Goldberger J J
Division of Cardiology, Department of Medicine, Wesley Pavilion, Northwestern University Memorial Hospital, 250 E. Superior Street, Chicago, IL 60611, USA.
Heart Dis. 2000 Jul-Aug;2(4):305-13.
Tremendous strides have been made in recent years in the treatment and prevention of sudden cardiac death. Large-scale trials have identified several strategies that may be implemented to improve survival in patients susceptible to sudden cardiac death. In patients who have had a sustained ventricular tachyarrhythmia, the current therapy of choice is an implantable cardioverter defibrillator. For prophylaxis of sudden cardiac death in patients without a previous event, several approaches should be considered. Beta-blockers are an effective pharmacologic therapy in patients after myocardial infarction, and their efficacy has also been demonstrated in patients with congestive heart failure. Antiarrhythmic drugs are not efficacious as prophylactic agents to reduce mortality in these populations. The best therapeutic approach for prophylactic therapy to prevent sudden cardiac death appears to be the implantable cardioverter defibrillator; however, its use can be justified only in patients at high risk for developing sudden cardiac death. Further work is needed to identify the high-risk populations in which this therapy is warranted.
近年来，在心脏性猝死的治疗和预防方面取得了巨大进展。大规模试验已经确定了几种可以实施的策略，以提高易发生心脏性猝死患者的生存率。对于发生持续性室性心律失常的患者，目前的首选治疗方法是植入式心脏复律除颤器。对于既往无心脏性猝死事件患者的心脏性猝死预防，应考虑几种方法。β受体阻滞剂是心肌梗死后患者的一种有效药物治疗，其疗效也已在充血性心力衰竭患者中得到证实。抗心律失常药物作为预防剂在这些人群中并不能有效降低死亡率。预防心脏性猝死的最佳治疗方法似乎是植入式心脏复律除颤器；然而，只有在发生心脏性猝死高危患者中使用才合理。需要进一步开展工作以确定有必要进行这种治疗的高危人群。
