Martinek Michal, Jiravsky Otakar, Cesnakova Konecna Alica, Adamek Jan, Chovancik Jan, Sknouril Libor
Department of Cardiology, Agel Hospital Trinec-Podlesi, 739 61 Trinec, Czech Republic.
Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic.
Medicina (Kaunas). 2025 Apr 14;61(4):721. doi: 10.3390/medicina61040721.
Aortic stenosis (AS) is a frequent valvular disease characterized by the obstruction of left ventricular outflow. The resulting hemodynamic and structural changes create an arrhythmogenic substrate, with sudden cardiac death (SCD) often caused by ventricular arrhythmias (VAs) being a feared complication. This review examines the relationship between severe AS and VA, detailing the epidemiology, pathophysiological mechanisms, risk factors, and management approaches prior to aortic valve replacement (AVR). We conducted a comprehensive narrative review of the historical and contemporary literature investigating ventricular arrhythmias in severe aortic stenosis. Literature searches were performed in PubMed, MEDLINE, and Scopus databases using keywords, including "aortic stenosis", "ventricular arrhythmia", "sudden cardiac death", and "aortic valve replacement". Both landmark historical studies and modern investigations utilizing advanced monitoring techniques were included to provide a complete evolution of the understanding. The prevalence of ventricular ectopy and non-sustained ventricular tachycardia increases with AS severity and symptom onset. Left ventricular hypertrophy, myocardial fibrosis, altered electrophysiological properties, and ischemia create the arrhythmogenic substrate. Risk factors include the male sex, concomitant aortic regurgitation, elevated filling pressures, and syncope. Diagnostic approaches range from standard electrocardiography to continuous monitoring and advanced imaging. Management centers on timely valve intervention, with medical therapy serving primarily as a bridge to AVR. Ventricular arrhythmias represent a consequence of valvular pathology in severe AS rather than an independent entity. Their presence signals advanced disease and a heightened risk for adverse outcomes. Multidisciplinary management with vigilant monitoring and prompt surgical referral is essential. Understanding this relationship enables clinicians to better identify high-risk patients requiring urgent intervention before life-threatening arrhythmic events occur.
主动脉瓣狭窄（AS）是一种常见的瓣膜疾病，其特征是左心室流出道受阻。由此产生的血流动力学和结构变化会形成致心律失常基质，室性心律失常（VA）常导致的心源性猝死（SCD）是一种令人担忧的并发症。本综述探讨了重度AS与VA之间的关系，详细阐述了在主动脉瓣置换（AVR）之前的流行病学、病理生理机制、危险因素及管理方法。我们对研究重度主动脉瓣狭窄时室性心律失常的历史和当代文献进行了全面的叙述性综述。使用关键词，包括“主动脉瓣狭窄”“室性心律失常”“心源性猝死”和“主动脉瓣置换”，在PubMed、MEDLINE和Scopus数据库中进行文献检索。纳入了具有里程碑意义的历史研究和利用先进监测技术的现代研究，以提供认识的完整演变。室性早搏和非持续性室性心动过速的患病率随AS严重程度和症状发作而增加。左心室肥厚、心肌纤维化、电生理特性改变和缺血形成了致心律失常基质。危险因素包括男性、合并主动脉瓣反流、充盈压升高和晕厥。诊断方法从标准心电图到连续监测和先进成像。管理的核心是及时进行瓣膜干预，药物治疗主要作为AVR的桥梁。室性心律失常是重度AS瓣膜病变的结果，而非独立的疾病实体。它们的出现预示着疾病进展和不良结局风险增加。多学科管理、密切监测和及时手术转诊至关重要。了解这种关系使临床医生能够更好地识别在危及生命的心律失常事件发生前需要紧急干预的高危患者。
