[Malignant arrhythmia].

Abstract

About 5 percent of the arrhythmias are serious, life threatening, malignant arrhythmias (MA). The MA is regularly associated with organic heart diseases (coronary heart disease, cardiomyopathy, valvular heart diseases), but a MA can develop without cardiac disorders e.g. in long QT syndrome or WPW syndrome. The most frequent type of the MA is the ventricular tachycardia (VT), mostly the sustained VT, not rarely degenerating to ventricular fibrillation (VF). The primary VF represents a rarer form of MA. The usual type of MA is the tachycardiac form, but there exists a MA with dominating bradycardia (bradycardia syncope, tachycardia associated with long lasting bradycardia). In the diagnosis of MA new investigatory methods (signal averaged electrography with high amplification, Holter monitoring, programmed electrical stimulation) play an important role. In the therapy of the MA the first step is the treatment of the cardiac disease involved in the pathogenesis of the MA. At present only about the 40% of the MA can be effectively treated with antiarrhythmic drugs. The pacemaker therapy is very efficacious in the bradycardiac type of MA. Cardiodefibrillator pacemaker can be used for the treatment of grave VT or VF. Electrical transvenous catheter ablation, heart surgical intervention can also be applied in the treatment of special MA. The prognosis of VA was very serious a decade ago, now with application of newer therapeutical procedure the prognosis of MA is permanently improving.