Rudic B, Tülümen E, Liebe V, Kuschyk J, Akin I, Borggrefe M
I. Medizinische Klinik, Abteilung für Kardiologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland.
Herz. 2017 Apr;42(2):123-131. doi: 10.1007/s00059-017-4545-6.
Sudden cardiac death (SCD) remains a major public health burden despite revolutionary progress in the last three decades in the treatment of ventricular tachyarrhythmia with the use of implantable cardioverter defibrillator (ICD) therapy. Survivors of sudden cardiac arrest are at high risk for recurrent tachyarrhythmia events. Early recognition of low left ventricular ejection fractions (≤35%) as a strong predictor of mortality and the causal association between ventricular tachyarrhythmia and SCD has led to a significant development of not only pharmacological antiarrhythmic therapy but also device-based prevention of SCD. The ICD therapy is nowadays routinely used for primary prevention of SCD in patients with significant structural cardiomyopathy and primary electrical arrhythmia syndromes, which are associated with high a risk and secondary prevention in survivors of sudden cardiac arrest. Additionally, effective approaches exist to significantly reduce the recurrence rate of ventricular tachyarrhythmia of various origins by complex electrophysiological endocardial and epicardial catheter ablation procedures.
尽管在过去三十年中，使用植入式心脏复律除颤器（ICD）治疗室性快速心律失常取得了革命性进展，但心脏性猝死（SCD）仍然是一项重大的公共卫生负担。心脏骤停幸存者发生反复快速心律失常事件的风险很高。早期认识到低左心室射血分数（≤35%）是死亡率的强有力预测指标，以及室性快速心律失常与SCD之间的因果关系，不仅推动了抗心律失常药物治疗的显著发展，也促进了基于设备的SCD预防。如今，ICD治疗通常用于患有严重结构性心肌病和原发性心律失常综合征患者的SCD一级预防，这些患者风险较高，也用于心脏骤停幸存者的二级预防。此外，通过复杂的电生理心内膜和心外膜导管消融手术，存在有效方法可显著降低各种起源的室性快速心律失常的复发率。
