Brachmann J, Hilbel T, Grünig E, Benz A, Haass M, Kübler W
Department of Cardiology, University Hospital, Heidelberg, Germany.
Pacing Clin Electrophysiol. 1997 Oct;20(10 Pt 2):2714-8. doi: 10.1111/j.1540-8159.1997.tb06121.x.
Although prognosis of dilated cardiomyopathy (DCM) has improved due to advances in diagnosis and therapy, still too many sudden cardiac deaths occur in DCM. Spontaneous ventricular ectopy is a very common finding in patients with DCM, but the prognostic significance of Holter monitoring remains controversial. Other noninvasive methods, e.g., late potentials and QT dispersion, have not yet contributed to the evaluation of prognosis for arrhythmogenic events in DCM. Programmed ventricular stimulation has been repeatedly used to stratify long-term prognosis, yet satisfactory data are still missing as many deaths occur in patients without inducible arrhythmias. Several prognostic studies are still in progress, and preliminary data for the use of ICDs already appear to be promising. In patients with poor left ventricular function and ICDs in situ, prognosis is determined by progression of heart failure. Heart transplantation may be the ultimate therapeutic instrument for end-stage heart failure patients. For patients with advanced DCM and increased risk for malignant arrhythmias who are unsuitable for orthotopic heart transplantation, the combined therapy with an ICD and dynamic cardiomyoplasty may be an alternative treatment.
尽管由于诊断和治疗的进展，扩张型心肌病（DCM）的预后有所改善，但DCM患者中仍有太多的心源性猝死发生。室性早搏在DCM患者中非常常见，但动态心电图监测的预后意义仍存在争议。其他非侵入性方法，如晚电位和QT离散度，尚未有助于评估DCM心律失常事件的预后。程控心室刺激已被反复用于分层长期预后，但由于许多无诱发性心律失常的患者发生死亡，仍缺乏令人满意的数据。几项预后研究仍在进行中，植入式心脏复律除颤器（ICD）应用的初步数据似乎很有前景。在左心室功能差且已植入ICD的患者中，预后取决于心力衰竭的进展。心脏移植可能是终末期心力衰竭患者的最终治疗手段。对于晚期DCM且恶性心律失常风险增加但不适合原位心脏移植的患者，ICD与动态心肌成形术的联合治疗可能是一种替代治疗方法。
