Ventricular Dysrhythmias

Cardiovascular nurses contribute significantly to health outcomes and frequently assume responsibility for the clinical and organizational processes to ensure positive outcomes for patients and families. In ventricular dysrhythmia populations, nurses have provided evidence for practices that influence outcomes and have studied patient outcomes related to mortality, morbidity, quality of life, psychological and physical functioning, symptoms, and family responses. Additionally, nurses have contributed to understanding organizational outcomes, such as costs and resource use related to patients with dysrhythmias. Most ventricular dysrhythmia outcome studies are descriptive. More intervention research is needed to develop a cohesive and comprehensive body of evidence upon which to base dysrhythmia nursing care to improve patient outcomes.

Cardiac resynchronization therapy through biventricular pacing in patients with heart failure and ventricular dyssynchrony

Cardiac resynchronization therapy provides a new adjunct in the armamentarium of therapies available to patients who remain symptomatic despite optimized standard therapies. It does not cure heart failure; patients must maintain evidence-based therapies promoted by the American Heart Association and American College of Cardiology. Therapy benefits can be influenced by lead placement and device programming, so it is essential that qualified personnel are consulted to initiate and monitor therapy. While we await final analysis of COMPANION and other studies that definitively answer the question of mortality benefits, substantial data support CRT in reversing left ventricular remodeling, providing hemodynamic benefits, and most importantly, imparting clinical benefits related to functional status, symptoms, quality of life, and morbidity. Acute and critical care nurses can take an active role in promoting this intervention for patients with wide QRS and cardiac dyssynchrony who are likely to benefit through improvement in cardiac function and efficiency.

Heart failure patients with ventricular dysynchrony: management with a cardiac resynchronization therapy device

Despite an array of treatment modalities, the overall prognosis for patients with severe heart failure remains bleak. Biventricular pacing, or cardiac resynchronization therapy, is gaining increasing acceptance as a compelling treatment for those individuals with advanced heart failure (New York Heart Association functional class III or IV). This article provides a brief description of the atrial and ventricular conduction disturbances common in patients with advanced heart failure. Current indications for therapy are outlined, as are recent results of cardiac resynchronization therapy trials. The implant procedure is described to provide a comprehensive overview of this innovative approach to re-establishing normal electromechanical activity and synchronous right and left ventricular contractions. Patient care, before and after device implant, is also summarized. The focus on patient education throughout this article may allow it to serve as a reference for health care providers involved in the care of patients with severe heart failure.

Cognitive therapy for ventricular dysrhythmia patients

Living with a serious ventricular dysrhythmia and its treatment poses certain psychological stressors including anxiety, depression, fear, and a sense of loss of control. Additional stressors related to side effects and technology issues may be present depending on whether the patient is treated with antidysrhythmic medications, an internal cardioverter defibrillator, or both. Cognitive therapy has been used with some success to reduce patient fear and improve psychological outcomes in some patient populations with illnesses characterized by loss of control including cancer and epilepsy. This article outlines a cognitive therapy approach for use with patients who have a serious ventricular dysrhythmia.