Duncker D, Veltmann C
Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Herz. 2018 Aug;43(5):415-422. doi: 10.1007/s00059-018-4710-6.
In patients with heart failure with reduced ejection fraction (HFrEF), optimal medical treatment includes beta-blockers, ACE inhibitors/angiotensinreceptor-neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists, and ivabradine when indicated. In device therapy of HFrEF, implantable cardioverter-defibrillators and cardiac resynchronization therapy (CRT) have been established for many years. CRT is the therapy of choice (class I indication) in symptomatic patients with HFrEF and a broad QRS complex with a left bundle branch block (LBBB) morphology. However, the vast majority of heart failure patients show a narrow QRS complex or a non-LBBB morphology. These patients are not candidates for CRT and alternative electrical therapies such as baroreflex activation therapy (BAT) and cardiac contractility modulation (CCM) may be considered. BAT modulates vegetative dysregulation in heart failure. CCM improves contractility, functional capacity, and symptoms. Although a broad data set is available for BAT and CCM, mortality data are still lacking for both methods. This article provides an overview of the device-based therapeutic options for patients with HFrEF.
在射血分数降低的心力衰竭（HFrEF）患者中，最佳药物治疗包括β受体阻滞剂、ACE抑制剂/血管紧张素受体脑啡肽酶抑制剂（ARNI）、盐皮质激素受体拮抗剂以及必要时使用的伊伐布雷定。在HFrEF的器械治疗方面，植入式心脏复律除颤器和心脏再同步治疗（CRT）已经应用多年。CRT是有症状的HFrEF且QRS波群增宽呈左束支传导阻滞（LBBB）形态患者的首选治疗方法（I类适应证）。然而，绝大多数心力衰竭患者表现为QRS波群狭窄或非LBBB形态。这些患者不适合CRT，可以考虑采用压力反射激活疗法（BAT）和心脏收缩力调制（CCM）等替代性电疗法。BAT可调节心力衰竭中的自主神经失调。CCM可改善心肌收缩力、功能能力和症状。尽管BAT和CCM有大量数据集，但两种方法的死亡率数据仍然缺乏。本文概述了HFrEF患者基于器械的治疗选择。
