Cisneros Clavijo Paulina Elizabeth, Dunay Silva Alexis Agustin, Dorado Ramírez John Manuel, Perez Correa Juan Felipe, Montenegro Cadena Yesith Mauricio, Martínez Arelio Luis Alberto, Viñan Andino Adriana Viviana, Cortes Sanchez Daniel Ricardo, Ramirez Castaño Edgard Andres
Endovascular Surgery, Enrique Garcés Hospital, Quito, ECU.
Hemodynamics, General and Interventional Cardioangiology, Pontificia Universidad Católica del Ecuador, Quito, ECU.
Cureus. 2024 Dec 30;16(12):e76641. doi: 10.7759/cureus.76641. eCollection 2024 Dec.
Ventricular tachycardia (VT) is a life-threatening arrhythmia often leading to sudden cardiac death, particularly in critically ill patients. Refractory VT, characterized by recurrent episodes requiring intervention, poses unique challenges for management, necessitating advanced diagnostic and therapeutic strategies. This systematic review evaluates the impact of imaging and pharmacological treatments in managing refractory VT in critically ill patients. A systematic literature search was conducted using keywords such as "refractory ventricular tachycardia", "critical illness", "imaging techniques", "pharmacological treatments", "antiarrhythmic drugs", "ICD interventions", and "non-invasive therapy". Databases searched included PubMed, Google Scholar, and Cochrane Library, identifying 1590 publications. After screening, 11 studies meeting the inclusion criteria were included in this review. Oral procainamide significantly reduced VT episodes but caused severe side effects in certain patients. Noninvasive interventions such as transcutaneous magnetic stimulation (TcMS) and noninvasive electrophysiology-guided radioablation reduced VT burden and antiarrhythmic drug (AAD) use, with TcMS decreasing VT episodes in the sham group (P < 0.001). Stereotactic body radiation therapy (SBRT) and stereotactic arrhythmia radiotherapy (STAR) reduced VT episodes. Ultrasound-guided stellate ganglion blockade decreased VT episodes (P < 0.001) within 24 hours. Catheter ablation improved composite outcomes, including ICD shocks and heart failure hospitalizations, compared to AAD therapy. Quality of life significantly improved with noninvasive therapies, though SBRT presented rare complications like pneumonitis. Imaging and pharmacological interventions effectively reduce VT burden and ICD interventions while showing varying safety profiles. However, the limited sample sizes, short follow-up durations, and heterogeneity across studies highlight the need for further high-quality research to establish long-term efficacy and safety.
室性心动过速（VT）是一种危及生命的心律失常，常导致心源性猝死，尤其是在危重症患者中。难治性室性心动过速的特征是反复发作且需要干预，给治疗带来了独特的挑战，因此需要先进的诊断和治疗策略。本系统评价评估了影像学和药物治疗对危重症患者难治性室性心动过速治疗的影响。使用 “难治性室性心动过速”、“危重症”、“成像技术”、“药物治疗”、“抗心律失常药物”、“植入式心脏复律除颤器（ICD）干预” 和 “非侵入性治疗” 等关键词进行了系统的文献检索。检索的数据库包括PubMed、谷歌学术和考克兰图书馆，共识别出1590篇出版物。筛选后，本评价纳入了11项符合纳入标准的研究。口服普鲁卡因胺可显著减少室性心动过速发作，但在某些患者中会引起严重副作用。经皮磁刺激（TcMS）和非侵入性电生理引导射频消融等非侵入性干预措施可减轻室性心动过速负担并减少抗心律失常药物（AAD）的使用，其中TcMS可减少假手术组的室性心动过速发作（P < 0.001）。立体定向体部放射治疗（SBRT）和立体定向心律失常放射治疗（STAR）可减少室性心动过速发作。超声引导下星状神经节阻滞在24小时内可减少室性心动过速发作（P < 0.001）。与AAD治疗相比，导管消融改善了综合结局，包括ICD电击和心力衰竭住院情况。非侵入性治疗显著改善了生活质量，不过SBRT会出现如肺炎等罕见并发症。影像学和药物干预可有效减轻室性心动过速负担并减少ICD干预，同时显示出不同的安全性。然而，样本量有限、随访时间短以及研究之间的异质性突出表明，需要进一步开展高质量研究以确定长期疗效和安全性。
