Arrhythmology Unit, Cardiovascular and Thoracic Department, AOU Siena, Viale Bracci, 14, 53100, Siena, Italy.
Cardiovascular Imaging Department, Blackrock Clinic, Dublin, Ireland.
Heart Fail Rev. 2018 Nov;23(6):885-896. doi: 10.1007/s10741-018-9732-x.
Chronic heart failure with reduced (≤ 40%) ejection fraction (HFrEF) poses a significant residual mortality risk despite modern optimal medical therapy. In the last decades, we have witnessed the introduction of breakthrough cardiac implantable electronic devices (CIED) aimed at addressing sudden cardiac death and HF progression in patients with HFrEF, leading to improved survival and functional capacity. Following their introduction, implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) have undergone substantial technological improvements and have been investigated in different settings of HFrEF, some of which yielded controversial results. In this review, we provide a comprehensive, yet pragmatic, approach to the individual key points in the electrical manipulation of the failing heart with ICD and CRT including patient selection, technological advances in the implant technique, follow-up, and long-term management. The aim of the review is to provide real-life-oriented advices to maximize the desired outcomes of CIED-based therapy of HFrEF. Accordingly, a framework to inform the decision-making process in candidates to ICD and/or CRT has been developed reflective of a critical appraisal of the most recently available evidence reappraising some domains beyond the classic views.
射血分数降低（≤40%）的慢性心力衰竭（HFrEF）尽管采用了现代最佳药物治疗，但仍存在显著的残余死亡风险。在过去的几十年中，我们见证了突破性的心脏植入式电子设备（CIED）的引入，这些设备旨在解决 HFrEF 患者的心脏性猝死和心力衰竭进展问题，从而提高了生存率和功能能力。在这些设备引入之后，植入式心脏复律除颤器（ICD）和心脏再同步治疗（CRT）经历了实质性的技术改进，并在不同的 HFrEF 环境中进行了研究，其中一些研究结果存在争议。在这篇综述中，我们对 ICD 和 CRT 对衰竭心脏的电操作的各个关键要点提供了一种全面而实用的方法，包括患者选择、植入技术的技术进步、随访和长期管理。本综述的目的是提供以实际为导向的建议，以最大限度地提高基于 CIED 的 HFrEF 治疗的预期效果。因此，我们制定了一个决策框架，反映了对最新可用证据的批判性评估，重新评估了一些超出经典观点的领域，以指导 ICD 和/或 CRT 候选者的决策过程。
