Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, INSERM, LTSI - UMR 1099, Université de Rennes, 2 rue Henri Le Guilloux, F-35000, Rennes, France.
Curr Heart Fail Rep. 2020 Aug;17(4):116-124. doi: 10.1007/s11897-020-00465-z.
Patients with cardiomyopathy and impaired left ventricular (LV) ejection fraction are at risk of sudden cardiac death (SCD). In selected heart failure patients, cardiac resynchronization therapy (CRT) provides LV reverse remodeling and improves the cellular and molecular function leading to a reduced risk of ventricular arrhythmia and SCD. Consequently, some CRT candidates may not need concomitant ICD therapy. This review aimed at focusing on the residual risk of SCD in patients receiving CRT and discussing the requirement of a concomitant ICD therapy in CRT candidates.
New imaging diagnostic tools may be helpful to accurately predict patient with a residual risk of SCD and who required a CRT-D implantation. Recent data highlighted that cardiac computed tomography (CT) or myocardial scar tissue analysis using contrast-enhanced cardiac magnetic resonance (CMR) was able to predict the occurrence of VA in patients with bi-ventricular pacing. Cardiac imaging and specifically myocardial scar analysis seem promising to evaluate the risk of SCD following bi-ventricular pacing and will probably be of great help in the future to accurately identify those who needs concomitant defibrillator's protection.
患有心肌病和左心室射血分数降低的患者有发生心源性猝死（SCD）的风险。在某些心力衰竭患者中，心脏再同步治疗（CRT）可提供左心室逆向重构，并改善细胞和分子功能，从而降低室性心律失常和 SCD 的风险。因此，一些 CRT 候选者可能不需要同时进行 ICD 治疗。本文旨在关注接受 CRT 治疗的患者的 SCD 残余风险，并讨论 CRT 候选者是否需要同时进行 ICD 治疗。
新的影像学诊断工具可能有助于准确预测 SCD 残余风险高且需要 CRT-D 植入的患者。最近的数据表明，心脏计算机断层扫描（CT）或使用对比增强心脏磁共振（CMR）的心肌瘢痕组织分析能够预测双心室起搏患者室性心律失常的发生。心脏影像学，特别是心肌瘢痕分析，似乎有希望评估双心室起搏后 SCD 的风险，并且可能在未来对准确识别需要同时进行除颤器保护的患者有很大帮助。
