Electrical management of heart failure: from pathophysiology to treatment.
Electrical management of heart failure: from pathophysiology to treatment.
复制标题
心力衰竭的电管理：从病理生理学到治疗
DOI：
10.1093/eurheartj/ehac088
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发表时间：
2022-05-21
影响因子：
39.3
通讯作者：
Huizar, Jose F.
中科院分区：
文献类型：
--
作者：
Prinzen, Frits W.;Auricchio, Angelo;Mullens, Wilfried;Linde, Cecilia;Huizar, Jose F.
关键词：
大多数心力衰竭（HF）患者存在电干扰，如房颤（AF）、不同步、心动过速和室性早搏（PVC）。虽然这些干扰可能是HF的后果，但越来越多的证据表明它们也可能导致或加重HF。动物研究表明，持续时间较长的左束支分支传导阻滞、心动过速、房颤和室性心动过速会导致器官、细胞和分子水平的功能紊乱。相反，电治疗可以逆转或减轻HF。临床研究表明，与药物治疗相比，心房和肺静脉消融在房颤患者的心律控制方面以及房室结消融在房颤患者的心率控制方面具有优越性。消融室性早搏也可改善左室功能。心脏起搏治疗（CRT）是一种已确立的辅助治疗，目前正在进行几项有趣的创新。目前的指南建议反映了这些消融治疗和CRT的安全性和有效性，但目前，这些治疗严重未得到充分利用。本文综述了射血分数降低心力衰竭（HFrEF）的电治疗。我们认为，治疗HF患者的专家团队应包括一名电生理学家，以便在HFrEF的管理中更广泛地使用电疗，并且还应包括患者的个体状况，例如治疗微调中的体型和性别。上面板：各种心律失常和传导异常与四种电异常之间的相互作用及其对重塑和发展心力衰竭的后果的示意图。方框中的红色文本表示治疗电异常的治疗方法，因此也是心力衰竭。CRT，心脏起搏治疗。下面板：根据上图和指南中提供的证据，推荐检查射血分数降低的心力衰竭患者接受各种电治疗的资格的流程图。
Electrical disturbances, such as atrial fibrillation (AF), dyssynchrony, tachycardia, and premature ventricular contractions (PVCs), are present in most patients with heart failure (HF). While these disturbances may be the consequence of HF, increasing evidence suggests that they may also cause or aggravate HF. Animal studies show that longer-lasting left bundle branch block, tachycardia, AF, and PVCs lead to functional derangements at the organ, cellular, and molecular level. Conversely, electrical treatment may reverse or mitigate HF. Clinical studies have shown the superiority of atrial and pulmonary vein ablation for rhythm control and AV nodal ablation for rate control in AF patients when compared with medical treatment. Ablation of PVCs can also improve left ventricular function. Cardiac resynchronization therapy (CRT) is an established adjunct therapy currently undergoing several interesting innovations. The current guideline recommendations reflect the safety and efficacy of these ablation therapies and CRT, but currently, these therapies are heavily underutilized. This review focuses on the electrical treatment of HF with reduced ejection fraction (HFrEF). We believe that the team of specialists treating an HF patient should incorporate an electrophysiologist in order to achieve a more widespread use of electrical therapies in the management of HFrEF and should also include individual conditions of the patient, such as body size and gender in therapy fine-tuning. Upper panel: Schematic representation of the interaction between the various arrhythmia and conduction abnormalities with four electrical abnormalities and their consequences for remodelling and developing heart failure. Red text in boxes indicates the therapeutic approaches that treat the electrical abnormalities and thereby also heart failure. CRT, cardiac resynchronization therapy. Lower panel: Flow chart of recommended checks for the eligibility of heart failure with reduced ejection fraction patients for the various electrical therapies based on the evidence presented in the upper panel and guidelines.
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影响因子：
2.8
作者：
Agarwal, Sunil K.;Simpson, Ross J., Jr.;Rautaharju, Pentti;Alonso, Alvaro;Shahar, Eyal;Massing, Mark;Saba, Samir;Heiss, Gerardo
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影响因子：
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影响因子：
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通讯作者：
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影响因子：
1.9
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通讯作者：
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