Pathogenesis of Ventricular Arrhythmias in Heart Failure
There is a large body of clinical evidence that impaired left ventricular function is an important and independent factor identifying the patient with coronary artery disease who is at high risk for sudden cardiac death [1–6]. However, even in the absence of coronary artery disease, heart failure appears to be arrhythmogenic. Patients with congestive heart failure, regardless of etiology, have a high incidence of sudden death and a high incidence of complex arrhythmias [7–14]. Between 30% and 50% of all deaths are sudden, presumably caused by ventricular fibrillation. In some reports the incidence of multiform ventricular premature beats, pairs, or nonsustained ventricular tachycardia is almost 90%. There is now general agreement that in patients with heart failure both the degree of left ventricular dysfunction and the presence of complex ventricular arrhythmias are independent risk factors for mortality [7, 10, 12]. Whereas clinically the relationship between heart failure and arrhythmias is well established, the reasons why this is so are largely unknown. In this chapter we discuss possible arrhythmogenic factors associated with heart failure, bearing in mind that almost certainly there is no single arrhythmogenic factor, and that it is impossible to state precisely in which way the many factors that could cause an arrhythmia interact.
KeywordsHeart Failure Ventricular Arrhythmia Sudden Cardiac Death Trigger Activity Chronic Congestive Heart Failure
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