Evaluation and Management of Premature Ventricular Complexes
Evaluation and Management of Premature Ventricular Complexes
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DOI：
10.1161/circulationaha.119.042434
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发表时间：
2020-04-28
期刊：
影响因子：
37.8
通讯作者：
Marcus, Gregory M.
中科院分区：
文献类型：
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作者：
Marcus, Gregory M.
早衰心室复合体（早衰心室复合体）是非常常见的，在大多数接受长期动态监测的个体中发现。年龄增长、身高增高、血压升高、有心脏病史、体力活动较少和吸烟都预示着更高的PVC频率。尽管室性早搏的根本原因在很大程度上仍然未知，但任何特定室性早搏的潜在机制包括触发性活动、自动性和再入性。室性早搏通常无症状，但也可导致心悸、呼吸困难、晕厥前期和疲劳。病史、体格检查和12导联心电图都是诊断和评估PVC的关键。超声心动图是指出现症状或特别频繁的室性早搏，心脏磁共振成像是有用的，当评估表明存在相关的结构性心脏病。需要动态监测来评估PVC频率。室性早搏患者的预后是可变的，对于不良结果的最具信息量的预测因素存在不确定性。室性早搏频率增高可能是心衰和死亡的危险因素，室性早搏导管消融成功后收缩功能障碍的消退表明两者之间可能存在因果关系。无症状或症状轻微、PVC负荷低、心室功能正常的患者最好采取简单的保证措施。对于大多数伴有症状或左室射血分数降低的室性早搏患者，药物治疗或导管消融都被认为是一线治疗，患者的偏好在决定首先尝试哪一种治疗方面起着重要作用。如果选择药物治疗，对于心室收缩功能正常的患者，受体阻滞剂或非二氢吡啶类钙通道阻滞剂都是合理的药物。如果这些初始药物失败，消融被拒绝、不成功或被认为不合适，则应考虑使用其他抗心律失常药物。导管消融是根除室性早搏最有效的方法，但可能会增加前期风险。仍有必要进行原始研究，以确定有室性早搏诱发心肌病风险的个体，并确定针对室性早搏根本原因的预防和治疗方法，以最大限度地提高疗效，同时将风险降至最低。
Premature ventricular complexes (PVCs) are extremely common, found in the majority of individuals undergoing long-term ambulatory monitoring. Increasing age, a taller height, a higher blood pressure, a history of heart disease, performance of less physical activity, and smoking each predict a greater PVC frequency. Although the fundamental causes of PVCs remain largely unknown, potential mechanisms for any given PVC include triggered activity, automaticity, and reentry. PVCs are commonly asymptomatic but can also result in palpitations, dyspnea, presyncope, and fatigue. The history, physical examination, and 12-lead ECG are each critical to the diagnosis and evaluation of a PVC. An echocardiogram is indicated in the presence of symptoms or particularly frequent PVCs, and cardiac magnetic resonance imaging is helpful when the evaluation suggests the presence of associated structural heart disease. Ambulatory monitoring is required to assess PVC frequency. The prognosis of those with PVCs is variable, with ongoing uncertainty regarding the most informative predictors of adverse outcomes. An increased PVC frequency may be a risk factor for heart failure and death, and the resolution of systolic dysfunction after successful catheter ablation of PVCs demonstrates that a causal relationship can be present. Patients with no or mild symptoms, a low PVC burden, and normal ventricular function may be best served with simple reassurance. Either medical treatment or catheter ablation are considered first-line therapies in most patients with PVCs associated with symptoms or a reduced left ventricular ejection fraction, and patient preference plays a role in determining which to try first. If medical treatment is selected, either beta-blockers or nondihydropyridine calcium channel blockers are reasonable drugs in patients with normal ventricular systolic function. Other antiarrhythmic drugs should be considered if those initial drugs fail and ablation has been declined, has been unsuccessful, or has been deemed inappropriate. Catheter ablation is the most efficacious approach to eradicate PVCs but may confer increased upfront risks. Original research remains necessary to identify individuals at risk for PVC-induced cardiomyopathy and to identify preventative and therapeutic approaches targeting the root causes of PVCs to maximize effectiveness while minimizing risk.