz, Sutton MS-J, Ferrao N, Horowaitz LN, Reichek N, Josephson ME (1983) Prognosis in severe heart failure: relationship to hemodynamic measurements and ventricular ectopic activity. J Am Coll Cardiol 2: 403

    Article  PubMed  CAS  Google Scholar 

  8. Von Olshausen K, Schafer A, Mehmel HC, Schwartz F, Senges J, Kubler W (1984) Ventricular arrhythmias in idiopathic dilated cardiomyopathy. Br Heart J 51: 195

    Article  Google Scholar 

  9. Franciosa JA, Wilen M, Ziesche SM, Cohn JN (1983) Survival in men with severe chronic left ventricular failure due to either coronary heart disease or idiopathic dilated cardiomyopathy. Am J Cardiol 51: 831

    Article  PubMed  CAS  Google Scholar 

  10. Huang SK, Messer JV, Denes P (1983) Significance of ventricular tachycardia in idiopathic dilated cardiomyopathy: observations in 35 patients. Am J Cardiol 51: 507

    Article  PubMed  CAS  Google Scholar 

  11. Francis GS (1983) Development of arrhythmias in the patient with congestive heart failure: pathophysiology, prevalence and prognosis. Am J Cardiol 51: 507

    Article  Google Scholar 

  12. Chakko CS, Gheorghiade M (1985) Ventricular arrhythmias in severe heart failure: incidence, significance, and effectiveness of antiarrhythmic therapy. Am Heart J 109: 497

    Article  PubMed  CAS  Google Scholar 

  13. Meinertz T, Hofman T, Kasper W, Treese N, Bechtold H, Stienen U, Pop T, Leitner E-RV, Andersen D, Meyer J (1984) Significance of ventricular arrhythmias in idiopathic dilated cardiomyopathy. Am J Cardiol 53: 902

    Article  PubMed  CAS  Google Scholar 

  14. Holmes J, Kubo SH, Cody RJ, Kligfield P (1985) Arrhythmias in ischemic and non-ischemic dilated cardiomyopathy: prediction of mortality by ambulatory electrocardiography. Am J Cardiol 55: 146

    Article  PubMed  CAS  Google Scholar 

  15. Bigger JT (1987) Why some patients with congestive heart failure die: arrhythmias and sudden cardiac death. Circulation 75 [Suppl IV]: 28–35

    Google Scholar 

  16. Unverferth DV, Magorein RD, Moeschberger ML, Baker PB, Fetters JK, Leier CV (1984) Factors influencing the one-year mortality of dilated cardiomyopathy. Am J Cardiol 54: 147

    Article  PubMed  CAS  Google Scholar 

  17. Bigger JT Jr, Weld RM, Rolnitzky LM (1981) The prevalence and significance of ventricular tachycardia detected by ambulatory ECG recording in the hospital phase of acute myocardial infarction. Am J Cardiol 48: 815

    Article  PubMed  Google Scholar 

  18. Cohn JN, Archibald DF, Ziesche S, Franciosa J A, Harston WE, Tristani FE, Dunkman WB, Jacobs W, Francis GS, Flohr KH, Goldman S, Cobb FR, Shah PM, Saunders R, Fletcher RD, Loeb HS, Hughes VC, Baker B (1986) Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study. N Engl J Med 314: 1547

    Google Scholar 

  19. CONSENSUS Trial Study Group (1987) Effects of enalapril on mortality in severe congestive heart failure: result of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 316: 1429–1435

    Article  Google Scholar 

  20. Captopril Multicenter Research Group I (1986) A cooperative multicenter study of capto- pril in congestive heart failure: hemodynamic effects and long-term response. Am Heart J 110: 439–447

    Google Scholar 

  21. Sakurari T, Kawai C (1983) Sudden death in idiopathic cardiomyopathy. Jpn Circ J 47: 581

    Article  Google Scholar 

  22. Francis GS (1986) Development of arrhythmias in the patient with congestive heart failure: pathophysiology, prevalence and prognosis. Am J Cardiol 57: 3B–7B

    Article  PubMed  CAS  Google Scholar 

  23. Buxton AE, Marchlinski FE, Waxman HL, Flores C, Cassidy DM, Josephson ME (1984) Prognostic factors in nonsustained ventricular tachycardia. Am J Cardiol 53: 1275

    Article  PubMed  CAS  Google Scholar 

  24. Fletcher RD, Archibald D, Orndorff J, Cohn J (1986) Dysrhythmias on short-term Holter as an independent predictor of mortality in congestive heart failure. J Am Coll Cardiol 7:143 A (abstr)

    Google Scholar 

  25. Bayes de Luna A, Coumel P, Leclerq JF (1987) Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J 117: 151–159

    Google Scholar 

  26. Luu M, Stevenson WG, Stevenson LW, Baron K, Warden J (1989) Diverse mechanisms of unexpected cardiac arrests in advanced heart failure. Circulation 80: 1675–1680

    Article  PubMed  CAS  Google Scholar 

  27. Cleland JGF, Dargie HJ, Hodsman GP (1984) Captorpril in heart failure: a double-blind controlled study. Br Heart J 52: 530–536

    Article  PubMed  CAS  Google Scholar 

  28. Kjekshus J (1987) Heart rate reduction - a mechanism of benefit? Eur Heart J 8 [Sup- pi 1]: 115–122

    PubMed  Google Scholar 

  29. Anderson JL, Lutz JR, Gilbert EM, Sorenson SG, Yanowitz FG, Menlove RL, Bartholomew M (1985) A randomized trial of low-dose beta-blockade therapy for idiopathic dilated cardiomyopathy. Am J Cardiol 55: 471–475

