Management of Arrhythmias in Heart Failure

Patients with heart failure (HF) often develop ventricular and supraventricular arrhythmias,[1] due in large part to electrical conduction abnormalities of the heart in this syndrome.[2] Cardiac remodeling and neurohumoral activation typical of HF create a substrate that increases the risk of developing arrhythmias and/or worsening pre-existing arrhythmias. [3] Advances in our understanding of the underlying pathophysiological mechanisms of HF have reinforced the importance of neurohumoral, mechanical and inflammatory processes as progressively more severe pump dysfunction occurs.[4] This combination increases the likelihood of arrhythmias, both atrial and ventricular, such that ventricular arrhythmias are found in up to 80% of patients with severe HF[5], conferring additional risk of mortality and morbidity [3], in particular via an increased risk of sudden cardiac death. [6—8] Arrhythmias are also responsible for an increased risk of rehospitalisation in one-third of HF patients