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Usefulness of suppression of ventricular arrhythmia by biventricular pacing in severe congestive cardiac failure

2000; Elsevier BV; Volume: 86; Issue: 2 Linguagem: Inglês

10.1016/s0002-9149(00)00865-1

1879-1913

Stuart Walker, Terry Levy, S. Rex, S. Brant, Jeffrey C. Allen, Charles Ilsley, Vincent Paul,

Cardiac Arrhythmias and Treatments

Ventricular arrhythmias are common in patients with congestive heart failure, even in the absence of palpitations. 1 Kjekshus J. Arrhythmias and mortality in congestive heart failure. Am J Cardiol. 1990; 65: 42I-48I Abstract Full Text PDF PubMed Scopus (220) Google Scholar Although these arrhythmias are markers of a worsened prognosis, 2 Francis G.S. Development of arrhythmias in the patient with congestive heart failure pathophysiology, prevalence and prognosis. Am J Cardiol. 1986; 57: 3B-7B Abstract Full Text PDF PubMed Scopus (165) Google Scholar , 3 Cohn J.N. Johnson G.R. Shabetai R. Loeb H. Tristani F. Rector T. Smith R. Fletcher R. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. The V-HeFT VA Cooperative Studies Group. Circulation. 1993; 87: VI5-V16 PubMed Google Scholar their suppression with class 1 antiarrhythmic drugs is associated with a further deterioration in outcome. 4 Arrhythmia Suppression Trial (CAST) InvestigatorsPreliminary report effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med. 1989; 321: 406-412 Crossref PubMed Scopus (3094) Google Scholar Suppression with amiodarone has a small beneficial effect at best, 5 Cairns J.A. Connolly S.J. Roberts R. Gent M. Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators. Lancet. 1997; 349: 675-682 Abstract Full Text Full Text PDF PubMed Scopus (867) Google Scholar , 6 Julian D.G. Camm A.J. Frangin G. Janse M.J. Munoz A. Schwartz P.J. Simon P. Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction EMIAT. European Myocardial Infarct Amiodarone Trial Investigators. Lancet. 1997; 349: 667-674 Abstract Full Text Full Text PDF PubMed Scopus (1002) Google Scholar , 7 Doval H.C. Nul D.R. Grancelli H.O. Perrone S.V. Bortman G.R. Curiel R. Randomised trial of low-dose amiodarone in severe congestive heart failure. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA). Lancet. 1994; 344: 493-498 Abstract PubMed Scopus (878) Google Scholar whereas the use of implantable cardioverter-defibrillators can only be justified in the subgroup of patients in whom nonsuppressible ventricular tachycardia can be demonstrated. 8 Antiarrhythmics versus Implantable Defibrillators (AVID) InvestigatorsA comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997; 337: 1576-1583 Crossref PubMed Scopus (2989) Google Scholar Biventricular pacing has been advocated for the symptomatic management of severe heart failure. 9 Auricchio A. Stellbrink C. Sack S. Block M. Vogt J. Bakker P. Mortensen P. Klein H. The pacing therapies for congestive heart failure (PATH-CHF) study rationale, design, and endpoints of a prospective randomised multicentre study. Am J Cardiol. 1999; 83: 130D-135D Abstract Full Text Full Text PDF PubMed Google Scholar , 10 Gras D. Mabo P. Tang T. Luttikuis O. Chatoor R. Pederson A.K. Tscheliessnigg H.H. Deharo J.C. Puglisi A. Silvestre J. Kimber S. Ross H. Ravazzi A. Paul V. Skehan D. Multi-site pacing as a supplemental treatment of congestive heart failure preliminary results of the Medtronic Inc. InSync study. Pacing Clin Electrophysiol. 1998; 21: 2249-2255 Crossref PubMed Scopus (369) Google Scholar Unfortunately a number of previous therapies that have been used for the symptomatic management of heart failure have resulted in a worsening of prognosis. 13 Packer M. Carver J.R. Rodeheffer R.J. Ivanhoe R.J. DiBianco R. Zeldis S.M. Hendrix G.H. Bommer W.J. Elkayam U. Kukin M.L. Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE Study Research Group. N Engl J Med. 1991; 325: 1468-1475 Crossref PubMed Scopus (1928) Google Scholar , 14 Uretsky B.F. Jessup M. Konstam M.A. Dec G.W. Leier C.V. Benotti J. Murali S. Herrmann H.C. Sandberg J.A. Multicenter trial of oral enoximone in patients with moderate to moderately severe congestive heart failure. Lack of benefit compared with placebo. Enoximone Multicenter Trial Group. Circulation. 1990; 82: 774-780 Crossref PubMed Scopus (282) Google Scholar , 15 Xamoterol in Severe Heart Failure Study GroupXamoterol in severe heart failure. Lancet. 1990; 336: 1-6 Abstract PubMed Scopus (489) Google Scholar This worsened prognosis may be secondary to an increase in sudden cardiac death, presumably mediated by ventricular arrhythmia. The effect of biventricular pacing on ventricular arrhythmogenesis in this patient group is unknown.