Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA.
Heart Fail Rev. 2023 Jan;28(1):229-240. doi: 10.1007/s10741-022-10246-6. Epub 2022 May 19.
Sudden cardiac death (SCD) and significant ventricular arrhythmias in patients with dilated cardiomyopathy (DCM) have been markedly reduced over the last couple of decades as a result of the advances in pharmacological and non-pharmacological treatment. Primary prevention implantable cardioverter-defibrillator (ICD) plays an important role in the treatment of patients at risk of SCD caused by ventricular arrhythmias. However, the arrhythmic risk stratification in patients with DCM remains extremely challenging, and the decision for primary prevention ICD implantation based on left ventricular ejection fraction (LVEF) solely appears to be insufficient. This review provides an update on current evidence for primary prevention ICD implantation, arrhythmic risk stratification, and left ventricular reverse remodeling (LVRR) prediction in patients with DCM in addition to most recent guideline recommendations for primary prevention ICD implantation in DCM patients and a proposed multiparametric algorithm based on arrhythmic risk stratification and left ventricular reverse remodeling (LVRR) prediction to better identify patients who are likely to benefit from primary prevention ICD.
在过去的几十年中，由于在药理学和非药理学治疗方面的进步，扩张型心肌病（DCM）患者的心脏性猝死（SCD）和严重室性心律失常明显减少。植入式心脏复律除颤器（ICD）的主要预防作用在治疗因室性心律失常而导致 SCD 的患者中发挥了重要作用。然而，DCM 患者的心律失常风险分层仍然极具挑战性，仅基于左心室射血分数（LVEF）来决定是否进行主要预防 ICD 植入似乎并不充分。本综述提供了有关 DCM 患者主要预防 ICD 植入、心律失常风险分层和左心室逆向重构（LVRR）预测的最新证据，以及 DCM 患者主要预防 ICD 植入的最新指南建议和基于心律失常风险分层和左心室逆向重构（LVRR）预测的拟议多参数算法，以更好地识别可能从主要预防 ICD 中获益的患者。
