Ventricular rhythm disorders are dangerous, but not all of them: a new staged stratification using electrocardiographic methods

The capability of predicting the degree of ventricular arrhythmia (VA) danger as the most prognostically adverse cardiac arrhythmia, as well as identification of the conditions of its progression to life-threatening forms are highly relevant tasks of modern cardiology. Objective. To stratify ventricular arrhythmia from conditionally non-serious to extremely dangerous considering the risk of its transition to life-threatening in patients with preserved or moderately reduced left ventricular ejection fraction using a step-by-step decision-making system, according to which doctor will be able to implement a unified approach to patient management by means of electrocardiographic screening methods at the outpatient stage. Material and methods. The study included 397 patients aged 18—85 years (median 53 years) with confirmed VA, in whom left ventricular ejection fraction was 45—77% (58.9±10.2%). After collecting the complaints and medical history, an examination consisting of three stages was carried out: I — standard electrocardiogram (ECG) at rest, II — monitoring of ECG, III — exercise tolerance test under ECG control. Results. A decision-making system based on the analysis of clinical and electrocardiographic characteristics of arrhythmia was implemented. At stage I, 4 patients with extremely dangerous and 2 with dangerous VAs have been identified; at stage II — 15 patients with extremely dangerous and 54 with dangerous VAs; at stage III — 2 patients with extremely dangerous and 89 with dangerous VAs. Thus, extremely dangerous VAs were reported in 5% and dangerous in 37% of patients. In the remaining 125 (31%) subjects, VAs were stratified as potentially dangerous and in 106 (27%) — as conditionally non-serious. The further management of patients corresponded to the gradation of VA. Conclusion. Step-by-step stratification of ventricular arrhythmia from conditionally non-serious to extremely dangerous is possible by the means of electrocardiographic examination methods. This approach allows to timely identify clinical situations in which urgent or planned hospitalization is required, as well as to determine the tactics of outpatient care.