CRT_D介导室性心动过速的研究进展

Advances in Ventricular Tachycardia Worsened by Cardiac Resynchronization Therapy Defibrillator

心室再同步心脏转复除颤器(CRT_D)可有效改善心力衰竭(CHF)患者的运动耐量和生活质量,预防猝死,提高生存率,但CRT_D植入后由于心室激动顺序的改变,使QT间期延长、跨室壁复极离散度(TDR)增加,潜在致室性心律失常风险;且CHF患者通常存在心肌解剖改变,传导的不均一性,也为折返性心动过速的发生提供了维持的机制;而多次电击也可导致肌钙蛋白升高,引起心肌损伤,局部心肌复极离散度增加(DRVR)和QT间期延长,以及电除颤后心肌纤维化和急性细胞损伤,反复室速、室颤也会引起进行性左心功能不全、心肌细胞凋亡、恶化心律失常基质和增加心律失常易感性。CRT_D潜在致室性心律失常作用逐渐引起人们的重视,本文就近年来CRT_D致室性心律失常的电生理机制与临床防治对策等做一综述。

Cardiac resynchronization therapy defibrillator （CRT_D） can improve heart failure patients exercise tolerance and the quality of life, to prevent sudden death and improve survival rate, but CRT_D implantation cause a reversal of the typical transmural activation sequence in ventricular, make QT interval prolongation, Transmural dispersion of repolarization （TDR） increases, the potential risk to ventricular arrhythmias; and CHF patients often exist myocardial anatomical change, conducting inhomogeneity, as well as the occurrence of reentrant tachycardia provides maintenance mechanism; and multiple shock can also lead to increased troponin, cause myocardial injury, the dispersion of regional ventricular repolarization （DRVR） increase and QT interval prolongation and electric defibrillation after acute myocardial fibrosis and cell damage, repeatedly ventricular tachycardia, ventricular fibrillation can also cause progressive left cardiac dysfunction, myocardial cell apoptosis, deteriorating cardiac arrhythmia matrix and increase arrhythmia susceptibility. The potential risk to ven-tricular arrhythmias gradually aroused people＇s attention,the article summarize the CRT_D electrophysiological mechanism of ventricular arrhythmia and clinical prevention and cure countermeasure, etc.