To Treat or Not To Treat Ventricular Arrhythmias in Dilated Cardiomyopathy?

  • D. Bracchetti
  • M. Mezzetti
  • G. Barbato
  • N. Franco
  • G. Casella
Conference paper


The management of patients (pts) with dilated cardiomyopathy (DC) and malignant ventricular arrhythmias (MVA), with particular attention to their treatment indication, should include a comprehensive clinical evaluation focusing on the potential role of triggering factors of rhythm disturbances. The clinical evaluation of the various interrelated adverse events that can precipitate MVA, as shown in Fig.1, is mandatory for the full understanding of the clinical problems of these pts. DC is characterized by a progressive dilatation of cardiac chambers, but principally of the left ventricle, together with poor and inadequate wall hypertrophy and severe reduction of myocardial contractility and overall ventricular function. Ischemic cardiomyopathy (ICM) and idiopathic cardiomyopathy (DCM) are the most common forms, but the etiology is often multifactorial. Death is caused by progressive heart failure, with mortality rates ranging from 30% to 50% at 1 year from symptom onset, or sudden cardiac death (SCD) presumably resulting from arrhythmias, accounting for 28%–45% of fatal events (1, 2). SCD could be ascribed in most cases to ventricular tachycardia (VT) degenerating into ventricular fibrillation (VF; 3). Previous observations warrant addressing the issue of treatment of pts with DC and MVA.


