Prystowsky Eric N
The Care Group, LLC, Indiana Heart Institute, St. Vincent Hospital, Indianapolis, IN, USA.
Rev Cardiovasc Med. 2003;4 Suppl 2:S47-54.
The most recent estimates show an apparent increase in sudden cardiac death (SCD) in the United States. A major reduction in SCD will depend on developing effective methods to identify and prevent risk factors for SCD. This article reviews the research milestones that have resulted in our current approach to risk stratification and treatment of patients at high risk for SCD. One of the earliest attempts to prevent SCD involved suppression of premature ventricular complexes (PVCs) in high-risk patients, but trials using a variety of antiarrhythmic drugs with the aim of suppressing PVCs and reducing mortality demonstrated negative survival results. In the case of amiodarone, clinical trial data to date suggest that it should not be used for primary prevention of SCD or to prolong survival in patients with congestive heart failure secondary to coronary artery disease. The implantable cardioverter defibrillator (ICD) has been demonstrated in multiple studies to be the most significant therapy for life-threatening ventricular arrhythmias and for primary and secondary prevention of SCD. It is recommended that the majority of patients who receive cardiac resynchronization therapy should have an ICD unit implanted in order to include defibrillator therapy.
最新估计显示，美国心脏性猝死（SCD）的发生率明显上升。大幅降低SCD将依赖于开发有效的方法来识别和预防SCD的危险因素。本文回顾了一系列研究里程碑，这些里程碑成就了我们目前对SCD高危患者进行风险分层和治疗的方法。预防SCD最早的尝试之一是抑制高危患者的室性早搏（PVC），但旨在抑制PVC并降低死亡率的各种抗心律失常药物试验均显示出生存结果为阴性。就胺碘酮而言，迄今为止的临床试验数据表明，它不应被用于SCD的一级预防或延长冠状动脉疾病所致充血性心力衰竭患者的生存期。多项研究已证明，植入式心脏复律除颤器（ICD）是治疗危及生命的室性心律失常以及SCD一级和二级预防的最重要疗法。建议大多数接受心脏再同步治疗的患者植入ICD装置，以便纳入除颤器治疗。
