Prystowsky E N
Indiana Heart Institute, St. Vincent Hospital, Indianapolis, IN, USA.
Rev Cardiovasc Med. 2001 Fall;2(4):197-205.
Sudden cardiac death (SCD) affects nearly 300,000 people each year in the U.S., and out-of-hospital rates for survival range from only 2% to 25%. A substantial reduction in SCD requires primary prevention through risk-stratification and secondary prevention of sustained ventricular tachycardia (VT-S) and ventricular fibrillation (VF). Because frequent premature ventricular complexes (PVCs) appeared to be associated with an increased risk for SCD in patients with significant ventricular dysfunction, it was thought that suppression of PVCs would prevent SCD. The implantable cardioverter defibrillator (ICD) electrically treats life-threatening VT-S and VF, and it can be implanted readily in the pectoral area. Two randomized, prospective, controlled trials demonstrated conclusively that the ICD is the treatment of choice in the primary prevention of SCD in patients with a previous MI. In addition, three randomized, controlled trials found the ICD to be superior to antiarrhythmic drugs in the secondary prevention of SCD. Physicians should learn to recognize patients who are candidates for the ICD and refer them to an electrophysiologist so that they can get this life-saving therapy.
在美国，心脏性猝死（SCD）每年影响近30万人，院外生存率仅为2%至25%。大幅降低SCD需要通过风险分层进行一级预防以及对持续性室性心动过速（VT-S）和心室颤动（VF）进行二级预防。由于频发室性早搏（PVC）似乎与严重心室功能障碍患者的SCD风险增加相关，因此人们认为抑制PVC可预防SCD。植入式心脏复律除颤器（ICD）可对危及生命的VT-S和VF进行电治疗，并且可以很容易地植入胸壁区域。两项随机、前瞻性对照试验确凿地表明，ICD是既往心肌梗死患者SCD一级预防的首选治疗方法。此外，三项随机对照试验发现，在SCD二级预防中，ICD优于抗心律失常药物。医生应学会识别适合植入ICD的患者，并将他们转诊给电生理学家，以便他们能够接受这种挽救生命的治疗。
