Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.
Chair of Cardiology, University of Campania, Ospedale Monaldi, Naples, Italy.
Pharmacol Res. 2019 May;143:27-32. doi: 10.1016/j.phrs.2019.03.004. Epub 2019 Mar 4.
Implantable cardiac defibrillators (ICD) are the foundation of therapy for the prevention of sudden cardiac death. While ICDs prevent SCD, they do not prevent the occurrence of ventricular arrhythmias which are usually symptomatic. Though catheter ablation has been successful in substrate modification of ventricular tachycardia in patients with ischemic cardiomyopathy, there is much less evidence to support its use in non-ischemic cardiomyopathy. Therefore, anti-arrhythmic drugs (AADs) are an essential adjunctive therapy for secondary prevention of ventricular arrhythmias in patients with non-ischemic cardiomyopathy. In patients with hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM), the prevalence of ventricular arrhythmias correlates with the volume of scar as characterized by late gadolinium enhancement. Beta-blockers forms the cornerstone of treatment to prevent ventricular arrhythmias in both HCM and DCM. Disopyramide is an important therapeutic option in HCM as it provides both negative inotropy which reduces obstruction as well as lass I anti-arrhythmic action. In DCM sotalol, through is combined beta-blocking and class III AD effects, significantly reduces the burden of ventricular arrhythmias. Though amiodarone is efficacious in the prevention of ventricular arrhythmias in both HCM and DCM, its use is limited by its side-effects profile. Evidence for AAD therapy for arrhythmogenic right ventricular dysplasia (ARVD) is limited by its low prevalence and lack of studies. ICDs have been shown to reduce SCD regardless of whether patients are receiving AAD therapy.
植入式心脏除颤器 (ICD) 是预防心脏性猝死的治疗基础。虽然 ICD 可预防 SCD，但它们并不能预防通常有症状的室性心律失常的发生。尽管导管消融术已成功用于改善缺血性心肌病患者的室性心动过速的基质，但在非缺血性心肌病中使用该方法的证据要少得多。因此，抗心律失常药物 (AAD) 是预防非缺血性心肌病患者室性心律失常的二级预防的重要辅助治疗方法。在肥厚型心肌病 (HCM) 和扩张型心肌病 (DCM) 患者中，室性心律失常的发生率与晚期钆增强所示的瘢痕体积相关。β受体阻滞剂是预防 HCM 和 DCM 中室性心律失常的治疗基石。双异丙吡胺是 HCM 的重要治疗选择，因为它具有降低梗阻的负性肌力作用和 I 类抗心律失常作用。在 DCM 中，索他洛尔通过联合β受体阻断和 III 类 AD 作用，显著降低了室性心律失常的负担。虽然胺碘酮在预防 HCM 和 DCM 中的室性心律失常方面是有效的，但由于其副作用，其使用受到限制。对于致心律失常性右室心肌病 (ARVD) 的 AAD 治疗证据有限，这是由于其发病率低且缺乏研究。ICD 可降低 SCD 的发生，无论患者是否接受 AAD 治疗。
