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COMPLEX VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH HEART FAILURE ARE RELATED TO URINARY EXCRETION OF CATECHOLAMINES, BUT NOT TO EJECTION FRACTION.
U. Grochowicz, R. Wołk, L. Ceremużyński
Dept. of Cardiology, Postgraduate Medical School, Warsaw, Poland

Background. Heart failure (CHF) is associated with complex neuro-hormonal disturbances. Although the role of noradrenaline (NA) in CHF has been extensively studied, the data concerning the pathophysiological effects of adrenaline (AD) is scarce. Aim. To assess the arrhythmogenic role of catecholamines in CHF. Methods. Urinary excretion of AD and NA, serum levels of aldosterone, K and Mg, as well as the incidence of arrhythmias (24 hr Holter) were assessed in 50 pts with CHF (NYHA II-III). The pts were allocated to 2 groups, according to the results of 24h Holter recordings: group A (undisturbed sinus rhythm or unifocal ventricular beats; 24 pts) and group B (complex arrhythmias: multiform ventricular beats, couplets or episodes of non-sustained ventricular tachycardia; 26 pts). Results. As shown in the Table, urinary excretion of AD and NA was significantly increased in pts with complex ventricular arrhythmias. Serum electrolyte levels and ventricular ejection fraction were similar in both groups.




mean±SD

Group A

Group B

p<


AD excretion (mg/24h)

5±4

9±6

0.005


NA excretion (mg/24h)

30±19

70±8

0.05


serum aldosterone (pg/ml)

119±61

101±53

Ns


serum K (mEq/L)

4.7±0.5

4.6±0.3

Ns


serum Mg (mEq/L)

1.7±0.2

1.7±0.4

Ns


ejection fraction (%)

37±11

37±9

Ns





Conclusions. Urinary excretion of AD and NA, but not ejection fraction, is related to the incidence of complex ventricular arrhythmias in pts with mild to moderate CHF. These results suggest an arrhythmogenic effect of both neural and adrenal sympathetic activation in CHF and may provide a rationale for the use of ß-blockers in this group of pts.


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