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Questions posted in the
Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Arhythmia, CHF and Batista procedureForum: The Heart Forum
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I am a 41 year old male with CHF, which the doctors believe derived from viral cardiomyopathy, onset in spring 1997. Althogu fairly stable and functional on medication (coreg, lasix, zestril, k-dur, digoxin and coumadin), my left ventrical is severely dilated. With a move to a new area and linking up with a new cardiologist, I have learned more about my condition. Specifically, although I have known about the risk of progressive deterioration, I now am more aware of the sudden cardiac death risk from arythmia. We had discussed my joining the scud-hft trial, but the transplant surgeon is concerned that the amniodaron (sp?) prong might be problematic given my elegibility for a transplant and the potential side effects of that drug. Other than CHF, I am in great health and have passed some of the objective tests as to general health and eligibility for transplant I have discussed the Batista procedure with my cardiologist and the transplant surgeon, and the surgeon's understanding is that the outcomes in terms of mortality rates and patient profiles are not pinned down sufficiently yet to compare conventional transplant vs. surgical remodeling results and mortality (which is confirmed by at least a little of what I have read here). My questions, though, are whether the Batista procedure alleviates the nerve damage that may be linked sudden cardiac death through arythmia? In other words, does the procedure have the potential for mechanically improving cardiac performance but not to reverse the risk of sudden cardiac death? Are there any studies that have defined mortality risks from sudden cardiac death (as opposed to progressive failure), with or without any differentiation for size of enlargment, age, gender, EF or other objective indices? Finally, I understand that arythmia leading to sudden cardiac death is somewhat idiosyncratic, i.e., not related to specific activity (rest or exercion); Is that the present understanding? Thanks so much for this service!
Dear Michael, thank you for your question. You raise many interesting points and ask insightful questions. The Batista procedure initially appeared promising as an alternative to transplantation, but we have found that it doesn't reverse the deterioration of patients with dilated cardiomyopathy and may not be helpful. Our transplant surgeons have the most experience outside of Brazil with this procedure, but since 1998, very few Batista procedures have been performed. Patients treated with this procedure seemed to have a gradual deterioration afterwards with progressive heart failure, and often have eventually needed transplantation. I don't know of an increased risk of sudden death after the Batista procedure, but the potential to cause arrhythmias exists since the left ventricular myocardium is manipulated during the procedure. Sudden cardiac death (SCD) with heart failure is notoriously hard to predict, but we do know that overall mortality is worse in patients who are elderly, who have severe left ventricular dysfunction with progressive clinical deterioration, and patients with previously known ventricular arrhythmias. Presently, there is a device called an implantable defibrillator that continuously records the heart rhythm and delivers an internal shock if a lethal arrhythmia develops. The SCUD-HFT trial is evaluating the relative merits of amiodarone compared with defibrillators in a randomized fashion. Thus, you should have further discussions with your own cardiologist to determine what the most appropriate course of action is for you presently. I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions. Good luck. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
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