Romano Letizia Rosa, Spaccarotella Carmen Anna Maria, Indolfi Ciro, Curcio Antonio
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, 80134 Naples, Italy.
Life (Basel). 2023 Sep 21;13(9):1940. doi: 10.3390/life13091940.
Common triggers for sudden cardiac death (SCD) are transient ischemia, hemodynamic fluctuations, neurocardiovascular influences, and environmental factors. SCD occurs rapidly when sinus rhythm degenerates into ventricular tachycardia (VT) and/or ventricular fibrillation (VF), followed by asystole. Such progressive worsening of the cardiac rhythm is in most cases observed in the setting of ischemic heart disease and often associated with advanced left ventricular (LV) impairment. Revascularization prevents negative outcomes including SCD and heart failure (HF) due to LV dysfunction (LVD). The implantable cardioverter-defibrillator (ICD) on top of medical therapy is superior to antiarrhythmic drugs for patients with LVD and VT/VF. The beneficial effects of ICD have been demonstrated in primary prevention of SCD as well. However, yet debated is the temporal management for patients with LVD who are eligible to ICD prior to revascularization, either through percutaneous or surgical approach. Restoration of coronary blood flow has a dramatic impact on adverse LV remodeling, while it requires aggressive long-term antiplatelet therapy, which might increase complication for eventual ICD procedure when percutaneous strategy is pursued; on the other hand, when LV and/or multiorgan dysfunction is present and coronary artery bypass grafting is chosen, the overall risk is augmented, mostly in HF patients. The aims of this review are to describe the pathophysiologic benefits of revascularization, the studies addressing percutaneous, surgical or no revascularization and ICD implantation, as well as emerging defibrillation strategies for patients deemed at transient risk of SCD and/or at higher risk for transvenous ICD implantation.
心脏性猝死（SCD）的常见触发因素包括短暂性缺血、血流动力学波动、神经心血管影响和环境因素。当窦性心律退化为室性心动过速（VT）和/或室颤（VF），随后出现心搏停止时，SCD迅速发生。这种心律的进行性恶化在大多数情况下见于缺血性心脏病患者，且常与严重的左心室（LV）功能损害有关。血运重建可预防包括SCD和因左心室功能障碍（LVD）导致的心力衰竭（HF）等不良后果。对于患有LVD和VT/VF的患者，在药物治疗基础上植入植入式心脏复律除颤器（ICD）优于抗心律失常药物。ICD在SCD一级预防中的有益作用也已得到证实。然而，对于有资格在血运重建前（无论是通过经皮还是手术方法）植入ICD的LVD患者的时机管理仍存在争议。冠状动脉血流的恢复对不良的左心室重构有显著影响，而这需要积极的长期抗血小板治疗，当采用经皮策略时，这可能会增加最终ICD手术的并发症；另一方面，当存在左心室和/或多器官功能障碍并选择冠状动脉旁路移植术时，总体风险会增加，在HF患者中尤为明显。本综述的目的是描述血运重建的病理生理益处、针对经皮、手术或不进行血运重建及ICD植入的研究，以及针对被认为有SCD短暂风险和/或经静脉植入ICD风险较高的患者的新兴除颤策略。
