Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT.
Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT.
Trends Cardiovasc Med. 2018 Jan;28(1):41-50. doi: 10.1016/j.tcm.2017.07.002. Epub 2017 Jul 10.
The use of mechanical circulatory support has become an increasingly common practice in patients with heart failure, whether used as bridge to transplantation or as destination therapy. The last couple of decades has seen a drastic change in the functioning of the left ventricular assist devices (LVAD), changing from the first generation devices running on pulsatile flow to the current continuous flow devices. Atrial and ventricular arrhythmias are common among heart failure patients, and though the systematic circulation is well supported in patients on mechanical circulatory support, these arrhythmias can still be the cause of detrimental symptoms and lead to potentially fatal outcomes. Several studies have shown that mortality rates in LVAD recipients secondary to lethal arrhythmias are uncommon, and newer generation continuous flow devices particularly seem to support hemodynamic support well. While it is common practice to implant ICDs in patients with LVADs and a history of ventricular arrhythmias, the efficacy behind this practice at preventing sudden death in this population is unknown. In this review, we highlight what is already known about the complications, management and treatment of atrial and ventricular arrhythmias in patients with LVAD devices.
机械循环支持在心力衰竭患者中的应用已经越来越普遍，无论是作为移植前的桥接治疗还是作为终末期治疗。在过去的几十年中，左心室辅助装置（LVAD）的功能发生了巨大变化，从第一代使用搏动流的装置转变为当前的连续流装置。心房和心室心律失常在心力衰竭患者中很常见，尽管机械循环支持患者的系统性循环得到了很好的支持，但这些心律失常仍然可能导致有害症状，并导致潜在的致命后果。几项研究表明，由于致命性心律失常导致 LVAD 接受者的死亡率并不常见，并且新一代的连续流装置似乎特别能够很好地支持血液动力学支持。虽然在有 LVAD 和室性心律失常病史的患者中植入 ICD 是一种常见做法，但这种做法在预防该人群猝死方面的疗效尚不清楚。在这篇综述中，我们强调了已经了解到的关于 LVAD 装置患者心房和心室心律失常的并发症、管理和治疗。
