Naksuk Niyada, DeSimone Christopher V, Kapa Suraj, Asirvatham Samuel J
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
Indian Heart J. 2014 Jan-Feb;66 Suppl 1(Suppl 1):S120-8. doi: 10.1016/j.ihj.2013.12.046. Epub 2014 Jan 3.
Preventing sudden cardiac death (SCD) remains a major unsolved problem in contemporary medical practice. As the most common cause of SCD, treatment for ventricular arrhythmias is the target area of interest in research field. While implantable cardioverter-defibrillator (ICD) effectively decreases death from ventricular arrhythmias in highly selected patients, risk of inappropriate shocks, mortality from frequent therapy, chance of failing in abortion of arrhythmias despite having a defibrillator, and our inability to recognize which of several hundreds of thousands of patients at risk for sudden death but do not meet current criteria for defibrillator, limit ICD effectiveness. In this article, a brief review of mechanism leading to SCD, the existing evidence for a defibrillator and the lacunae in present guidelines for patients clearly at risk for sudden death but without proven benefit from a defibrillator are presented in Section I. Following this, interventional approaches, both catheter-based and general measures that may serve as adjuncts to a defibrillator in preventing this all too common catastrophic end event, are summarized in Section II.
预防心源性猝死（SCD）仍然是当代医学实践中一个尚未解决的主要问题。作为SCD最常见的原因，室性心律失常的治疗是研究领域关注的目标。虽然植入式心脏复律除颤器（ICD）能有效降低高度筛选患者因室性心律失常导致的死亡，但不适当电击的风险、频繁治疗导致的死亡率、尽管有除颤器但心律失常终止失败的可能性，以及我们无法识别数十万有猝死风险但不符合当前除颤器标准的患者中的哪些人，都限制了ICD的有效性。在本文中，第一部分简要回顾了导致SCD的机制、除颤器的现有证据以及目前针对明显有猝死风险但未从除颤器中获得证实益处的患者指南中的空白。在此之后，第二部分总结了介入方法，包括基于导管的方法和一般措施，这些方法可作为除颤器的辅助手段，用于预防这种极为常见的灾难性结局事件。
