Peichl Petr, Rafaj Adam, Kautzner Josef
Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Heart Rhythm O2. 2021 Dec 17;2(6Part B):796-806. doi: 10.1016/j.hroo.2021.08.007. eCollection 2021 Dec.
Congestive heart failure (HF) is a progressive affliction defined as the inability of the heart to sufficiently maintain blood flow. Ventricular arrhythmias (VAs) are common in patients with HF, and conversely, advanced HF promotes the risk of VAs. Management of VA in HF requires a systematic, multimodality approach that comprises optimization of medical therapy and use of implantable cardioverter-defibrillator and/or device combined with cardiac resynchronization therapy. Catheter ablation is one of the most important strategies with the potential to abolish or decrease the number of recurrences of VA in this population. It can be a curative strategy in arrhythmia-induced cardiomyopathy and may even save lives in cases of an electrical storm. Additionally, modulation of the autonomic nervous system and stereotactic radiotherapy have been introduced as novel methods to control refractory VAs. In patients with end-stage HF and refractory VAs, an institution of the mechanical circulatory support device and cardiac transplant may be considered. This review aims to provide an overview of current evidence regarding management strategies of VAs in HF with an emphasis on interventional treatment.
充血性心力衰竭(HF)是一种进行性疾病,定义为心脏无法充分维持血流。室性心律失常(VAs)在HF患者中很常见,反之,晚期HF会增加VAs的风险。HF中VA的管理需要一种系统的多模式方法,包括优化药物治疗以及使用植入式心脏复律除颤器和/或结合心脏再同步治疗的设备。导管消融是最重要的策略之一,有可能消除或减少该人群中VA的复发次数。它在心律失常性心肌病中可能是一种治愈性策略,甚至在电风暴情况下可以挽救生命。此外,自主神经系统调节和立体定向放射治疗已被引入作为控制难治性VA的新方法。对于终末期HF和难治性VA患者,可考虑使用机械循环支持设备和心脏移植。本综述旨在概述目前关于HF中VA管理策略的证据,重点是介入治疗。