Alings A M W
Department of Cardiology, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands.
Neth J Med. 2003 May;61(5 Suppl):4-7.
Sudden cardiac death (SCD) is the most important cause of death in the industrialised world. Treatment with antiarrhythmic drugs (AAD), however, proved disappointing in preventing SCD. From drugs with electrophysiological properties, only treatment with beta-blockers has been shown to improve clinical outcome. This lack of efficiency of AADs heralded a new era of secondary and primary prevention trials, comparing implantable cardioverterdefibrillator (ICD) with drug therapy. Three large randomised secondary prevention trials were conducted in patients with prior myocardial infarction who where resuscitated from VT or VF. Meta-analysis of these three studies show consistent ICD benefit. This ICD benefit is also observed in three large randomised primary prevention trials in patients with a prior myocardial infarction and left ventricular dysfunction. The beneficial effect of ICD therapy proves to be significantly more pronounced in patients with the lowest left ventricular ejection fraction (26-30%). In patients with nonischaemic dilated cardiomyopathy and low ejection fractions, however, currently the only evidence-based indication for ICD implantation is secondary prevention.
心脏性猝死（SCD）是工业化国家最重要的死亡原因。然而，事实证明，抗心律失常药物（AAD）治疗在预防SCD方面效果不佳。在具有电生理特性的药物中，只有β受体阻滞剂治疗显示可改善临床结局。AADs的这种低效性开启了二级和一级预防试验的新时代，将植入式心脏复律除颤器（ICD）与药物治疗进行比较。针对曾发生室性心动过速（VT）或室颤（VF）后复苏的既往心肌梗死患者开展了三项大型随机二级预防试验。对这三项研究的荟萃分析显示ICD具有一致的益处。在三项针对既往心肌梗死和左心室功能不全患者的大型随机一级预防试验中也观察到了这种ICD益处。ICD治疗的有益效果在左心室射血分数最低（26 - 30%）的患者中更为显著。然而，在非缺血性扩张型心肌病且射血分数较低的患者中，目前ICD植入唯一基于证据的指征是二级预防。
