Gatzoulis Konstantinos A, Sideris Antonios, Kanoupakis Emmanuel, Sideris Skevos, Nikolaou Nikolaos, Antoniou Christos-Konstantinos, Kolettis Theofilos M
Electrophysiology Laboratory, First Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece.
Ann Noninvasive Electrocardiol. 2017 Mar;22(2). doi: 10.1111/anec.12430. Epub 2017 Feb 3.
Primary prevention of sudden cardiac death by means of implantable cardioverter-defibrillators constitutes the holy grail of arrhythmology. However, current risk stratification algorithms lead to suboptimal outcomes, by both allocating ICDs to patients not deriving any meaningful survival benefit and withholding them from those erroneously considered as low-risk for arrhythmic mortality.
In the present review article we will attempt to present shortcomings of contemporary guidelines regarding sudden death prevention in ischemic and dilated cardiomyopathy patients and present available data suggesting encouraging results following implementation of multifactorial approaches, by using multiple modalities, both noninvasive and invasive. Invasive electrophysiological testing, namely programmed ventricular stimulation, will be discussed in greater length to highlight both its potential usefulness and currently ongoing multicenter studies aiming to provide evidence necessary to make the next step in sudden death risk stratification.
Promising findings have been reported by multiple study groups regarding novel strategies for both negative selection of low and positive selection of relatively preserved ejection fraction patients as candidates for ICD implantation.
The era of ejection fraction as the sole risk stratifier for arrhythmic risk in heart failure appears to be drawing to an end, especially if current underway large studies validate previous findings.
通过植入式心脏复律除颤器进行心脏性猝死的一级预防是心律失常学的圣杯。然而，目前的风险分层算法导致了次优结果，既将植入式心脏复律除颤器分配给未获得任何有意义生存益处的患者，又不给那些被错误地认为心律失常死亡风险低的患者使用。
在本综述文章中，我们将试图阐述当代关于缺血性和扩张型心肌病患者猝死预防指南的不足之处，并展示现有数据，这些数据表明采用多因素方法（使用多种非侵入性和侵入性方式）后取得了令人鼓舞的结果。将更详细地讨论侵入性电生理检查，即程控心室刺激，以突出其潜在用途以及目前正在进行的旨在提供证据以便在猝死风险分层方面迈出下一步的多中心研究。
多个研究小组报告了关于新策略的有前景的发现，这些新策略用于对射血分数相对保留的患者进行ICD植入候选者的低风险阴性选择和高风险阳性选择。
射血分数作为心力衰竭心律失常风险唯一分层指标的时代似乎即将结束，特别是如果当前正在进行的大型研究证实先前的发现。
