Tse Gary, Yeo Jie M, Chan Yin Wah, Lai Eric T H Lai, Yan Bryan P
Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, University of Hong KongHong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong KongHong Kong, China.
Faculty of Medicine, Imperial College London London, UK.
Front Physiol. 2016 Jul 21;7:308. doi: 10.3389/fphys.2016.00308. eCollection 2016.
Sudden cardiac death (SCD) remains an unsolved problem in the twenty-first century. It is often due to rapid onset, ventricular arrhythmias caused by a number of different clinical conditions. A proportion of SCD patients have identifiable diseases such as cardiomyopathies, but for others, the causes are unknown. Viral myocarditis is becoming increasingly recognized as a contributor to unexplained mortality, and is thought to be a major cause of SCD in the first two decades of life. Myocardial inflammation, ion channel dysfunction, electrophysiological, and structural remodeling may play important roles in generating life-threatening arrhythmias. The aim of this review article is to examine the electrophysiology of action potential conduction and repolarization and the mechanisms by which their derangements lead to triggered and reentrant arrhythmogenesis. By synthesizing experimental evidence from pre-clinical and clinical studies, a framework of how host (inflammation), and viral (altered cellular signaling) factors can induce ion electrophysiological and structural remodeling is illustrated. Current pharmacological options are mainly supportive, which may be accompanied by mechanical circulatory support. Heart transplantation is the only curative option in the worst case scenario. Future strategies for the management of viral myocarditis are discussed.
心脏性猝死（SCD）在21世纪仍是一个未解决的问题。它通常是由于多种不同临床状况导致的快速发作的室性心律失常。一部分SCD患者有可识别的疾病，如心肌病，但对其他患者来说，病因不明。病毒性心肌炎越来越被认为是不明原因死亡的一个因素，并且被认为是20岁前SCD的主要原因。心肌炎症、离子通道功能障碍、电生理和结构重塑可能在产生危及生命的心律失常中起重要作用。这篇综述文章的目的是研究动作电位传导和复极化的电生理学，以及它们的紊乱导致触发和折返性心律失常发生的机制。通过综合临床前和临床研究的实验证据，阐述了宿主（炎症）和病毒（细胞信号改变）因素如何诱导离子电生理和结构重塑的框架。目前的药物选择主要是支持性的，可能会伴有机械循环支持。在最坏的情况下，心脏移植是唯一的治愈选择。本文还讨论了病毒性心肌炎未来的治疗策略。
