Rath Benjamin, Köbe Julia, Reinke Florian, Eckardt Lars
Klinik für Kardiologie II: Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Deutschland.
Herzschrittmacherther Elektrophysiol. 2021 Mar;32(1):41-47. doi: 10.1007/s00399-021-00745-8. Epub 2021 Jan 29.
Cardiac resynchronization therapy (CRT) is an integral part in the treatment of chronic heart failure. However, a high degree of biventricular pacing is essential for the effectiveness of this therapy. In addition to atrial fibrillation, premature ventricular contractions (PVC) are a common cause of reduced biventricular stimulation in CRT. In addition to the prognostically unfavorable reduction of biventricular pacing, PVC are generally associated with reduced outcome in the presence of structural heart disease. Options to increase biventricular stimulation percentage by reprogramming the CRT devices are limited in the majority of cases. Due to the mutual relationship between cardiomyopathy and ventricular arrhythmias, adequate heart failure therapy is essential for the reduction of ventricular ectopy. In addition to beta-blocker therapy, specific antiarrhythmic medication is mostly limited to class III antiarrhythmic drugs due to the structural heart disease usually present in CRT patients. Catheter ablation is superior to pharmacological therapy especially in the field of idiopathic PVC, but promising data are also available for catheter ablation of PVC in structural heart disease and CRT nonresponders.
心脏再同步治疗（CRT）是慢性心力衰竭治疗的一个重要组成部分。然而，高度的双心室起搏对于该治疗的有效性至关重要。除心房颤动外，室性早搏（PVC）是CRT中双心室刺激减少的常见原因。除了双心室起搏在预后方面的不利减少外，在存在结构性心脏病的情况下，PVC通常还与预后不良相关。在大多数情况下，通过重新编程CRT设备来提高双心室刺激百分比的选择有限。由于心肌病与室性心律失常之间的相互关系，充分的心力衰竭治疗对于减少室性早搏至关重要。除β受体阻滞剂治疗外，由于CRT患者通常存在结构性心脏病，特定的抗心律失常药物大多限于Ⅲ类抗心律失常药物。导管消融优于药物治疗，尤其是在特发性PVC领域，但在结构性心脏病和CRT无反应者的PVC导管消融方面也有有前景的数据。
