A surprising new arrhythmia mechanism in heart failure.

Heart failure is the most common discharge diagnosis in the United States, with a prognosis worse than many cancers.1 Patients with heart failure die for two reasons: advanced circulatory insufficiency or sudden death.2 We know that continuous online monitoring of cardiac rhythm from patients with advanced heart failure is inevitably abnormal and often shows long runs of irregular and/or polymorphic ventricular tachycardia. Unlike patients with ventricular tachycardia due to healed myocardial infarction, those with heart failure rarely have ventricular tachycardia inducible by programmed stimulation, and when it is, its prognostic importance is uncertain. Therapy with conventional antiarrhythmics is no more successful in patients with heart failure than in those with serious ventricular arrhythmias due to healed infarction.