Roles and indications for use of implantable defibrillator and resynchronization therapy in the prevention of sudden cardiac death in heart failure
Roles and indications for use of implantable defibrillator and resynchronization therapy in the prevention of sudden cardiac death in heart failure
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DOI：
10.1007/s10741-016-9542-y
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发表时间：
2016-07-01
影响因子：
4.6
通讯作者：
Polonsky, Bronislava
中科院分区：
文献类型：
--
作者：
Biton, Yitschak;Baman, Jayson R.;Polonsky, Bronislava
植入式器械适用于心力衰竭患者潜在危及生命的室性快速性心律失常的一级和二级预防。早期的研究，包括具有里程碑意义的MADIT试验，表明植入式心律转复除颤器（ICD）和心脏除颤治疗（CRT）设备可以分别在中止和预防可导致心脏性猝死的室性心律失常方面发挥重要作用。迄今为止，已经有许多随机对照试验，以及各自的子研究分析，试图更好地了解这些干预措施在患者护理中的适应症。在这里，我们总结了这些研究的主要结果，我们讨论了ICD治疗缺血性和非缺血性心肌病的作用，支持可穿戴式除颤器的新证据，以及修改后的ICD编程策略对患者结局的影响。关于CRT治疗，心室逆向重构现象是预防未来室性快速性心律失常发作的重要预后指标。总之，我们提供了一个可能的选择标准，可用于识别合适的患者ICD和/或CRT治疗的概述，支持的数据。
Implantable devices are indicated in the primary and secondary prevention of potentially life-threatening ventricular tachyarrhythmias in patients with heart failure. Early studies, including the landmark MADIT trials, showed that implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices can play a significant role in aborting and preventing ventricular arrhythmias, respectively, that can cause sudden cardiac death. To this day, there have been a number of randomized controlled trials, with respective substudy analyses, that have attempted to better understand the indications for these interventions in patient care. Here, we summarize the major results of these studies, and we discuss the role of ICD therapy for both ischemic and non-ischemic cardiomyopathy, emerging evidence in support of wearable defibrillators, and the impact of modified ICD programming strategies on patient outcomes. Regarding CRT therapy, the phenomenon of ventricular reverse remodeling is an important prognostic indicator in preventing future ventricular tachyarrhythmia episodes. In summation, we provide an overview of the possible selection criteria that can be used in identifying appropriate patients for ICD and/or CRT therapy, as supported by the data.