Revascularization of theHeart Muscle in Malignant Ventricular Tachyarrhytmia - Prognostic Value

Overview

Background.
The survival of patients with chronic ischaemic heart disease and malignant ventricular tachy-arrhythmia is influenced positively in some instances by revascularization of the heart muscle and implantationof a cardioverter - defibrillator. The objective of the submitted work was to evaluate by perspective follow-up ofsubjects with chronic ischaemic heart disease and malignant ventricular tachyarrhythmia: a) the effect of revascu-larization of the heart muscle on the prognosis, making use of programmed stimulation of the ventricles and tes-ting the effectiveness of antiarrhythmic treatment; b) the importance of implantation of a cardioverter - defibrilla-tor in revascularized and non-revascularized subjects for the prevention of sudden —arrhythmicla deaths.Methods and Results. The authors examined 37 patients (32 men and 5 women), age bracket 34 to 78 years(mean age 61±11) with IHD and spontaneous ventricular tachyarrhythmia after ruling out acute myocardial infar-ction. The group was divided into sub-groups without revascularization (21 subjects) and with revascularization(16 subjects). In both sub-groups programmed stimulation of the ventricles was implemented. During the dia-gnostic finding of programmed stimulation they tested antiarrhythmic drugs, most frequently amiodarone admi-nistered orally. A cardioverter-defibrillator was implanted to 10 patients. All patients were followed-up to death,the longest period being 24 months. They evaluated the frequency of cardiac deaths (death on cardiac groundsincl. sudden —arrhythmicl- death) and sudden —arrhythmicl- deaths (death within on hour after onset of symptomsor first recorded malignant ventricular tachyarrhythmia). In the sub-group without revascularization with dia-gnostic inducibility of the heart muscle in 85.7 % of patients the authors described 9 cardiac deaths (42.9 %) and8 sden —arrhythmicla deaths (38.1 %). Conversely in the sub-group with revascularization and with diagnosticprogrammed stimulation of the ventricles in half the subjects 5 clinical deaths were found (31.3 %) and 3 sudden—arrhythmicla deaths (18.8 %). Analysis of 11 sudden —arrhythmicla deaths revealed that no subjects with an im-planted cardioverter-defibrillator (5) died (documented malignant ventricular tachyarrhythmia). Five of the six pa-tients who died (all without a cardioverter-defibrillator) were not revascularized.Conclusions. Revascularization of the heart muscle in patients with ischaemic heart disease (a fter eliminationof acute cardiac infarction) and malignant ventricular tachyarrhythmia reduces the risk of relapse of this arrhyt-hmia. The benefit of implantation of a cardioverter-defibrillator was recorded in all subjects regardless of the re-vascularization of the heart muscle.

Key words:
arrhythmia, ischaemic heart disease, suden cardiac death, ventricular tachyarrhythmia, coronarybypass, programmed stimulation of the ventricles, revascularization of the myocardium.