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Sudden cardiac death and ventricular arrhythmias in patients with implanted antiarrhythmic devices and CHF

Osadchy A. M., Kurnikova E. A., Marinin V. A., Lebedev D. S.

Keywords: sudden cardiac death, ventricular arrhythmia, surgical methods, CHF

DOI: 10.18087/rhfj.2013.2.1785

Background. Implantable cardioverter-defibrillators (ICDs) are the only possible and effective means for primary and secondary prevention and treatment of «arrhythmic» sudden cardiac death (SCD). «Electrical storm» (ES) is defined as the occurrence of three or more episodes of ventricular tachycardia / fibrillation (VT / VF) developing in patients with ICD within a 24h period with effective recovery of the heart rhythm after cardioversion / defibrillation. Aim. To study long-term predictors of ES, ventricular arrhythmias and clinical outcomes in patients with implanted antiarrhythmic devices having CHF of different etiology and to improve results of prevention of treatment. Materials and methods. This retrospective study included 282 patients who have undergone examination and treatment between 1999 and 2012. For prevention and treatment of SCD and CHF, ICD, CRT-D and CRT-P were implanted in 74 patients. The patients were divided into two groups; patients of Group 1 had ES and patients of Group 2 did not have ES. Mean follow-up period was 7.2±1.1 years. To study the X-ray anatomy of coronary venous and arterial vasculature, prolonged diagnostic coronary angiography (CAG) including evaluation of the venous phase was performed with a suggested method in 208 patients with various nosologies (IHD, DCMP, HCMP). In studying the X-ray anatomy of coronary vessels, patients were divided into Group 3 with documented IHD and Group 4 without signs of IHD. Effects of enlarged chambers on heart vein anatomy and pattern of heart rhythm disturbances were evaluated. Results. 74 patients (26.7 %) had 228 VT / VF episodes and 23 ES episodes. In 5 patients (6.7 %), ES developed within the first year of implantation of an antiarrhythmic device. A multifactorial analysis identified EF, LV EDP, increasing CHF, dyselectrolyte disorders, and number of electrical «shocks» per year as ES predictors. Mouths of coronary vessels, left interventricular and great cardiac veins were visualized in all 208 patients independent on the etiology of heart disease and dimensions of left heart chambers. The LV posterior vein was visualized in two groups in 94 and 92 % of cases. Conclusion. «Electrical storm» is a life-threatening condition and implanted antiarrhythmic devices with a capability of cardioversion / defibrillation effectively prevent SCD. The high probability of ES within the first year of antiarrhythmic device implantation calls for a special approach in the treatment and prevention of SCD. Implantation of a LV electrode should be performed with a consideration of preoperational data on heart vein anatomy.
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Osadchy A. M., Kurnikova E. A., Marinin V. A. et al. Sudden cardiac death and ventricular arrhythmias in patients with implanted antiarrhythmic devices and CHF. Russian Heart Failure Journal. 2013;14 (2):99-104

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