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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.
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