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Approach to reduction of ventricular arrhythmias and implantable cardioverter-defibrillator therapies in patients with heart failure

Sengupta, Jay; Abdelhadi, Raed

Current Opinion in Cardiology: May 2013 - Volume 28 - Issue 3 - p 337–343
doi: 10.1097/HCO.0b013e3283604420
CARDIAC FAILURE: Edited by David Feldman and Josef Stehlik

Purpose of review: Prevention of ventricular arrhythmias and implantable cardioverter-defibrillator (ICD) therapies in patients with heart failure will be reviewed.

Recent findings: ICD utilization in patients with heart failure has resulted in significantly improved long-term survival. However, there is growing evidence that ICD shocks are associated with increased morbidity and mortality. As a result, there is increasing emphasis on the treatment strategies to avoid ICD therapies. Optimal heart failure management with medical as well as cardiac resynchronization therapy when indicated is an essential part of treatment; however, adjunctive measures may be necessary to suppress ventricular arrhythmias, prevent unnecessary shocks, and improve quality of life.

Summary: Device programming can help avoid ICD therapies by delaying time to detection, increasing detection rate cutoffs, and discriminating between supraventricular and ventricular arrhythmias. Still, as patients live longer with advanced stages of heart failure, there will be a need to suppress sustained ventricular arrhythmias that would otherwise require ICD therapy. Antiarrhythmic drugs offer a noninvasive option to help suppress ventricular arrhythmias. With more experience and better catheter mapping and ablation techniques, there is a movement toward an early invasive strategy for ventricular tachycardia management in patients with heart failure.

Minneapolis Heart Institute, Minneapolis, Minnesota, USA

Correspondence to Jay Sengupta, MD, 800 East 28th Street, Minneapolis, MN 55407, USA. Tel: +1 612 863 3900; e-mail: jay.sengupta@allina.com

© 2013 Lippincott Williams & Wilkins, Inc.