Block M, Scheld H, Breithardt G
Department of Cardiology-Angiology, Hospital of the Westfälische Wilhelms-University of Münster, Germany.
Arch Mal Coeur Vaiss. 1996 Feb;89 Spec No 1:141-7.
Indications for of automatic cardioverter-defibrillators of automatic in patients with ventricular tachyarrhythmias have changed since the publications of first guidelines in 1991. Less invasive surgical approaches reduced the perioperative mortality. Tiered therapy devices improved the quality of life by reducing appropriate and inappropriate shocks. A low annual incidence of sudden death with implantable cardioverter defibrillators and frustrating results with antiarrhythmic drugs caused an extension of implantable cardioverter-defibrillator indications. Despite the absence of prospective studies implantable cardioverter-defibrillators have become a first line treatment for patients with ventricular tachyarrhythmias which are not due to acute myocardial infarction. In cardiac arrest survivors implantable cardioverter-defibrillator therapy has become the gold standard due to the low annual incidence of sudden death seen in implantable cardioverter-defibrillator patients. The results of ongoing prospective studies comparing implantable cardioverter-defibrillator therapy to antiarrhythmic drugs have to be awaited and will influence tomorrow's indications for implantable cardioverter-defibrillator therapy in patients with documented ventricular tachyarrhythmias. Additionally, studies evaluating prophylactic implantable cardioverter-defibrillator implantations in patients at high risk for ventricular tachyarrhythmias might expand indications for implantable cardioverter-defibrillator therapy.
自1991年首次发布指南以来，心室快速心律失常患者使用自动心脏复律除颤器的指征已发生变化。侵入性较小的手术方法降低了围手术期死亡率。分层治疗设备通过减少适当和不适当的电击改善了生活质量。植入式心脏复律除颤器导致的猝死年发生率较低，以及抗心律失常药物效果不佳，使得植入式心脏复律除颤器的指征有所扩大。尽管缺乏前瞻性研究，但植入式心脏复律除颤器已成为非急性心肌梗死所致心室快速心律失常患者的一线治疗方法。在心脏骤停幸存者中，由于植入式心脏复律除颤器患者的猝死年发生率较低，植入式心脏复律除颤器治疗已成为金标准。比较植入式心脏复律除颤器治疗与抗心律失常药物治疗的正在进行的前瞻性研究结果有待观察，这些结果将影响未来有记录的心室快速心律失常患者植入式心脏复律除颤器治疗的指征。此外，评估在心室快速心律失常高危患者中预防性植入植入式心脏复律除颤器的研究可能会扩大植入式心脏复律除颤器治疗的指征。
