Curr Cardiol Rep (2014) 16:510 DOI 10.1007/s11886-014-0510-7
INVASIVE ELECTROPHYSIOLOGY AND PACING (EK HEIST, SECTION EDITOR)
Arrhythmias in Structural Heart Disease H. Sawyer Gillespie & Charles C. H. Lin & Jordan M. Prutkin
# Springer Science+Business Media New York 2014
Abstract The presence of structural heart disease is often associated with the development of electrical abnormalities of the heart, manifesting as atrial and ventricular arrhythmias. These can occur in those with ischemic and nonischemic cardiomyopathies, congenital heart disease, and various acquired and intrinsic structural abnormalities of the myocardium. Treatment of these arrhythmias generally involves treatment of the underlying disorder first, if possible, such as with surgical or catheter-based intervention. Other therapies, including medical therapy with beta-blockers and antiarrhythmic agents, pacemakers and implantable cardioverter-defibrillators (ICDs), and ablation may be offered both as prophylactic therapy or if arrhythmias have developed. In some instances, therapy is undertaken regardless of whether there are symptoms. ICDs provide support for those patients at risk for malignant, life-threatening arrhythmias, but appropriate patient and device selection are vital to improve mortality and to limit adverse events. Keywords Atrial fibrillation . Ventricular fibrillation . Ventricular tachycardia . Cardiomyopathy . Congenital heart disease . Arrhythmias . Structural heart disease
Introduction Supraventricular and ventricular arrhythmias constitute a significant cause of morbidity and mortality in those w i t h s t r u ctu r a l h ea r t d i s e a s e, w h eth er d ue t o This article is part of the Topical Collection on Invasive Electrophysiology and Pacing H. S. Gillespie : C. C. H. Lin : J. M. Prutkin (*) Division of Cardiology, University of Washington, 1959 NE Pacific Street, Box 356422, Seattle, WA 98195, USA e-mail: [email protected]
development of a cardiomyopathy or congenital heart disease. These arrhythmias often present later in the course of disease and may manifest as palpitations, chest pain, dyspnea, dizziness, syncope, or sudden cardiac death (SCD). A thorough evaluation of patients with complaints suggestive of an arrhythmia is vital.
Atrial Fibrillation in Heart Failure and Cardiomyopathy Prevalence Atrial fibrillation (AF) and cardiomyopathy frequently occur concurrently, and those with heart failure have a 4.5- to 5.9fold increased risk for developing AF, with up to 50 % in those with NYHA class IV heart failure having AF [1, 2]. For those who have either heart failure or AF alone, the development of the other portends a worse survival . Further, AF with rapid ventricular response may lead to tachycardia-induced cardiomyopathy, which can be reversible upon management of AF by rate or rhythm control .
Treatment In patients with AF, heart failure and left ventricular ejection fraction (LVEF)≤35 % are moderate risk factors for development of thromboembolism, and, in general, anticoagulation should be offered to these patients [5••]. For most patients, the optimal management of asymptomatic AF in those with cardiomyopathy should focus on rate control. The AFFIRM trial of rate vs rhythm control demonstrated no significant difference in mortality, although only 4.8 % of patients had cardiomyopathy and 25.9 % of patients had LVEF