Amit Guy, Costantini Otto
Arrhythmia Prevention Center, MetroHealth Campus, Case Western Reserve University, 2500 MetroHealth Drive, Hamman 334, Cleveland, OH 44109-1998, USA.
Curr Treat Options Cardiovasc Med. 2007 Oct;9(5):345-55. doi: 10.1007/s11936-007-0054-x.
Based on current guidelines, most electrophysiologists today are implanting cardioverter-defibrillators (ICDs) using a low left ventricular ejection fraction alone as the sole stratifier for the risk of sudden cardiac death. However, left ventricular ejection fraction is a better marker of total mortality than sudden death. As a result, this strategy is flawed because it exposes many patients to the risk and cost of ICD therapy without its benefits. Primary prevention trials based on this strategy show that the rate of appropriate ICD shocks is only 5% to 10% per year. We believe that the effectiveness of ICD therapy can be improved by the use, in addition to ejection fraction, of one or more of the noninvasive tests, which are reviewed in this article. Such tests are more adequate to evaluate the arrhythmogenic substrate of the patient than the left ventricular ejection fraction alone. Whether any of these tests can help us identify the patients at the lowest risk of sudden death, who could safely avoid ICD implant, remains to be determined.
根据当前指南，如今大多数电生理学家仅将低左心室射血分数作为心脏性猝死风险的唯一分层指标来植入心脏复律除颤器（ICD）。然而，左心室射血分数是全因死亡率而非猝死的更好指标。因此，这一策略存在缺陷，因为它使许多患者承受ICD治疗的风险和费用却无法从中获益。基于该策略的一级预防试验表明，每年适当的ICD电击率仅为5%至10%。我们认为，除射血分数外，使用本文中所综述的一种或多种非侵入性检查可提高ICD治疗的有效性。此类检查比单独的左心室射血分数更适合评估患者的致心律失常基质。这些检查能否帮助我们识别出猝死风险最低、可安全避免植入ICD的患者，仍有待确定。
