Heart Failure and Arrhythmias

186 Pages·1990·3.868 MB·English

by  H. Just (auth.), Priv.-Doz. Johannes Brachmann MD, Prof. Rainer Dietz MD, Prof. Wolfgang Kübler MD (eds.)

1. Brachmann R. Dietz W Kubler
(Eds.)
Heart Failure
and Arrhythmias
With 41 Figures and 17 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Priv.-Doz. JOHANNES BRACHMANN, MD
Prof. RAINER DIETZ, MD
Prof. WOLFGANG KUBLER, MD
Department of Internal Medicine III, Cardiology
Medizinische UniversiHitsklinik
Bergheimer Str. 58
6900 Heidelberg, FRG
ISBN-13 :978-3-642-75328-2 e-ISBN-13:978-3-642-75326-8
DOl: 10.1007/978-3-642-75326-8
Library of Congress Cataloging-in· Publication Data. Heart failure and arrhythmias / 1. Brach
mann, R. Dietz, W Kiibler, (eds.). p. cm. Based on an international satellite workshop to the
World Congress of Clinical Pharmacology, held in Heidelberg/Mannheim from July 23 -29, 1989.
Includes bibliographical references. Includes index.
ISBN-13 :978-3-642-75328-2
1. Congestive heart failure-Congresses. 2. Heart failure-Congresses. 3. Arrhythmia-Con
gresses. I. Brachmann, 1. II. Dietz, R. (Rainer). III. Kiibler, W IV. World Congress of Clini
cal Pharmacology (1989: Heidelberg, Germany and Mannheim, Germany) [DNLM: 1. Arrhyth
mia-drug therapy-congresses. 2. Arrhythmia-physiopathology-congresses. 3. Heart Failure,
Congestive-drug therapy-congresses. 4. Heart Failure, Congestive-physiopathology-con
gresses. WG 370 H4362 1989] RC685.C53H43 1990 616.1'2-dc20 DNLM/DLC for Library
of Congress 90-9813 CIP.
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Preface
Heart failure is a clinical entity characterized by a certain combination
of symptoms and signs. Although there is neither a definition covering
all aspects of it nor any generally accepted criteria for evaluating its
severity, it is the endstage of many different heart diseases, in most cases
associated with a poor prognosis. Approximately 50% of the patients
with advanced heart failure die from pump failure, whereas the other
half succumb suddenly and unexpectedly due to ventricular tachyar
rhythmias. Although impaired left ventricular function is the main risk
factor, sudden death may already occur in less severe cases of heart
failure. In certain cardiac diseases, such as dilative cardiomyopathy, the
occurrence of ventricular arrhythmias may be related directly to the
underlying heart disease, as the frequency and severity (Lown classifica
tion) of ventricular ectopics are not related to left ventricular impair
ment.
Treatment of ventricular tachyarrhythmias is still an unsolved prob
lem, especially in patients with heart failure, who need it the most. The
vast majority of antiarrhythmic agents are more or less negatively ino
tropic and may therefore substantially aggravate ventricular impair
ment. Nonpharmacological approaches - such as the implantation of a
defibrillator - still require major surgery with the associated increased
risk to the patient in heart failure.
No agreement has yet been reached on the criteria for evaluating how
effective treatment has been, either for heart failure or for ventricular
tachyarrhythmias. In fact, the basic questions when and how to treat
have also not been resolved for these two conditions.
The symposium "Heart Failure and Arrhythmias" was dedicated to
these problems and covered both theoretical topics, such as pathophys
iology and pathogenesis, and clinical ones, including prognostic implica
tions.
The symposium was designed as an international satellite workshop
to the World Congress of Clinical Pharmacology, which took place in
HeidelbergjMannheim from 23-29 July 1989. It was organized by J.
Brachmann and R. Dietz, who were supported by T. Beyer, M. Haass,
K. J. Osterziel, A. Pfeifer, C. Schmitt, W. Waas, and B. Waldecker.
VI Preface
The symposium has been made possible by an educational grant
from ICI-Pharma, Plank stadt, Federal Republic of Germany. We are
very grateful to both the organizers and the sponsors.
Heidelberg, Mai 1990 1. BRACHMANN
R. DIETZ
W KUBLER
Contents
I Pathophysiology
Editorial:
Heart Failure and Arrhythmias
H. lUST .......... . 3
Pathogenesis of Impaired Pump Function
in Congestive Heart Failure
A.M. KATZ (With 1 Figure) ...... . 8
Pathogenesis of Ventricular Arrhythmias in Heart Failure
M.I lANSE, IM.T. DE BAKKER, and T. OPTHOF (With 2 Figures) 16
Evaluation of the Severity of Heart Failure:
Role of Compensatory Mechanisms
R. DIETZ, T. FISCHER, M. HAASS, K.I OSTERZIEL, and W W AAS
(With 7 Figures) . . . . . . . . . . . . . . . . . . . 24
Tissue Renin-Angiotensin Systems in the Pathophysiology
of Heart Failure
A.T. HIRSCH and Y.I DZAU (With 1 Figure and 1 Table) 33
Evaluation of the Severity of Ventricular Rhythm
Disturbances: Value of Electrophysiological Testing
