[Prevention of complications: a forgotten aspect of therapy? arrhythmia complication in heart failure]

Heart failure has a high prevalence in the western world: 1-1.5% in the general population and 2-5% in patients above 65 years old. The association with cardiac dysarrhythmia is very common: 20-30% of patients have atrial fibrillation and significant ventricular arrhythmias occur in 50%. The pathophysiology of cardiac arrhythmias is multifactorial, including reentry, increased automaticity and triggered activity. Several prognostic factors have been described in patients with coronary artery disease, however, the two more important are the functional class and the severity of left ventricular dysfunction. In order to prevent disarrhythmic complications, the appropriate treatment of heart failure and of the underlying cardiac disease are very important. Class III antiarrhythmic drugs and the implantable cardioverter-defibrillator are increasingly used as primary (in high risk patients) or secondary prophylactic agents.