Department of Electrophysiology, Sulpizio Cardiovascular Center, University of California, San Diego Health System, San Diego, California, USA.
Curr Opin Cardiol. 2020 May;35(3):308-311. doi: 10.1097/HCO.0000000000000731.
Orthotopic heart transplantation (OHT) significantly improves morbidity and mortality in patients with end-stage heart disease. Despite advances in surgical technique, immunosuppressive therapies, and patient monitoring, long-term risk of arrhythmias and sudden cardiac death (SCD) in the denervated heart remains unchanged.
SCD is responsible for approximately 10% of all posttransplant deaths with a pooled incidence rate of 1.30 per 100 person years and is strongly associated with cardiac allograft vasculopathy (CAV). Risk factors for SCD and CAV include higher donor age, younger recipient age, and reduced left ventricular ejection fraction. Little is known about the time course between CAV and SCD. Although some registry data establish ventricular fibrillation as a documented terminal rhythm, the arrhythmia may not be the mechanism of SCD.
In this review, we identify risk factors and general independent predictors of arrhythmia and SCD and discuss the utility of implantable cardiac defibrillators in post-cardiac transplant patients.
原位心脏移植（OHT）显著改善了终末期心脏病患者的发病率和死亡率。尽管手术技术、免疫抑制疗法和患者监测有所进步，但去神经心脏的心律失常和心脏性猝死（SCD）的长期风险仍未改变。
SCD 约占所有移植后死亡的 10%，累积发生率为每 100 人年 1.30 例，与心脏移植血管病（CAV）密切相关。SCD 和 CAV 的危险因素包括供体年龄较高、受体年龄较小和左心室射血分数降低。关于 CAV 和 SCD 之间的时间进程知之甚少。尽管一些登记数据将心室颤动确立为记录的终末节律，但心律失常可能不是 SCD 的机制。
在这篇综述中，我们确定了心律失常和 SCD 的危险因素和一般独立预测因素，并讨论了植入式心脏除颤器在心脏移植后患者中的应用。
