Department of Internal Medicine II, Cardiology, Pneumology, Intensive Care, University Hospital Regensburg.
Herz- & Gefäßzentrum Göttingen.
Dtsch Arztebl Int. 2018 May 11;115(19):335-341. doi: 10.3238/arztebl.2018.0335.
Heart failure affects 1–2% of the population and is associated with elevated morbidity and mortality. Cardiac arrhythmias are often a result of heart failure, but they can cause left-ventricular systolic dysfunction (LVSD) as an arrhythmia-induced cardiomyopathy (AIC). This causal relationship should be borne in mind by the physician treating a patient with systolic heart failure in association with cardiac arrhythmia.
This review is based on pertinent publications retrieved by a selective search in PubMed (1987–2017) and on the recommendations in current guidelines.
The key criterion for the diagnosis of an AIC is the demonstration of a persistent arrhythmia (including pathological tachycardia) together with an LVSD whose origin cannot be explained on any other basis. Nearly any type of tachyarrhythmia or frequent ventricular extrasystoles can lead, if persistent, to a progressively severe LVSD. The underlying pathophysiologic mechanisms are incompletely understood; the increased ventricular rate, asynchronous cardiac contractions, and neurohumoral activation all seem to play a role. The most common precipitating factors are supraventricular tachycardias in children and atrial fibrillation in adults. Recent studies have shown that the causal significance of atrial fibrillation in otherwise unexplained LVSD is underappreciated. The treatment of AIC consists primarily of the treatment of the underlying arrhythmia, generally with drugs such as beta-blockers and amiodarone. Depending on the type of arrhythmia, catheter ablation for long-term treatment should also be considered where appropriate. The diagnosis of AIC is considered to be well established when the LVSD normalizes or improves within a few weeks or months of the start of targeted treatment of the arrhythmia.
An AIC is potentially reversible. The timely recognition of this condition and the appropriate treatment of the underlying arrhythmia can substantially improve patient outcomes.
心力衰竭影响 1%-2%的人群，与发病率和死亡率升高相关。心律失常通常是心力衰竭的结果，但它们可导致左心室收缩功能障碍（LVSD），即心律失常性心肌病（AIC）。治疗伴有心律失常的收缩性心力衰竭患者的医生应牢记这种因果关系。
本综述基于在 PubMed（1987-2017 年）进行选择性检索获得的相关文献，并参考当前指南中的建议。
AIC 的诊断关键标准是持续性心律失常（包括病理性心动过速）的明确诊断以及无法用其他任何原因解释的 LVSD。几乎任何类型的心动过速或频繁室性期外收缩，如果持续存在，都可能导致逐渐严重的 LVSD。潜在的病理生理机制尚未完全阐明；心室率增加、心脏收缩不同步和神经激素激活似乎都起作用。最常见的诱发因素是儿童的室上性心动过速和成人的心房颤动。最近的研究表明，在其他原因不明的 LVSD 中，心房颤动的因果意义被低估了。AIC 的治疗主要包括基础心律失常的治疗，通常使用β受体阻滞剂和胺碘酮等药物。根据心律失常的类型，在适当的情况下还应考虑导管消融作为长期治疗。当心律失常的靶向治疗开始后数周或数月内 LVSD 正常化或改善时，可认为 AIC 的诊断成立。
AIC 具有潜在的可逆转性。及时识别这种情况并对基础心律失常进行适当治疗，可以显著改善患者结局。
