心力衰竭合并心律失常的治疗

Treatment of Heart Failure with Arrhythmia

心力衰竭是一种复杂的临床综合征,具有很高的致残和致死率。心力衰竭患者死亡的主要原因为泵衰竭或心源性猝死(SCD),而后者最主要的原因就是恶性心律失常。随着循证医学证据的增加和心力衰竭机制研究的进展,并通过肾素-血管紧张素系统抑制药(RAS抑制药)和β受体阻滞药等药物的广泛应用,心力衰竭患者的死亡率显著降低,患者的生命得到了延长,生活质量也有很大的改善。但在心力衰竭患者中复杂性恶性心律失常仍有很高的发病率,且伴有此类心律失常者年死亡率可高达50%,其中相当的比例死于心律失常导致的猝死。因此要提高心力衰竭患者的生存率,除了有效的抗心力衰竭治疗外,还应正确、合理地抗心律失常治疗。

Heart failure is a complex clinical syndrome with high disability and death rate. In patients with severe chronic heart failure, some die of pump failure and many other deaths are sudden due to fatal malignant arrhythmia. With the progress in evidence-based medicine and studies on mechanisms of heart failure, overall mortality in patients with heart failure was significantly reduced through treatment with renin-angiotensin system inhibitors （RAS inhibitors） and beta-blockers. However, there is still a high incidence of malignant arrhythmias in heart failure patients whose mortality rate is up to 50%, and many of them are cardiac sudden deaths induced by life-threatening arrhythmia.Therefore, selection of the most beneficial strategy for the individual patient to reduce the risk of sudden death remains a major challenge in cardiology. Selection of the most beneficial strategy for the individual patient to reduce the risk of sudden death remains a major challenge in cardiology.