Electrophysiologic effects of statins in patients with ischemic cardiomyopathy and ventricular tachyarrhythmia

Statin therapy may be beneficial not only to reduce the risk of vascular events but also to reduce the risk of ventricular arrhythmias and sudden cardiac death. We evaluated the effects of statins on electrophysiologic parameters in patients with ischemic cardiomyopathy and established ventricular tachyarrhythmia. Prospective study. Eleven patients [all male, mean age 57.9 +/- 6.64 years], with ischemic cardiomyopathy and ventricular tachyarrhythmia on admission were included in the study. Two academic tertiary care centers. A baseline electrophysiologic study was performed before implantable-cardioverter defibrillator [ICD] implantation. Forty milligram of atorvastatin was started and electrophysiologic study was repeated one month later and results were compared. Basic intervals, corrected sinus node recovery time [cSNRT], sino-atrial conduction time [SACT], atrio-ventricular node refractory period [AVNRP], atrio-ventricular Wenckebach period [AVWP], ventricular refractory period [VRP], ventriculo-atrial dissociation measurement, corrected QT [QTc] interval and QT dispersion were measured. Also, ventricular arrhythmia inducibility was evaluated with various techniques. Although, QTc interval and QT dispersion decreased significantly with statin treatment [p < 0.05], there were no statistically significant differences in the measurements of basic intervals, cSNRT, SACT, AVNRP, AVWP, VRP and ventriculo-atrial dissociation compared to pretreatment measurements [p > 0.05]. Additionally, while induction of ventricular tachyarrhythmia occurred in 72.7% of patients before statin therapy, this rate decreased to 36.4% with treatment [p - 0.13]. Statin treatment led to significant decreases in QTc interval and QT dispersion, but it did not change other electrophysiologic parameters significantly

Experience in ICD implantation and follow-up in Ibn-Albitar Hospital

Survivals of sudden cardiac death [SCD] episodes have recurrence rate of 30-50% within two years, with malignant ventricular arrhythmias most often responsible. The overall survival rate for SCD in USA is 5%. Ninety-five percent of patients suffering their initial event fail to survive to become candidate for secondary prevention. Because of the wide spread acceptance of implantable cardioverter defibrillator [ICD] as a method treating the survivals of SCD, attention has turned to primary prevention. Implantable cardioverter-defibrillator [ICD] is highly effective in primary and secondary prevention of SCD due to life threatening ventricular tachycardia [VT]. To register and interpret the results of implantation and follow-up of ICD during the period between 2002-2007 in Ibn Al-Bitar hospital. Sixty patients with standard indications for ICD; data were pooled from patients history, ECG, Echocardiography, Holter, blood investigation and coronary angiography.75% males and 25% females. After implantation, class III anti-arrhythmic drugs [Amiodarone] were stopped, except for patients with a history of supraventricular tachycardia or recurrent VT. Coronary artery disease [CAD] was the most common presentation of patients for whom implantation was done; coronary artery disease [CAD] 43%, dilated cardiomyopathy [DCM] 26%, and hypertrophic obstructive cardiomyopathy [HOCM] 16%. Sixty-three of them had moderate-severe LV dysfunction [LVEF<40%]. Recurrent VT was the most common cause of implantation [76%]. Primary prevention was aimed in [60%] of patients and secondary prevention in 40%. Sixty percent of those with ICD implanted due to primary prevention fulfil MADIT II [Multicenter Automatic Defibrillator Implantation Trial II] criteria. The majority of patients had structural heart disease. Most non-sustained VTs reverted to sinus rhythm by antitachycardia pacing [ATP] therapy from ICD [90%].A11 VF events reverted to sinus rhythm by high energy shock from ICD devices. ICD is highly effective in primary and secondary prevention of life threatening VT/VF

Nonsustained ventricular tachycardia in heart failure

Heart failure is a common clinical syndrome with a high morbidity and mortality, despite advances in medical treatment. Death from dangerous ventricular arrhythmias is frequently implicated. Eighty patients with heart failure [HF] [fitting the criteria of heart failure] who were admitted to the medical city teaching hospital during a period of 8 months, were studied for incidence of nonsustained ventricular tachycardia [N.S.V.T.] [detected by Holter monitoring] and its association with the severity of left ventricular dysfunction [measured by ejection fraction], ventricular size [measured by left ventricular end diastolic dimension], and other factors. It was found that out of 80 patients with H.F, 20 patients [25%] have N.S.V.T. N.S. V.T was found to be significantly associated with the severity of H.F. and left ventricular dimension. The arrhythmia was found to be strongly related with hypokalemia. The incidence of N.S. V. T. is less in patients receiving beta-blockers in their treatment regimen. Nonsustained ventricular tachycardia is a common finding in heart failure and is related to the severity of heart failure and other factors related to the disease and its treatment

Effect of relaxation program on the rate of ventricular arrhythmia in patients with myocardial infarction

Relaxation is one of the efficient methods in decreasing the occurance of ventricular arrhythmia. The aim of this study was to assess the effect of relaxation methods on the rate of ventricular arrhythmia in patients swith myocardial infarction. This study is a clinical trial in which 60 patients with myocardial infarction have been randomly divided into two, experimental and control groups. Data collecting tools were a demographic characteristics form and also a ventricular arrhythmia checklist. In order to assess the effect of relaxation, relaxation method was performed on experimental and control groups and the rate of occurance of ventricular arrhythmia was compared before and after relaxation in both groups. Most of the studied cases were married with primery education level and their monthly income was more than 2000000 Rials. The findings of this study showed that the rate of ventricular arrhythmia in the experimental group was lower in comparison with the control group and this difference was statisticaly significant. Relaxation can be used as an efficient element in decreasing ventricular arrhythmia in patients with myocardial infarction

Arritmias ventriculares: ¿cómo abordarlas? / Ventricular arrhythmias: how to approach?

El tratamiento de las arritmias ventriculares continúa siendo un problema. El estudio dl CAST nos ha dejado enseñanzas que se deben tener siempre presente, especialmente en lo que se refiere al potencial proarrítmico de las drogas antiarrítmicas. En efecto, las drogas antiarrítmicas en las arritmias ventriculares pueden ser más dañinas que útiles. Probablemente la única droga que puede no ser peligrosa es la amiodarona, aunque su utilidad es discutida por algunos. 18 estudios randomizados que usaron amiodarona para prevención primaria de arritmias ventriculares complejas, muestran reducción de la mortalidad, lo que apoyaría aún más, loa justificación del uso de esta droga. Otros estudios recientes, apoyan el uso de DIC en pacientes con arritmias ventriculares complejas en quienes ha fracasado el uso de amiodarona