ICD一级预防面临的挑战

Prophylactic ICD implantation for primary prevention of sudden cardiac death

心脏性猝死(SCD)目前已成为除肿瘤之外的第二位死亡病因。埋藏式心脏转复除颤器(ICD)是防治SCD最有效的治疗之一。ICD一级预防是针对SCD的极高危人群进行的猝死预防性治疗,1998年仅在相关指南中为Ⅱb类推荐,而到2005年就上升为Ⅰ类推荐的治疗指征。然而,近年来有文章认为,当缺血性心衰患者满足ICD一级预防的Ⅰ类指征同时又有多个死亡风险因素时,治疗后的全因死亡率并不降低。2016年刚发布的DANISH研究结果表明,非缺血性心衰患者符合ICD一级预防的Ⅰ类指征者,植入后远期的全因死亡率并未下降,这些对ICD一级预防提出了严峻的挑战。

Sudden cardiac death（SCD）is the second leading cause of death in addition to cancer in the human.Over the past two decades,implantable cardioverter defibrillator（ICD）implantation has been shown to be associated with substantial reductions in the rate of SCD and become one of the most effective treatment for SCD already.ICD implantation for primary prevention of SCD has be a classⅠ recommendation for patients with left ventricular dysfunction since 2005 guidelines.However,ICD therapy is also faced with severe challenges in the primary prevention of SCD,such as non-success of reducing long-term mortality from any cause in patients with nonischemic systolic heart failure in DANISH study（2016）.So prophylactic ICD implantation for the primary prevention of SCD appears promising,but is still under development.