Abstract
Heart failure patients are predisposed to develop arrhythmias. Supraventricular arrhythmias can exacerbate the heart failure symptoms by decreasing the effective cardiac output and their control require pharmacological, electrical, or catheter-based intervention. In the setting of atrial flutter or atrial fibrillation, anticoagulation becomes paramount to prevent systemic or cerebral embolism. Patients with heart failure are also prone to develop ventricular arrhythmias that can present a challenge to the managing clinician. The management strategy depends on the type of arrhythmia, the underlying structural heart disease, the severity of heart failure, and the range from optimization of heart failure therapy to catheter ablation. Patients with heart failure, irrespective of ejection fraction are at high risk for developing sudden cardiac death, however risk stratification is a clinical challenge and requires a multiparametric evaluation for identification of patients who should undergo implantation of a cardioverter defibrillator. Finally, patients with heart failure can also develop symptomatic bradycardia, caused by sinus node dysfunction or atrio-ventricular block. The treatment of bradycardia in these patients with pacing is usually straightforward but needs some specific issue.
Highlights
Arrhythmias confers a substantial risk of mortality and morbidity in patients with heart failure (HF), and this represents a major health care burden worldwide
This review focuses on the management of arrhythmias, both tachyarrhythmias and bradyarrhytmias, in patients with HF
While the ever-increasing percentage of HF patients implanted with devices capable of pacing precludes quantification of bradycardic risk at the current time, earlier registries illustrated that bradyarrhythmias with electromechanical dissociation were the mechanism of Sudden cardiac death (SCD) in a significant number of selected HF patients [52]
Summary
Arrhythmias confers a substantial risk of mortality and morbidity in patients with heart failure (HF), and this represents a major health care burden worldwide. HF hospitalizations are increasing, and many of these may be related to supraventricular arrhythmias (SVAs) [3] such as atrial fibrillation (AF). Atrial fibrillation per se contributes to an increased risk of mortality and morbidity of stroke and thromboembolism, and silent AF is common among patients with HF [4], not infrequently leading to a first presentation of AF with an ischemic stroke [5]. Sudden cardiac death (SCD) is a major cause of mortality among HF patients and is commonly related to cardiac arrhythmias [6], ventricular arrhythmias (VAs). This review focuses on the management of arrhythmias, both tachyarrhythmias and bradyarrhytmias, in patients with HF
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