Ebert M, Thomsen Y, Richter S
Sektion Rhythmologie, Klinik für Innere Medizin und Kardiologie, Herzzentrum Dresden, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Deutschland.
Herzschrittmacherther Elektrophysiol. 2025 Mar;36(1):10-20. doi: 10.1007/s00399-024-01064-4. Epub 2025 Jan 22.
Patients with systolic heart failure (HF) and structural heart disease often suffer from ventricular tachycardias (VTs), which lead to increased morbidity and mortality. Despite advancements in pharmacological therapy and the use of implantable cardioverter-defibrillators, treatment options are limited due to side effects and decreased effectiveness. Catheter ablation (CA) has emerged as a promising therapy for drug-refractory VTs, especially in patients with structural heart disease. This article reviews current knowledge on the indications, efficacy, and long-term prognosis of CA in patients with HF. Additionally, it discusses the importance of preprocedural planning, risk stratification, and emerging therapeutic strategies such as mechanical circulatory support and stereotactic arrhythmia radioablation. The complex relationship between VT and HF, as well as potential risks like acute hemodynamic decompensation, are also addressed.
收缩性心力衰竭(HF)和结构性心脏病患者常患有室性心动过速(VTs),这会导致发病率和死亡率增加。尽管药物治疗和植入式心脏复律除颤器的使用取得了进展,但由于副作用和疗效降低,治疗选择仍然有限。导管消融(CA)已成为治疗药物难治性VTs的一种有前景的疗法,尤其是在结构性心脏病患者中。本文综述了关于HF患者CA的适应证、疗效和长期预后的当前知识。此外,还讨论了术前规划、风险分层以及机械循环支持和立体定向心律失常射频消融等新兴治疗策略的重要性。还探讨了VT与HF之间的复杂关系以及急性血流动力学失代偿等潜在风险。