Abstract
BackgroundVentricular arrhythmias cause a significant proportion of sudden deaths. Several studies demonstrate a high prevalence of ventricular arrhythmias in patients with heart failure regardless of the etiology. The aim of this study was to determine the prevalence of silent ventricular arrhythmias in ambulatory heart failure patients with reduced left ventricular ejection fraction (HFrEF) and its correlation to the prognosis.ResultsFour hundred (400) ambulatory HFrEF patients on maximum tolerated doses of heart failure medications were included. Holter monitoring for 7 days was done in all patients searching for silent ventricular arrhythmias. The patients were followed-up for one year to detect the occurrence of major adverse cardiovascular events. We divided the study population into 2 groups based on an LVEF cutoff value of 30% (Group A < 30%, Group B ≥ 30%). Holter monitoring revealed ventricular arrhythmias in 304 patients. Patients with left ventricular ejection fraction (EF) < 30% (Group A) had more complex ventricular arrhythmias in the form of frequent Premature ventricular contractions (PVCs) of ≥ 5% and or non-sustained ventricular tachycardia (NSVT) runs. Furthermore, Among Group A, more major cardiovascular events were observed. Multivariate regression analysis showed that frequent PVCs and severely reduced LVEF were the strongest independent predictors of major cardiovascular events.Conclusionsventricular arrhythmias are common in HFrEF patients even in the compensated status. Both, left ventricular systolic function and the PVCs burden were found to be the strongest predictors of major adverse cardiovascular events.
Highlights
Ventricular arrhythmias cause a significant proportion of sudden deaths
The aim of the present study was to determine the prevalence of silent ventricular arrhythmias on one-week ambulatory ECG monitoring in clinically compensated outpatient heart failure patients with reduced ejection fraction (HFrEF) and its impact on the prognosis
Ventricular arrhythmias are common in patients with advanced heart failure, with a prevalence of up to 33% in chronic ambulatory patients and it predict increased mortality from HF [9]. pre-operative ventricular arrhythmias were noted in Up to 45% in patients supported with a left ventricular assist device (LVAD) [10]
Summary
Ventricular arrhythmias cause a significant proportion of sudden deaths. Several studies demonstrate a high prevalence of ventricular arrhythmias in patients with heart failure regardless of the etiology. The aim of this study was to determine the prevalence of silent ventricular arrhythmias in ambulatory heart failure patients with reduced left ventricular ejection fraction (HFrEF) and its correlation to the prognosis. Heart failure is a clinical syndrome characterized by typical symptoms (fatigue and shortness of breath) that could be associated by clinical signs of systemic or pulmonary venous congestion or both. This is caused by cardiac structural and/or functional abnormality. Premature ventricular complexes (PVCs) are the most common ventricular arrhythmias Their impact on the patient’s prognosis depends on the presence of cardiac structural and/or functional abnormalities. In the absence of an underlying structural heart disease, PVCs are regarded as a benign phenomenon [2].
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