Stambler B S, Wood M A, Ellenbogen K A
Department of Medicine, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.
Pacing Clin Electrophysiol. 1992 Apr;15(4 Pt 1):451-70. doi: 10.1111/j.1540-8159.1992.tb05140.x.
Sudden, unexpected cardiac death continues to be a major clinical problem in patients with congestive heat failure. This review summarizes the current state of knowledge regarding the identification and management of these patients. The roles of ambulatory ECG monitoring, electrophysiological testing, signal-averaged ECG, and other methods of predicting increased risk of sudden death are discussed. The modes of sudden cardiac death and the potential mechanisms of ventricular arrhythmias in congestive heart failure are reviewed. Current therapeutic options including antiarrhythmic drugs, neurohormonal blockade, and automatic implantable cardioverter defibrillators are discussed. Finally, future directions and ongoing clinical investigations of the management of these complex patients are considered.
在充血性心力衰竭患者中，心源性猝死仍然是一个主要的临床问题。本文综述了关于这些患者识别与管理的当前知识状况。讨论了动态心电图监测、电生理检查、信号平均心电图以及其他预测猝死风险增加方法的作用。回顾了充血性心力衰竭中心源性猝死的模式以及室性心律失常的潜在机制。讨论了当前的治疗选择，包括抗心律失常药物、神经激素阻断以及植入式自动心脏复律除颤器。最后，考虑了这些复杂患者管理的未来方向和正在进行的临床研究。
