Ventricular electrical remodeling and arrhythmogenesis : Observations concerning the evolvement and reversibility

Following cardiac diseases such as an insufficient valve or a myocardial infarction, the heart attempts to adapt to the new situation. The heart can adapt its structure or contractility, but it can also adapt its electrical properties. This phenomenon is called electrical remodelling and is associated with an increased sensitivity to lethal ventricular arrhythmias. This electrical remodelling is of importance in patients with congestive heart failure because it leads to sudden cardiac death in about 50% of the cases in this population. In this thesis, several aspects contributing to electrical remodeling have been studied. In patients with end-stage heart failure, a genetic variant has been studied which might lead to an increase in electrical remodelling. In the same patient group, it was found that a heterogeneous distribution of a cell-cell communication protein was associated with a higher risk for the development of arrhythmias. An attempt was made to relieve electrical remodeling using pacemakers and ventricular assist devices. This was only partially possible. After the treatment, a substrate for the development of arrhythmias remained present