Objective: To study the incidence of ventricular arrhythmia (VT) in heart failure (HF) patients after cardiac resynchronization therapy (CRT-D) and identify the influencing factors for VT occurrence, to explore the impact of CRT-D shocks on mortality and the management of appropriate shocks. Methods: A total of 42 patients with successfully implanted CRT-D in our hospital from 2009-01 to 2015-04 were studied. There were 2 groups of patients: Ischemic cardiomyopathy group,n=12 including 8 patients for primary prevention and 4 for secondary prevention; Non-ischemic cardiomyopathy group,n=30 including 19 patients for primary prevention and 11 for secondary prevention. The patients with appropriate shocks received four step-wise therapy as drug, equipment parameter adjustments, revascularization and radiofrequency ablation (RA). Results: The patients in Ischemic cardiomyopathy group were followed-up for (38.1±24.0) months, 7 patients suffered from post-operative VT, 5 patients had CRT-D appropriate shocks. The patients in Non-ischemic cardiomyopathy group were followed-up for (27.5±17.8) months, 11 patients suffered from post-operative VT, 10 patients had CRT-D appropriate shocks. The occurrence rates of post-operative VT and CRT-D appropriate shocks were similar between 2 groups,P>0.05; the success rate for ATP treating VT was higher in Ischemic cardiomyopathy group (69% vs 55%),P<0.05. Cox regression analysis indicated that CRT-D as secondary prevention was the independent influencing factor for VT occurrence,P=0.001. During follow-up period, 9 patients with shocks died; the mortality in patients with shocks was higher than those without shocks (43% vs 0%),P<0.05. With four step-wise therapy, 80% patients in Ischemic cardiomyopathy group had no more shocks; with three step-wise therapy as drug, equipment parameter adjustments and RA, 90% patients in Non-ischemic cardiomyopathy group had no more shocks, 10% patients had reduced shocks. Conclusion: CRT-D as secondary prevention was the independent impact factor for post-operative VT occurrence, no matter appropriate or inappropriate shocks would elevate the risk of death in HF patients. Step-wise therapy was important to reduce appropriate shocks.

Objective To define the clinical characteristics and outcome of patients with dilatedhypertrophic cardiomyopathy (D-HCM).Methods Clinical data of HCM patients hospitalized from January 2002 to December 2015 in our hospital were retrospectively analyzed.Patients were divided into D-HCM and classic HCM patients.The D-HCM patients were followed up by phone.Results A total of 616 consecutive HCM patients were evaluated.Twenty one patients (3.4％) were diagnosed with D-HCM (average age (58.8 ± 10.4) years,13 males).It took (14.2 ± 7.1) years for classic HCM patients to develop D-HCM.Compared to classic HCM patients,D-HCM patients were younger at the time of first HCM diagnosis ((39.7 ± 10.4) years old vs.(48.5 ±9.5) years old,P ＜0.001) and had higher ratio of sudden cardiac death family history (19.0％ (4/21) vs.2.5％ (14/558),P =0.003),more patients of future D-HCM patients had ventricular tachycardia (38.1％ (8/21) vs.5.7％ (32/558),P ＜0.001) and higher TroponinⅠ(66.7％ (14/21) vs.9.3％ (52/558),P ＜ 0.001) before the left ventricular cavity enlargement.Moreover,MLVWH ((24.8 ± 4.2) mm vs.(17.2 ± 3.5) mm,P ＜ 0.001) was significantly thicker and LAD ((39.8 ±5.9) mm vs.(35.2 ± 3.3) mm,P ＜ 0.001) was significantly larger in D-HCM patients than in classical HCM patients.During the(3.8 ± 1.9) years follow up period,12 out of 21 D-HCM patients died (57.1％),5 cases(23.8％)died of severe heart failure and 7 cases(33.3％) died of sudden cardiac death.One patient received heart transplantation.Conclusions Few classical HCM patients progressed into D-HCM in this cohort.Patients diagnosed as HCM at young age,HCM patients with abnormal Troponin Ⅰ and ventricular tachycardia are at higher risk of developing D-HCM.The prognosis of D-HCM is very poor,and heart failure and sudden cardiac death are the main causes of death.