Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
Neth Heart J. 2009 Mar;17(3):107-10. doi: 10.1007/BF03086228.
At first sight, guidelines for implantation of an implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death in patients with left ventricular systolic dysfunction seem unambiguous. There are clear cut-off values for ejection fraction, and functional class. However, determination of the ejection fraction itself is not unambiguous, and other risk factors for sudden death that may have a profound effect on risk are not used for decision-making. Furthermore, to obtain a clinically significant impact on survival, expected longevity is important as it can greatly compromise the benefit in elderly patients but underestimate the long-term potential of ICD therapy in younger patients. (Neth Heart J 2009;17:107-10.).
乍一看,植入式心脏复律除颤器(ICD)用于左心室收缩功能障碍患者的一级预防心源性猝死的植入指南似乎是明确的。有明确的射血分数和功能分级截断值。然而,射血分数本身的测定并不明确,并且可能对风险有深远影响的其他猝死风险因素也未用于决策。此外,为了对生存产生显著影响,预期寿命很重要,因为它会极大地降低老年患者的获益,而低估了 ICD 治疗在年轻患者中的长期潜力。(荷兰心脏杂志 2009 年;17:107-10.)