Kadish Alan H, Reiffel James A, Naccarelli Gerald V, DiMarco John P
Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Am J Cardiol. 2008 Sep 8;102(5A):29G-37G. doi: 10.1016/j.amjcard.2008.06.008.
The post-myocardial infarction (MI) patient with left ventricular dysfunction (LVD) is at risk for ventricular arrhythmias resulting in sudden cardiac death. In high-risk post-MI patients with a depressed left ventricular ejection fraction, prophylactic implantable cardioverter defibrillators (ICDs) may significantly improve survival. These benefits are in addition to those of optimal pharmacologic therapy, and ICD therapy should be considered the standard of care in these patients. Recent device trials have demonstrated the benefits of prophylactic ICD placement in patients who have been selected based on post-MI left ventricular systolic dysfunction alone. In addition, cardiac resynchronization therapy can improve the quality of life beyond that achievable with drug therapy alone and should be considered in patients with symptomatic heart failure with QRS prolongation. Further risk stratification studies of post-MI LVD patients will allow ICD therapy to be applied in a more cost-effective manner.
患有左心室功能障碍（LVD）的心肌梗死后（MI）患者有发生室性心律失常导致心源性猝死的风险。在左心室射血分数降低的高危心肌梗死后患者中，预防性植入式心脏复律除颤器（ICD）可显著提高生存率。这些益处是在最佳药物治疗的基础之上，ICD治疗应被视为这些患者的标准治疗方法。最近的器械试验已经证明了在仅根据心肌梗死后左心室收缩功能障碍选择的患者中预防性植入ICD的益处。此外，心脏再同步治疗可改善生活质量，其效果优于单纯药物治疗，对于有症状的心力衰竭且QRS波增宽的患者应考虑采用。对心肌梗死后LVD患者进行进一步的风险分层研究将使ICD治疗能以更具成本效益的方式应用。
