Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Curr Opin Cardiol. 2014 Mar;29(2):152-9. doi: 10.1097/HCO.0000000000000035.
To review the management of ventricular arrhythmias in patients with heart failure secondary to reduced ejection fraction (HFrEF).
Recurrent ventricular arrhythmias and automatic implantable cardioverter defibrillator (AICD) shocks are responsible for significant mortality and morbidity in patients with HFrEF. Antiarrhythmic drugs and catheter ablation are the main treatment options. Frequent premature ventricular contractions (PVCs; >10,000-20,000/24-h period) are being recognized as a cause of cardiomyopathy and suboptimal response to cardiac resynchronization therapy (CRT). Patients with ventricular assist devices (VADs) have frequent ventricular tachyarrhythmias resulting in increased morbidity and mortality. Such patients may need continuation of active ICD therapy and adjunctive catheter ablation.
There is a pressing need to develop new antiarrhythmic drugs to treat patients with recurrent AICD shocks. The effectiveness of catheter ablation as first-line therapy for preventing ventricular arrhythmias and recurrent AICD shocks needs to be directly compared with amiodarone. Ventricular tachyarrhythmias are common in CRT patients and patients with VADs. Frequent PVCs may result in a reversible form of HFrEF.
旨在回顾射血分数降低性心力衰竭（HFrEF）患者室性心律失常的管理。
复发性室性心律失常和自动植入式心脏复律除颤器（AICD）电击是 HFrEF 患者死亡率和发病率高的主要原因。抗心律失常药物和导管消融是主要的治疗选择。频繁的室性期前收缩（PVC；>10000-20000/24 小时）被认为是心肌病和心脏再同步治疗（CRT）反应不佳的原因。心室辅助装置（VAD）患者常发生室性心动过速，导致发病率和死亡率增加。此类患者可能需要继续进行主动 ICD 治疗和辅助导管消融。
迫切需要开发新的抗心律失常药物来治疗反复发生 AICD 电击的患者。导管消融作为预防室性心律失常和复发性 AICD 电击的一线治疗方法的有效性需要与胺碘酮直接比较。室性心动过速在 CRT 患者和 VAD 患者中很常见。频繁的 PVC 可能导致可逆性 HFrEF。
