Arrhythmia-Induced Cardiomyopathies: Mechanisms, Recognition, and Management.
Arrhythmia-Induced Cardiomyopathies: Mechanisms, Recognition, and Management.
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DOI：
10.1016/j.jacc.2015.08.038
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发表时间：
2015-10-13
影响因子：
24
通讯作者：
Olshansky B
中科院分区：
文献类型：
--
作者：
Gopinathannair R;Etheridge SP;Marchlinski FE;Spinale FG;Lakkireddy D;Olshansky B
心律失常诱发的心肌病（AIC）是一种潜在的可逆性疾病，其中左心室功能障碍由房性或室性心律失常诱发或介导。已经确定了对罪犯心律失常的细胞和细胞外变化，但具体的病理生理机制仍不清楚。早期识别AIC并使用药物或消融技术及时治疗罪犯心律失常可导致症状缓解和心室功能恢复。尽管心律失常引起的心肌病可能需要数月至数年才能发生，但复发性心律失常可导致心室功能迅速下降，并伴有心力衰竭，提示残留的超微结构异常。左心室射血分数正常的患者猝死的报告对这种情况的完全可逆性提出了质疑。AIC的几个方面，包括特定的病理生理机制，诱发因素，防止超微结构变化的最佳治疗策略，以及猝死的长期风险仍然没有得到解决，需要进一步研究。
Arrhythmia-induced cardiomyopathy (AIC) is a potentially reversible condition in which left ventricular dysfunction is induced or mediated by atrial or ventricular arrhythmias. Cellular and extracellular changes in response to the culprit arrhythmia have been identified, but specific pathophysiological mechanisms remain unclear. Early recognition of AIC and prompt treatment of the culprit arrhythmia using pharmacological or ablative techniques results in symptom resolution and recovery of ventricular function. Although cardiomyopathy in response to an arrhythmia may take months to years to develop, recurrent arrhythmia can result in rapid decline in ventricular function with development of heart failure, suggesting residual ultrastructural abnormalities. Reports of sudden death in patients whose left ventricular ejection fraction have normalized cast doubt on the complete reversibility of this condition. Several aspects of AIC, including specific pathophysiological mechanisms, predisposing factors, optimal therapeutic strategies to prevent ultrastructural changes, and long-term risk of sudden death remain unresolved and need further research.