and Recording of Late Potentials
L. SEIPEL, G. BREITHARDT, and M. BORGGREFE
(With 3 Figures and 1 Table) . . . . . . . . . . . . . . .. 43
II Approaches to Treatment
Hemodynamic Approach
Editorial:
How to Treat - The Hemodynamic Approach
K. KOCHSIEK .............. . 53
VI II Contents
Structural Basis of Left Ventricular Dysfunction:
Role of Collagen Network Remodeling
and Potential Therapeutic Interventions
M.A. SILVER and K.T. WEBER (With 2 Figures) 54
Treatment of Heart Failure by "Afterload" Reduction:
Vasodilator or Angiotensin Converting Enzyme Inhibitor?
P.A. POOLE-WILSON (With 2 Figures and 3 Tables) 66
Possible Role of Positive Inotropic Drugs
in Congestive Heart Failure and in Left Ventricular Dysfunction
H. POULEUR (With 1 Table) . . . . . . . . . . . . . . . .. 76
Prognostic Indices and Prolongation of Life
K. SWEDBERG (With 2 Figures) ..... . 83
Antiarrhythmic Approach
Editorial:
Heart Failure and Malignant Ventricular Arrhythmias
A.I CAMM .............. . 91
Heart Failure and Ventricular Arrhythmias -
The Antiarrhythmic Approach
B. LUDERITZ (With 1 Figure and 1 Table) 93
When to Treat Arrhythmias in Heart Failure?
A.P.M. GORGELS, P. BRUGADA, and H.IJ. WELLENS
(With 6 Figures and 1 Table) . . . . . . . . . . . . . . . . 100
Antiarrhythmic Drugs in Heart Failure
I BRACHMANN, C. SCHMITT, T. BEYER, B. WALDECKER, T. HILBEL,
M. SCHWEIZER, and W KUBLER (With 3 Figures and 2 Tables) 111
Nonpharmacologic Therapy
for Malignant Ventricular Tachyarrhythmias in Patients
with Congestive Heart Failure
S. SAKSENA (With 4 Figures) . . . . . . . . . . . . . 119
Role of Antiarrhythmic Drug Therapy in Patients
with Congestive Heart Failure
R.L. WOOSLEY (With 4 Figures and 3 Tables) . . . . . . . . . 136
Contents IX
III Prognosis
Obtaining Reliable Information
from Randomized Controlled Trials in Congestive Heart Failure
and Left Ventricular Dysfunction
S. YUSUF (With 4 Tables) . . . . . . . . . . . . . . . . . . 147
Prognostic Significance of Asymptomatic Ventricular
Arrhythmias in Heart Failure: Potential for Mortality Reduction
by Pharmacologic Control
B.N. SINGH, M.P. SCHOENBAUM, M. ANTIMISIARIS,
and C. TAKANAKA (With 3 Figures) ............. 161
SUbject Index . . . . . . . . . . . . . . . . . . . . . . . 175
List of Contributors
ANTIMISIARIS, M., MD
Division of Cardiology 691/111 E, VA Medical Center
of West Los Angeles
Wilshire and Sawtelle Boulevards, Los Angeles, CA 90073, USA
BAKKER, IM.T. DE, MD
Department of Clinical and Experimental Cardiology and the
Interuniversity Cardiology Institute, Academisch Medisch Centrum
Meibergdreef 9, 1105 AZ Amsterdam ZO, The Netherlands
BEYER, T., MD
Department of Internal Medicine III, Medizinische Universitiitsklinik
Bergheimer Str. 58, 6900 Heidelberg, FRG
BORGGREFE, M., MD
Department of Internal Medicine C, Medizinische Universitiitsklinik
Albert-Schweitzer-Str., 4400 Munster, FRG
BRACHMANN, I, MD
Department of Internal Medicine III, Cardiology
Medizinische U niversitiitsklinik
Bergheimer Str. 58, 6900 Heidelberg, FRG
BREITHARDT, G., MD
Department of Internal Medicine C, Medizinische Universitiitsklinik
Albert-Schweitzer-Str., 4400 Munster, FRG
BRUGADA, P., MD
Department of Cardiology, University Hospital Maastricht
University of Limburg
P.O. Box 1918, 6201 BX Maastricht, The Netherlands
CAMM, A.I, MD
Department of Cardiological Sciences
St. George's Hospital Medical School
London SW17 ORE, UK
XII List of Contributors
DIETZ, R., MD
Department of Internal Medicine III, Cardiology
Medizinische Universitatsklinik
Bergheimer Str. 58, 6900 Heidelberg, FRO
DZAU, V.l, MD
Cellular Vascular Research Laboratory
Brigham and Women's Hospital
Harvard Medical School
75 Francis Street, Boston, MA 02115, USA
FISCHER, T., MD
Department of Internal Medicine III, Medizinische Universitatsklinik
Bergheimer Str. 58, 6900 Heidelberg, FRO
OORGELS, A.P.M., MD
Department of Cardiology, University Hospital Maastricht
University of Limburg
P.O. Box 1918, 6201 BX Maastricht, The Netherlands
HAASS, M., MD
Department of Internal Medicine III, Cardiology
Medizinische U niversitatsklinik
Bergheimer Str. 58, 6900 Heidelberg, FRO
HILBEL, T., MD,
Department of Internal Medicine III, Medizinische Universitatsklinik
Bergheimer Str. 58, 6900 Heidelberg, FRO
HIRSCH, A.T., MD
Cardiovascular Physiology Laboratory
Brigham and Women's Hospital
Harvard Medical School
75 Francis Street, Boston, MA 02115, USA
JANSE, M.I, MD
Department of Clinical and Experimental Cardiology and the
Interuniversity Cardiology Institute, Academisch Medisch Centrum
Meibergdreef 9, 1105 AZ Amsterdam ZO, The Netherlands
JUST, H., MD
Department of Internal Medicine III, Cardiology
Hugstetter Str. 55, 7800 Freiburg i. Br., FRO
KATZ, A.M., MD
Cardiology Division, Department of Medicine
University of Connecticut
Farmington, CT 06032, USA