Beta-blocker therapy for long QT syndrome and catecholaminergic polymorphic ventricular tachycardia: Are all beta-blockers equivalent?
Beta-blocker therapy for long QT syndrome and catecholaminergic polymorphic ventricular tachycardia: Are all beta-blockers equivalent?
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DOI：
10.1016/j.hrthm.2016.09.012
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发表时间：
2017-01-01
期刊：
影响因子：
5.5
通讯作者：
Gold, Michael R.
中科院分区：
文献类型：
--
作者：
Ackerman, Michael J.;Priori, Silvia G.;Gold, Michael R.
先天性长QT综合征（LQTS）和儿茶酚胺能多形性室性心动过速（CPVT）是两种最常见的心脏通道病。在经历过LQS触发的心脏事件（惊厥性晕厥、惊厥性晕厥后癫痫发作或心脏骤停流产）的患者中，未经治疗的自然史是严峻的，15年时死亡率> 50%。(1)然而，今天，早期诊断有助于简单的心理治疗，猝死的发生率已显着下降。(1)这些疾病的治疗策略已经扩展到包括药物治疗，去神经手术或植入装置。（2，3）重要的是，β受体阻滞剂药物治疗是LQTS和CPVT的主要治疗手段。2013年HRS/EHRA/APHRS关于遗传性原发性心律失常患者诊断和管理的专家共识声明和2015年ESC室性心律失常患者管理和预防心源性猝死指南要求将通用β受体阻滞剂治疗作为所有LQTS或CPVT患者的首选方法，除非患者出现LQTS/CPVT触发的心脏骤停。（2，4）表1显示了β受体阻滞剂的使用如何被视为这些通道病的一线治疗。（2，4）
Congenital long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT) are 2 of the most common cardiac channelopathies. Among patients who have experienced an LQTS-triggered cardiac event (arrhythmic syncope, arrhythmic syncope followed by seizures, or aborted cardiac arrest), the untreated natural history is grim, with > 50% mortality at 15 years.(1) Today, however, early diagnosis facilitate simple mentation of appropriate therapy, and the incidence of sudden death has dropped significantly.(1) Treatment strategies for these conditions have expanded to include drug therapy, denervation surgery, or implantable devices.(2,3)Importantly, drug therapy with beta-blockers represents the therapeutic main stay for both LQTS and CPVT. The 2013 HRS/EHRA/APHRS Expert Consensus Statement on the Diagnosis and Management of Patients with Inherited Primary Arrhythmia and the 2015 ESC Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death call for universal beta-blocker therapy as a first approach in all patients with either LQTS or CPVT, except in cases in which the patient presents with LQTS/CPVT-triggered sudden cardiac arrest.(2,4) Table 1 shows how beta-blocker usage is considered first-line therapy in these channelopathies.(2,4)