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[室性心律失常:治疗中已得到证实的有哪些?]

[Ventricular arrhythmias : What has been confirmed in therapy?].

作者信息

Duncker D, Bauersachs J, Veltmann C

机构信息

Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.

出版信息

Internist (Berl). 2017 Dec;58(12):1272-1280. doi: 10.1007/s00108-017-0341-x.

Abstract

Ventricular arrhythmias include a wide range of potentially benign single ventricular premature contractions to ventricular tachycardia and ventricular fibrillation with a risk for sudden cardiac death. The diagnosis of ventricular arrhythmia is made by 12-lead electrocardiogram, 24 h Holter monitoring, an external or implantable loop recorder, or during in-hospital monitoring. Especially the diagnosis of wide complex tachycardias is challenging in terms of differentiating between ventricular tachycardia and supraventricular tachycardia with aberrant atrioventricular conduction. After documentation of ventricular arrhythmias, diagnostic work-up with respect to structural or electrical cardiomyopathy is mandatory followed by risk stratification for sudden cardiac death. Therapeutic options for treatment of ventricular arrhythmias range from pharmacological therapy and interventional procedures such as catheter ablation and implantable devices. The current article provides an overview of the diagnosis of ventricular tachycardia and underlying cardiomyopathies. Furthermore, medical and interventional therapies are described. In addition, the indications for implantable and wearable defibrillators are presented.

摘要

室性心律失常包括一系列潜在的良性单发性室性早搏,直至室性心动过速和心室颤动,后者有心脏性猝死风险。室性心律失常的诊断通过12导联心电图、24小时动态心电图监测、外置或植入式环形记录仪,或在住院监测期间进行。特别是宽QRS波心动过速的诊断,在鉴别室性心动过速和伴有异常房室传导的室上性心动过速方面具有挑战性。记录室性心律失常后,必须针对结构性或电活性心肌病进行诊断性检查,随后进行心脏性猝死风险分层。室性心律失常的治疗选择包括药物治疗和介入程序,如导管消融和植入式装置。本文概述了室性心动过速及潜在心肌病的诊断。此外,还描述了药物和介入治疗。另外,还介绍了植入式和可穿戴式除颤器的适应证。

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