2014


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2014/№1

Effect of cardiac resynchronization therapy on the time course of ventricular tachycardia in patients with dilated cardiomyopathy and severe heart failure

Lebedev D. I., Minin S. M., Krivolapov S. N.

Keywords: dilatation, ventricular rhythm disorder, cardiomyopathy, resynchronization therapy

DOI: 10.18087/rhfj.2014.1.1919

Background. Despite improved survival rate provided by new pharmaceuticals, 5year survival of patients diagnosed with HF is 50 % and most of fatal outcomes occur suddenly and unpredictably. Aim. To study the effect of cardiac resynchronization therapy (CRT) on the course of ventricular tachycardia in patients with dilated cardiomyopathy (DCMP) and to analyze a possibility for using radionuclide methods for predicting the development of life-threatening arrhythmias during the treatment. Materials and methods. The study included 70 patients with DCMP aged from 32 to 75 years (55±12 years), NYHA FC III CHF, LV EF 30.1±3.8 %, 6min walk distance 290.5±64.3 m, and end-diastolic volume (EDV) 220.7±50.9 ml. 34hour ECG monitoring was performed for all patients prior to and at one year of CRT. The first group included 35 (50 %) patients with paroxysmal ventricular tachycardia (VT); the second group included 35 (50 %) patients without VT episodes. CRT devices with defibrillation option were implanted to all patients. Results. In one year, positive clinical changes were observed in all patients: LV EF increased to 42.8±4.8 % (p≤0.001); HF FC decreased to FC II; 6min walk distance increased to 377.2±45.3 m (p≤0.001); and LV EDV reduced to 197.9±47.8 ml (p≤0.005). 28 (80 %) patients had no VT episodes over one year; 7 (20 %) patients had unstable VT episodes. Patients with an increase in EF by 14 % and a decrease in EDV by 35 ml did not have any VT episodes over the year. In patients who still had paroxysmal VT during the study, EF was increased by 9 % and EDV was reduced only by 13 ml. The second stage of study included evaluation of the effect of CRT-induced changes in myocardial metabolic defect (MMD) on possible development of VT episodes. Patients with the CRT-induced decrease in MMD to below 15 % did not have VT episodes; when post-treatment MMD exceeded 15 %, the patients had episodes of paroxysmal VT. Conclusion. Effective CRT statistically significantly reduces the number of VT episodes in patients with DCMP. The improvement in fatty acid metabolism resulting from CRT provides a decrease in the number of VT episodes.
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Lebedev D. I., Minin S. M., Krivolapov S. N. Effect of cardiac resynchronization therapy on the time course of ventricular tachycardia in patients with dilated cardiomyopathy and severe heart failure. Russian Heart Failure Journal. 2014;15(1):39–44

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