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室性快速心律失常的流行病学:过去几十年有哪些变化?

Epidemiology of ventricular tachyarrhythmia : Any changes in the past decades?

作者信息

Jong-Ming Pang Benjamin, Green Martin Stephen

机构信息

H-1285, University of Ottawa Heart Institute, 40 Ruskin Street, K1Y 4W7, Ottawa, ON, Canada.

出版信息

Herzschrittmacherther Elektrophysiol. 2017 Jun;28(2):143-148. doi: 10.1007/s00399-017-0503-5. Epub 2017 May 8.

Abstract

Ventricular tachyarrhythmias include potentially lethal episodes of sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) as well as hemodynamically tolerated ventricular ectopic activity. Sustained VT or VF may develop in the setting of acute myocardial infarction or as clinical sequelae of advanced cardiomyopathy. The incidence of these serious arrhythmias is estimated from retrospective and observational studies and registries of sudden cardiac arrest and sudden cardiac death. Over the past few decades, there has been a gradual decline in the incidence of life-threatening ventricular tachyarrhythmias which has been largely driven by upstream treatments for and prevention of coronary artery disease and its sequelae. In addition primary prevention implantable cardioverter-defibrillators (ICDs) have improved survival in patients at risk for malignant ventricular arrhythmias and sudden cardiac death. Improved understanding, and improved diagnostic and imaging methods have elucidated many of the previously classified "idiopathic" ventricular arrhythmias as inherited arrhythmic syndromes and occult cardiomyopathies. In addition, improved sensitivity and duration of ECG monitoring has allowed increased detection of ventricular ectopic activity.

摘要

室性快速心律失常包括持续性室性心动过速(VT)和心室颤动(VF)等潜在致命发作,以及血流动力学可耐受的室性异位活动。持续性VT或VF可能在急性心肌梗死的情况下发生,或作为晚期心肌病的临床后遗症出现。这些严重心律失常的发生率是根据对心脏骤停和心源性猝死的回顾性、观察性研究及登记数据估算得出的。在过去几十年中,危及生命的室性快速心律失常的发生率逐渐下降,这在很大程度上是由冠状动脉疾病及其后遗症的上游治疗和预防措施推动的。此外,一级预防植入式心脏复律除颤器(ICD)提高了有恶性室性心律失常和心源性猝死风险患者的生存率。对疾病的更好理解以及改进的诊断和成像方法,已将许多先前分类为“特发性”的室性心律失常阐明为遗传性心律失常综合征和隐匿性心肌病。此外,心电图监测的敏感性提高和监测时间延长,使得室性异位活动的检测增加。

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