Acute heart failure and in-hospital complex ventricular arrhythmogenesis. Can we predict its occurence?

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Abstract Background There is a complex interplay between heart failure (HF) and complex ventricular arrhythmias (CVA), as one can trigger and/or aggravate the other. The purpose of this study was to highlight factors associated with either an increased incidence or a protective effect against the occurrence of CVA in hospitalized patients due to acute heart failure (AHF). Materials-methods This retrospective observational study involved patients hospitalized for AHF from February 2023 to May 2024. We recorded demographic characteristics, comorbidities, HF and anti-arrhythmic medication and admission laboratory parameters (NT-proBNP, creatinine [Cr], estimated glomerular filtration rate [eGFR], CRP, etc.). Echocardiographic parameters were recorded during the first 48 hours of hospitalization (left ventricular ejection fraction [LVEF], estimated pulmonary artery systolic pressure [ePASP] etc.), along with the total number of deaths. Patients with in-hospital recordings from either a monitor or a 24-hour Holter rhythm recorder were divided into two groups based on the presence or absence of CVA. CVA was defined as the presence of ventricular fibrillation, sustained or non-sustained ventricular tachycardia, or premature ventricular contractions >10% of the total beats. Results Data were extracted from 93 out of 305 hospitalized patients, with 28 (30.1%) presenting with CVA. Ischemic cardiomyopathy, the use of angiotensin–renin axis inhibitors (ACEi/ARB) and amiodarone were associated with a reduced incidence of CVA. No statistically significant differences were found in the comorbidities, laboratory, and imaging parameters studied. In the subpopulation of patients with ischemic cardiomyopathy, a statistically significant difference was observed in the use of antiarrhythmics (72.5% vs. 49.1%, p=0.033) compared to patients with other causes of HF, while no difference was found in the use of ACE-i/ARBs. Conclusions Angiotensin–renin axis inhibitors and antiarrhythmics play a pivotal role in preventing arrhythmic complications in HF. Administering guideline-recommended medication can prevent potentially lethal arrhythmias and improve the patients’ quality of life.Baseline characteristics and medication

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