心脏再同步治疗:当前的指导方针和超越药物治疗的近期进展
Christian Butter1,2, Martin Seifert1,2, Christian Georgi1,2
1Cardiology Department, Immanuel Klinikum Bernau Herz-Zentrum Brandenburg, University of Brandenburg, Bernau, Germany.
Current pharmaceutical design
|May 29, 2023
概括
心脏再同步疗法 (CRT) 是心力衰竭 (HF) 的一个关键治疗方法,使用左捆分支阻塞 (LBBB). 较新的节奏策略显示出希望,可能减少对可植入心脏转换器-除器 (ICD) 的需求.
科学领域:
- 心脏病学 心脏病学
- 电力生理学 电力生理学
- 心脏衰竭管理的管理
背景情况:
- 建议心脏再同步治疗 (CRT) 用于心力衰竭 (HF) 患者的左捆分支阻塞 (LBBB) 和减少喷射分数,以及最佳医学治疗 (OMT).
- 前庭动 (AF) 和需要右心室节奏影响CRT决策.
- 步调的进步提供了当CRT不可行或不有效时的替代方案.
研究的目的:
- 对心力衰竭中CRT的当前指导方针和新兴策略进行审查.
- 讨论替代步调技术的作用及其长期有效性.
- 根据心力衰竭治疗的改进,评估植入式心脏转换器-除器 (ICD) 的不断变化的指示.
主要方法:
- 2021年欧洲心脏病学会 (ESC) 对心脏节拍和CRT的指导方针的审查.
- 分析替代步调站点和多线路/多站点策略.
- 导电系统步调及其潜在好处的讨论.
- 考虑先进心力衰竭药疗对器械治疗决策的影响.
主要成果:
- 对于特定的HF/LBBB患者个人资料 (LVEF ≤ 35%,QRS ≥ 150 ms) 强调CRT.
- 在接受CRT的AF患者中,AV结节切除是相关的.
- 多线路/多站点节奏和导电系统节奏显示优越性或承诺比传统的CRT.
- 改善的药物治疗可能会在某些患者中消除对ICD的需要.
结论:
- 对于精选的心力衰竭患者来说,CRT仍然至关重要,指南在不断变化.
- 新型节奏策略提供了比标准CRT有前途的替代方案和潜在的改进.
- ICD的必要性应该是个性化的,考虑到优化医疗治疗对左心室功能的影响.
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