Ma Jin, Chen Qiuxiong, Lin Dongqun, Ma Shiyu
Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
State Key Laboratory of Dampness Syndrome of Chinese Medicine, Guangzhou, China.
J Cell Mol Med. 2025 Apr;29(7):e70526. doi: 10.1111/jcmm.70526.
Patients who experience post-myocardial infarction (MI) and present with a left ventricular ejection fraction of less than 35% are classified as being at high risk for sudden cardiac death due to ventricular arrhythmias (VAs). The expansion of scar tissue and the extension of the infarct border zone (IBZ) following MI play critical roles in the progression of heart failure and the onset of VAs. Various aspects of structural remodelling, including cardiac fibrosis, along with electrophysiological changes such as alterations in gap junctions, ion channels, and autonomic nervous system function within the IBZ may contribute to abnormal impulse generation and conduction, thereby increasing susceptibility to arrhythmias. Currently, management strategies for VAs primarily encompass pharmacologic interventions (e.g., β-blockers, amiodarone), device-based approaches (e.g., ICD implantation), or catheter ablation techniques as outlined by ESC Guidelines. In this review, we systematically summarise both structural characteristics inherent in ischaemic myocardial substrates and clinical treatment strategies regarding VAs. We propose that early prevention strategies aimed at mitigating arrhythmogenic substrate formation represent an innovative approach to treating VAs following MI.
经历过心肌梗死（MI）且左心室射血分数低于35%的患者，被归类为因室性心律失常（VAs）而有心脏性猝死高风险。心肌梗死后瘢痕组织的扩展以及梗死边缘区（IBZ）的延伸，在心力衰竭进展和室性心律失常发作中起关键作用。结构重塑的各个方面，包括心脏纤维化，以及IBZ内的电生理变化，如缝隙连接、离子通道和自主神经系统功能的改变，可能导致异常冲动的产生和传导，从而增加心律失常易感性。目前，室性心律失常的管理策略主要包括药物干预（如β受体阻滞剂、胺碘酮）、基于设备的方法（如植入式心脏复律除颤器[ICD]）或欧洲心脏病学会（ESC）指南中概述的导管消融技术。在本综述中，我们系统总结了缺血性心肌基质固有的结构特征以及关于室性心律失常的临床治疗策略。我们提出，旨在减轻致心律失常基质形成的早期预防策略是治疗心肌梗死后室性心律失常的一种创新方法。
