Ventricular arrhythmias in heart failure

Prof. Dr. Thorsten Lewalter was born on October 18, 1964 in Fulda, Germany. He was a student of medicine at the University of Marburg and took a degree of MD in 1991. He is currently professor of Internal Medicine and director of the Department of Cardiology at St.Vincenz Paderborn Academic Hospital at the University of Göttingen, Germany. He joined the clinical and research work as a trainee at the University of Bonn, where he was later elected as professor of Medicine in May 2007. His interests turned Prof. Dr. Lewalter at an early age towards clinical and experimental cardiac electrophysiology; h ehas been in charge of the EP laboratories at the Universityof Bonn between 2000 and 2008. His outstanding contribution to arrhythmology is marked by his membership at several scientific communities. He is a prominent member of the Arrhythmia Working Group of the German Cardiac Society and a member of the editorial board of the Journal of Interventional Cardiac Electrophysiology and Europace. Prof. Dr. Lewalter has been elected President for the Annual Autumn Scientific Meeting of the German Society of Cardiology in 2008.

Aside from the common tachycardia mechanisms like enhanced automaticity or myocardial reentry, bundle-branch reentry tachycardia is a specific mechanism predominantly documented in patients with significant structural heart disease, heart failure and impaired conduction in the His-Purkinje-System. The surface ECG during tachycardia demonstrates a typical bundlebranch block pattern, mainly left bundle branch block what can be explained by the fact that in the majority of cases antegrade conduction uses the right bundle and retrograde conductionruns via the left bundle. In cases of a right bundle branch block the reverse pattern is present. Identification of a bundle branch re-entrant tachycardia offers the smart possibility of catheter ablation mainly by ablating the right bundle. The indication to additionally implant an ICD for prevention of sudden death needs to be tailored to each individual case including parameters like left ventricular ejection fraction or additional inducible ventricular arrhythmias.There is evidence that in selected cases without structural heart disease but frequent premature ventricular contractions, sustained or non-sustained ventricular tachycardias (like in right or leftventricular outflow tract tachycardia) the arrhythmia itself leads to heart failure and reduced left ventricular (LV) function (“tachycardiomyopathy”). This form of tachycardia is reversible; thus normalization of LV function was reported after successful catheter ablation of right ventricular outflow tract tachycardia.