الفهرس 
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Abstract
Despite the recent remarkable progression in the treatment of CHF the overall mortality continued to be extremely high. It is generally known that ≈40% of these patients die suddenly. VAs had been presumed to be the cause of a significant proportion of sudden deaths. Other causes include bradyrrhythmias and pulseless electrical activity. Furthermore, studies demonstrated a high prevalence of VAs in patients with HF regardless the etiology.
Based on data from a number of studies, almost 80% of CHF patients had frequent PVCs whereas > 40% had runs of NSVT. In addition, studies had demonstrated the independent value of the presence of VAs as predictor of total mortality and morbidity.
VAs include a spectrum that ranges from PVC to VF with variable clinical presentation that ranges from a total lack of symptoms to cardiac arrest. They were especially common in those with ischemic etiology and with a lower LVEF. The risk of VAs was also increased by concurrent co-morbidities such as electrolyte disturbances, OSA, hypoxemia, catecholamine excess and in renal or hepatic dysfunction along with pro-arrhythmic drug effects.
The aim of our study was to determine the prevalence of silent VAs in stable HFrEF patients and its relation to the outcome (death, HF hospitalization and sustained VT).
This study was a prospective observational study enrolling 100 ambulatory (HFrEF) patients. Full clinical assessment including 12 lead ECG, ECHO and 48 hour Holter monitoring . All patients had been followed up clinically for at least 6 months. The occurrence of major cardiovascular events were considered as the study composite end point (death, HF hospitalization and sustained VT).
Among the 100 patients enrolled in our study they were predominantly males (93%) . Their age ranged from 40 to 69 years with mean age of 56.07 ± 7.89 years with 56 patients were < 60 years (56.0%).
Among the studied patients 49 patients (49%) were hypertensives and 46 patients (46%) were diabetics. 82 patients (82%) suffered from ACS. 61 patients (74.4%) had PCI while 21 patients (25.6%) underwent CABG. 79 patients (79%) were smokers .
Regarding the ECG parameters, the minimum heart rate was 55 beats/minute while the maximum heart rate was 110 beats/minute with mean value (77.95 ± 11.79). 27 patients (27%) with BBB 19 of them (70%) with LBBB and 8 patient (30%) with RBBB, while 73 patients (73%) did not had any BBB.
Among our patients, LVEF ranged from 25 to 40% with mean value (32.33 ± 4.88). 52 patients (52%) had severely reduced LV systolic function (EF ≤ 30%). 82 patients (82 %) had resting RWMA (ICM group) while 18 patients (18%) had global hypokinesia (DCM group).
Regarding coronary angiography, among our patients, 82 patients (82%) had coronary artery disease (CAD) while 18 patients shows normal coronary angiography.
Regarding 48 hour Holter monitoring In 76 patients (76%) PVCs were detected by 48 hour Holter. 27 patients (35.5%) of them had in-frequent PVCs (less than 5% of the total beats) in the form of singles, couplets with no NSVT or sustained VT but in 49 patients (64.5%) they had frequent PVCs (5% of more of the total beats) in the form of singles, couplets and or NSVT in 23 patients ( 47.93%) of them had single run or multiple runs of NSVT but no sustained VT was detected.