Ventricular Arrhythmia Antiarrhythmic Drug Antiarrhythmic Agent Negative Inotropic Effect Holter Monitoring 
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  1. 1.
    Fuster V et al (1981) The natural history of idiopathic dilated cardiomyopathy. Am J Cardiol 47: 525PubMedCrossRefGoogle Scholar
  2. 2.
    Kannel WB, Plehn JF (1988) Cardiac failure and sudden death in the Framingham study. Am Heart J 115: 869–875PubMedCrossRefGoogle Scholar
  3. 3.
    Pratt CM et al (1983) Analysis of ambulatory electrocardiograms in 15 patients during spontaneous ventricular fibrillation with special reference to preceding arrhythmic events. J Am Coll Cardiol 2: 789PubMedCrossRefGoogle Scholar
  4. 4.
    Hollifield JW (1984) Potassium and magnesium abnormalities: diuretics and arrhythmias in hypertension. Am J Med 77: 28PubMedCrossRefGoogle Scholar
  5. 5.
    Brown MJ, Brown DC (1983) Hypokalemia from beta2-receptor stimulation by circulating epinephrine. N Engl J Med 309: 1414PubMedCrossRefGoogle Scholar
  6. 6.
    Cohn JN et al (1984) Plasma norepinephrine as guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 311: 819PubMedCrossRefGoogle Scholar
  7. 7.
    Lazzara R et al (1988) Electrophysiological mechanisms for ventricular arrhythmias and sudden death in patients with chronic heart failure. Clin Cardiol 110–1Google Scholar
  8. 8.
    Packer M et al (1992) Lack of relation between ventricular arrhythmias and sudden death in patients with chronic heart failure. Circulation [Suppl 1] 85: 50–56Google Scholar
  9. 9.
    Maskin CS et al (1984) High prevalence of nonsustained ventricular tachycardia in severe congestive heart failure. Am Heart J 107: 896–901PubMedCrossRefGoogle Scholar
  10. 10.
    Morady F, Scheinman M (1983) Electrophysiologic testing in the management of survivors of out of hospital cardiac arrest. Am J Cardiol 51: 85–90PubMedCrossRefGoogle Scholar
  11. 11.
    Wilber JD, Garan H (1988) Out-of-hospital cardiac arrest: role of electrophysiologic testing in the prediction of long term outcome. N Engl J Med 318: 19–24PubMedCrossRefGoogle Scholar
  12. 12.
    Larsen L, Markham J (1994) Sudden death in idiopathic dilated cardiomyopathy: role of ventricular arrhythmias. PACE 16: 1051–1059CrossRefGoogle Scholar
  13. 13.
    Poll DS et al (1986) Usefulness of programmed stimulation in idiopathic dilated cardiomyopathy. Am J Cardiol: 58: 992–997PubMedCrossRefGoogle Scholar
  14. 14.
    Zheutlin TA, Roth HC (1986) Programmed electrical stimulation to determine the need for antiarrhythmic therapy in patients with complex ventricular ectopic activity. Am Heart J 111: 860–867PubMedCrossRefGoogle Scholar
  15. 15.
    Tchou P, Blank Z (1989) Mechanism of inducible ventricular tachycardia in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 13: 174AGoogle Scholar
  16. 16.
    Tchou P, Jazayeri M (1988) Transcatheter electrical ablation of the right bundle branch: a method of treating macro-reentrant ventricular tachycardia due to bundle branch reentry. Circulation 78: 246PubMedCrossRefGoogle Scholar
  17. 17.
    Packer M, Gheorghiade M (1993) Withdrawal of digoxin from patients with chronic heart failure treated with angiotensinconverting-enzyme inhibitors. N Engl J Med 829: 1–7CrossRefGoogle Scholar
  18. 18.
    Gheorghiade M, Ferguson B (1991) Digoxin: a neurohormonal modulator in heart failure? Circulation 84: 2181–1816PubMedGoogle Scholar
  19. 19.
    Lown B, Podrid P (1977) Effect of digitalis drug on ventricular premature beats. N Engl J Med 296: 301PubMedCrossRefGoogle Scholar
  20. 20.
    Teo KK, Yusuf C (1993) Role of antiarrhythmic prophylaxis in acute myocardial infarction. JAMA 13: 1589–1595CrossRefGoogle Scholar
  21. 21.
    Neri R et al (1987) Ventricular arrhythmias in dilated cardiomyopathy: efficacy of amiodarone. Am Heart J 113: 707PubMedCrossRefGoogle Scholar
  22. 22.
    Herre J, Sauve M (1989) Long-term results of amiodarone therapy in patients with recurrent sustained ventricular tachycardia or ventricular fibrillation. J Am Coll Cardiol 13 (2): 442–449PubMedCrossRefGoogle Scholar
  23. 23.
    Ceremuzynski Y, Kleczar E (1992) Effect of amiodarone on mortality after myocardial infarction. J Am Coll Cardiol 20: 1056–1062PubMedCrossRefGoogle Scholar
  24. 24.
    Burkart F, Pfisterer M (1990) Effect of antiarrhythmic therapy on mortality in survivors of myocardial with asymptomatic complex ventricular arrhythmias: Basel Antiarrhythmic Study of Infarct Survival ( BASIS ). J Am Coll Cardiol 16: 1711–1718PubMedCrossRefGoogle Scholar
  25. 25.
    Doval HC, Null DR (1994) Randomized trial of low dose amiodarone in severe congestive heart failure. Lancet 344: 493–498PubMedCrossRefGoogle Scholar
  26. 26.
    SOLVD Investigators (1992) Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fraction. N Engl J Med 327: 685–691CrossRefGoogle Scholar
  27. 27.
    Webster MWI, Fitzpatrick MA (1985) Effects of enalapril on ventricular arrhythmias in congestive heart failure. Am J Cardiol 56: 566–569PubMedCrossRefGoogle Scholar
  28. 28.
    Cohn JN et al (1991) A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 325: 303–308PubMedCrossRefGoogle Scholar
  29. 29.
    Waagstein F, Bristow MR (1993) Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy.Lancet 342: 1441–1446Google Scholar
  30. 30.
    Block P (1983) Hemodynamic effects of antiarrhythmic agents. Am J Cardiol 52: 14CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • D. Bracchetti
    • 1
  • M. Mezzetti
    • 1
  • G. Barbato
    • 1
  • N. Franco
    • 1
  • G. Casella
    • 1
  1. 1.Divisione di CardiologiaOspedale MaggioreBolognaItaly

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