Acute Effects of Angiotensin II Receptor Blocker on Ventricular Repolarization Alternans in Chronic Heart Failure

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Repolarization alternans, which can be detected clinically as microvolt-level T-wavealternans (TWA), is considered an important mechanism underlying the initiation ofventricular tachycardia/ventricular fibrillation (VT/VF) linked to sudden cardiac death(SCD). Recently, the rennin-angiotensin system (RAS) inhibitors have been suggestedto have potential benefits in reducing SCD as well as heart failure death with chronicheart failure (CHF).In this study, we tested the acute effects of an angiotensin II receptor blocker (ARB),valsartan, on the development of TWA and the heart rate at which TWA appeared(onset heart rate; OHR). Fifty consecutive patients with CHF underwent TWAmeasurement. Patients with positive TWA were administered valsartan (80mg/day)orally for 3 days. Alternans voltage in the vector magnitude lead (Valt) and the OHRwere compared before and after the drug exposure.TWA was positive in 19 patients (38%), negative in 16 (32%), and indeterminate in15 (30%). Nineteen patients with positive TWA received valsartan. However, 3patients were withdrawn due to adverse drug reactions. In all the remaining 16patients, markedly reduced Valt (6.1 ± 3.8 μV to 2.5 ± 1.9 μV; P = 0.002) and increasedOHR (94 ± 9 beats/min to 102 ± 9 beats/min; p = 0.002) were observed. In particular,3 patients became TWA negative.These results suggest that the RAS inhibitors prevent SCD by the improvement ofrepolarization abnormality.
神戸大学の論文