Heart Rhythm Service, Cardiology Division, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Heart Rhythm Service, Cardiology Division, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Can J Cardiol. 2014 Feb;30(2):244-6. doi: 10.1016/j.cjca.2013.11.015. Epub 2013 Nov 20.
The management of ventricular tachyarrhythmias has changed significantly over the past several decades. The advent of readily available implantable cardioverter defibrillators (ICDs) has had the greatest effect, with important mortality effects in patients with ventricular tachycardia and structural heart disease. ICDs have been shown to reduce sudden death in patients with ischemic and nonischemic cardiomyopathies; evidence of adverse consequences of ICD shocks, however, is mounting. In addition to the negative effects on patient-reported quality of life, anxiety, and depression, frequent ventricular arrhythmias and ICD shocks have also been associated with increased mortality. It is therefore important to identify and implement effective ventricular tachycardia-suppressive strategies. Antiarrhythmic drugs represent one such method, but are challenged by unfavourable side effect profiles and proarrhythmic risk. Catheter ablation of ventricular tachycardia is now a well-accepted intervention, which has been demonstrated to reduce recurrent arrhythmias. Questions persist regarding the optimal role for ablation compared with drug therapy.
过去几十年中，室性心动过速的治疗策略发生了显著变化。植入式心律转复除颤器（ICD）的广泛应用带来了最大的影响，为伴有室性心动过速和结构性心脏病的患者带来了重要的生存获益。ICD 已被证实可降低缺血性和非缺血性心肌病患者的猝死风险；然而，ICD 电击带来不良后果的证据也越来越多。除了对患者报告的生活质量、焦虑和抑郁产生负面影响外，频繁的室性心律失常和 ICD 电击也与死亡率升高相关。因此，确定并实施有效的室性心动过速抑制策略非常重要。抗心律失常药物是一种方法，但由于不良的副作用和致心律失常风险，其应用受到挑战。导管消融术现已成为一种广泛接受的干预手段，已被证实可减少心律失常的复发。与药物治疗相比，消融术的最佳作用仍存在疑问。
