Ventricular arrhythmias in patients with heart failure secondary to reduced ejection fraction: a current perspective
Ventricular arrhythmias in patients with heart failure secondary to reduced ejection fraction: a current perspective
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DOI：
10.1097/hco.0000000000000035
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发表时间：
2014-03
影响因子：
2.3
通讯作者：
G. Nair;P. Nery;C. Redpath;D. Birnie
中科院分区：
文献类型：
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作者：
G. Nair;P. Nery;C. Redpath;D. Birnie
综述目的：综述继发于射血分数降低（HFrEF）的心力衰竭患者室性心律失常的治疗。最近的研究结果复发性室性心律失常和自动植入式心律转复除颤器（AICD）电击是HFrEF患者显著死亡率和发病率的原因。抗肿瘤药物和导管消融术是主要的治疗选择。频繁的室性期前收缩（PVC; >10 000-20 000/24 h周期）被认为是心肌病的原因和对心脏起搏治疗（CRT）的次优反应。心室辅助装置（VAD）患者频繁发生室性快速性心律失常，导致发病率和死亡率增加。这些患者可能需要继续积极的ICD治疗和连续的导管消融。目前迫切需要开发新的抗心律失常药物来治疗复发性AICD休克患者。导管消融作为预防室性心律失常和复发性AICD电击的一线治疗的有效性需要直接与胺碘酮进行比较。室性快速性心律失常在CRT患者和VAD患者中很常见。频繁的PVC可能导致可逆形式的HFrEF。
Purpose of review To review the management of ventricular arrhythmias in patients with heart failure secondary to reduced ejection fraction (HFrEF). Recent findings Recurrent ventricular arrhythmias and automatic implantable cardioverter defibrillator (AICD) shocks are responsible for significant mortality and morbidity in patients with HFrEF. Antiarrhythmic drugs and catheter ablation are the main treatment options. Frequent premature ventricular contractions (PVCs; >10 000–20 000/24-h period) are being recognized as a cause of cardiomyopathy and suboptimal response to cardiac resynchronization therapy (CRT). Patients with ventricular assist devices (VADs) have frequent ventricular tachyarrhythmias resulting in increased morbidity and mortality. Such patients may need continuation of active ICD therapy and adjunctive catheter ablation. Summary There is a pressing need to develop new antiarrhythmic drugs to treat patients with recurrent AICD shocks. The effectiveness of catheter ablation as first-line therapy for preventing ventricular arrhythmias and recurrent AICD shocks needs to be directly compared with amiodarone. Ventricular tachyarrhythmias are common in CRT patients and patients with VADs. Frequent PVCs may result in a reversible form of HFrEF.