The aim of this study was to investigate the association between left ventricular remodeling, atrial fibrillation (AF), and the severity of ventricular tachycardia (VT) in patients with ventricular rhythm disturbances admitted in a level 3 facility of acute cardiac care. Material and Methods: The RHYTHM-ACC registry was a single-center observational study, including 150 consecutive patients with sustained or non-sustained ventricular tachycardia (sVT and nsVT, respectively) admitted in an intensive cardiac care unit (ICCU), separated in: group 1 - 29 patients (21.01%) with dilated cardiomyopathy (DCM), and group 2 - 109 patients (78.99%) with normal ventricular performance. We investigated the difference between clinical characteristics of patients with sVT versus those with nsVT in each study group, and the association between AF and different forms of ventricular arrhythmia in 38 (25.33%) patients with AF and 112 (74.66%) patients in sinus rhythm. Results: There were no significant differences between the study groups with respect to type of ventricular arrhythmia: sVT (46.87% vs. 36.44%, p = 0.2), nsVT (43.75% vs. 55.93%, p = 0.2), or ventricular fibrillation (VF) (9.37% vs. 7.62%, p = 0.7). However, patients with DCM presented a significantly higher incidence of AF (43.75% vs. 20.33%, p = 0.01) and bundle branch block (37.5% vs. 11.86%, p = 0.0007). VF occurred more frequently in patients with AF compared to those in sinus rhythm (18.42% vs. 4.46%, p = 0.006). Multivariate analysis identified the co-existence of AF (OR = 4.8, p = 0.01) and the presence of a bundle branch block (BBB) (OR = 3.9, p = 0.03) as the most powerful predictors for the degeneration of VT into VF in patients admitted with sVT or nsVT in an ICCU unit. Conclusions: In patients with any type of VT admitted in an ICCU, the presence of ventricular remodeling is associated with a higher incidence of AF and conduction abnormalities, but not with a more severe pattern of ventricular arrhythmia. At the same time, AF and BBB seem to represent the most powerful predictors for degeneration of VT into VF, independent of the type of VT.
2. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling - concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol. 2000;35:569-582.
3. Anand IS, Florea VG, Solomon SD, Konstam MA, Udelson JE. Noninvasive assessment of left ventricular remodeling: concepts, techniques, and implications for clinical trials. J Card Fail. 2002;8:S452-64. doi:
7. Suthahar N, Meijers WC, Silljé HHW, de Boer RA. From Inflammation to Fibrosis - Molecular and Cellular Mechanisms of Myocardial Tissue Remodelling and Perspectives on Differential Treatment Opportunities. Curr Heart Fail Rep. 2017;14:235-250. doi:
9. Heymans S, Hirsch E, Anker SD, et al. Inflammation as a therapeutic target in heart failure? A scientific statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2009;11:119-129. doi:
16. Kalifa J, Jalife J, Zaitsev AV, et al. Intra-atrial pressure increases rate and organization of waves emanating from the superior pulmonary veins during atrial fibrillation. Circulation. 2003;108:668-671. doi:
17. Lalani GG, Schricker A, Gibson M, Rostamian A, Krummen DE, Narayan SM. Atrial conduction slows immediately before the onset of human atrial fibrillation: a bi-atrial contact mapping study of transitions to atrial fibrillation. J Am Coll Cardiol. 2012;59:595-606. doi:
18. Mills RW, Narayan SM, McCulloch AD. Mechanisms of conduction slowing during myocardial stretch by ventricular volume loading in the rabbit. Am J Physiol Heart Circ Physiol. 2008;295:H1270-H1278. doi:
19. Stiles MK, John B, Wong CX, et al. Paroxysmal lone atrial fibrillation is associated with an abnormal atrial substrate: characterizing the ‘second factor’. J Am Coll Cardiol. 2009;53:1182-1191. doi:
20. Healey JS, Israel CW, Connolly SJ, et al. Relevance of electrical remodeling in human atrial fibrillation: results of the asymptomatic atrial fibrillation and stroke evaluation in pacemaker patients and the atrial fibrillation reduction atrial pacing trial mechanisms of atrial fibrillation study. Circ Arrhythm Electrophysiol. 2012;5:626-631. doi:
32. Mazur A, Kusniec J, Strasberg B. Bundle branch reentrant ventricular tachycardia. Indian Pacing Electrophysiol J. 2005;5:86-95.
33. Hodkinson EC, Aston K, Walsh SJ. Left bundle branch block morphology ventricular tachycardia in a marathon runner. Ulster Med J. 2012;81:130-133.
34. Gorenek B, Cengiz O, Kudaiberdieva G, et al. Mode of onset of polymorphic ventricular tachycardia in acute myocardial infarction. Can J Cardiol. 2010;26:e254-257.
35. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119-177. https://doi.org/10.1093/eurheartj/ehx393.
36. Blomstrom-Lundqvist C, Mazzanti A, Blom N, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Eur Heart J. 2015;36:2793-2867. doi:
41. López Gil M, Arribas F, Cosío FG. Ventricular fibrillation induced by rapid atrial rates in patients with hypertrophic cardiomyopathy. Europace. 2000;2:327-332. https://doi.org/10.1053/eupc.2000.0117.
42. Link MS, Bockstall K, Weinstock J, et al. Ventricular Tachyarrhythmias in Patients With Hypertrophic Cardiomyopathy and Defibrillators: Triggers, Treatment, and Implications. J Cardiovasc Electrophysiol. 2017;28:531-537. doi: