VENTRICULAR DYSRHYTHMIAS, LEFT-VENTRICULAR HYPERTROPHY, AND SUDDEN-DEATH

Left ventricular hypertrophy has been documented to be a powerful risk factor for sudden death, acute myocardial infarction, and other cardi ovascular morbidity and mortality. The major determinant of left ventr icular mass is the hemodynamic burden. However, the hypertrophic proce ss is modified by demographic parameters (age, sex, race), nutritional parameters (salt intake, alcohol, obesity), and neuroendocrine factor s (angiotensin, catecholamines, growth hormones, etc.). Ventricular ec topy and more serious arrhythmias are commonly seen in patients with l eft ventricular hypertrophy. Specific antihypertensive therapy will re duce left ventricular hypertrophy, although not all antihypertensive d rugs are equipotent in this regard. A reduction in left ventricular hy pertrophy has been shown to diminish left-ventricular-hypertrophy-asso ciated arrhythmias. However, it remains to be shown that patients with left ventricular hypertrophy and ventricular ectopy are at a higher r isk of sudden death than those without ventricular ectopy and that the reduction of left-ventricular-hypertrophy-associated ventricular ecto py indeed confers a clinical benefit that exceeds the one from the red uction in arterial pressure alone.