    Article  PubMed  CAS  Google Scholar 

  30. Currie PJ, Kelly MJ, McKenzie A, Harper RW, Lim YL, Federman J, Anderson ST, Pitt A (1984) Oral beta-adrenergic blockade with metoprolol in chronic severe dilated cardiomyopathy. J Am Coll Cardiol 3: 203–209

    Article  PubMed  CAS  Google Scholar 

  31. Engelmeier RS, O’Connell JB, Walsh R, Rad N, Scanlon PJ, Gunnar RM (1985) Improvement in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: a double-blind, randomized, placebo-controlled trial. Circulation 72: 536–546

    Article  PubMed  CAS  Google Scholar 

  32. Furberg CD, Yusuf S (1988) Effect of drug therapy on survival in chronic congestive heart failure. Am J Cardiol 62:41 A–45 A

    Google Scholar 

  33. Parmley WW, Chatterjee K (1988) Congestive heart failure and arrhythmias: an overview. Am J Cardiol 57:34 B–37 B

    Article  Google Scholar 

  34. Dargie HJ, Cleland JGF, Leckie BJ, Inglis CG, East BW, Ford I (1987) Relation of arrhythmias and electrolyte abnormalities to survival in patients with severe congestive heart failure. Circulation 75 [Suppl 4]: 98–107

    Google Scholar 

  35. Singh BN, Courtney K (1990) On the classification of anti-arrhythmic mechanisms: experimental and clinical correlations. In: Zipes DP, Jaliffe J (eds) Cardiac electrophysiology: from the cell to the bedside. Saunders, Philadelphia

    Google Scholar 

  36. Singh BN (1987) Effects of anti-arrhythmic compounds on the cardiac action potential: basis for the interpretation of their anti-arrhythmic actions. In: Zipes DP (ed) Progress of cardiology. Lea and Febiger, Philadelphia, pp 37–86

    Google Scholar 

  37. Singh BN, Vaughan Williams EM (1970) A third class of antiarrhythmic action. Effects on atrial and ventricular intracellular potentials and other pharmacologic actions on cardiac muscle of in MJ1999 and AH 3474. Br J Pharmacol 39: 675–685

    PubMed  CAS  Google Scholar 

  38. Singh BN, Vaughan Williams EM (1970) The effect of amiodarone, a new anti-anginal drug, on cardiac muscle. Br J Pharmacol 39: 357–367

    Google Scholar 

  39. Singh BN, Nademanee K (1985) Control of arrhythmias by selective lengthening of cardiac repolarization: theoretical considerations and clinical observations. Am Heart J 109:421– 430

    Google Scholar 

  40. Singh BN (1988) Control of cardiac arrhythmias by lengthening repolarization. Futura, Mount Kisco, pp 1–577

    Google Scholar 

  41. Singh BN (1988) When is QT prolongation anti-arrhythmic and when is it pro-arrhythmic? (editorial) Am J Cardiol 63: 867–869

    Google Scholar 

  42. Singh BN (1989) Controlling cardiac arrhythmias: to delay conduction or to prolong refractoriness? (editorial) Cardiovasc Drugs Therapy 3: 671–674

    CAS  Google Scholar 

  43. Packer M, Lee WH, Kessler PD, Gottlieb SS, Bernstein JL, Kukin ML (1987) Role of neurohumoral mechanisms in determining survival in patients with severe chronic heart failure. Circulation 75 [Suppl IV]: 30–35

    Google Scholar 

  44. Cardiac Arrhythmia Suppression Trial (CAST) Investigators (1981) Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 321: 375–385

    Google Scholar 

  45. McKenna WJ, Oakley CM, Krikler DM, Goodwin JF (1985) Improved survival with amiodarone in patients with hypertrophic cardiomyopathy and ventricular tachycardia. Br Heart J 53: 412–416

    Article  PubMed  CAS  Google Scholar 

  46. Burkart F, Pfisterer, Kiowski W, Burckhardt D, Follath F (1989) Improved survival of patients with asymptomatic ventricular arrhythmias after myocardial infarction with amiodarone: a randomized control trial. Circulation 80: 11–119

    Google Scholar 

  47. Nademanee K, Stevenson W, Weiss J, Singh BN (1988) The role of amiodarone in the survivors of sudden arrhythmic deaths. In: Singh BN (ed) Control of cardiac arrhythmias by lengthening repolarization. Futura, Mount Kisco, pp 489–508

    Google Scholar 

  48. Chew CYC, Collett JT, Campbell C, Kannan R, Singh BN (1982) Beneficial effects of amiodarone pretreatment on early ischemic ventricular arrhythmias relative to infarct size and regional myocardial blood flow in the conscious dog. J Cardiovasc Pharmacol 4:1028– 1036

    Article  PubMed  CAS  Google Scholar 

  49. Patterson E, Eller BT, Abrams GD, Luchessi BR (1983) Ventricular fibrillation in conscious canine preparation of sudden coronary death: prevention by short-term and long-term amiodarone administration. Circulation 68: 857–866

    Article  PubMed  CAS  Google Scholar 

  50. Takanaka C, Singh BN (1990) Barium-induced non-driven action potentials as a model of triggered automaticity and early afterdepolarizations: differing effects of amiodarone and quinidine and significance of slow-channel activity. J Am Coll Cardiol 15 (1): 213–221

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. B. N. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. P. Schoenbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Antimisiaris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Takanaka
    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

Singh, B.N., Schoenbaum, M.P., Antimisiaris, M., Takanaka, C. (1990). Prognostic Significance of Asymptomatic Ventricular Arrhythmias in Heart Failure: Potential for Mortality Reduction by Pharmacologic Control. 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_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-75326-8_19

  • 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