植入心律转复除颤器作为心力衰竭患者心脏性猝死的一级预防

心力衰竭是多种心脏疾病发展至晚期的一个严重临床综合征，随着人口老龄化速度的加快、心血管疾病发病率的上升，心脏疾病尤其是心肌梗死的有效治疗使更多的患者得以生存，但随后慢性心力衰竭患者日趋增多。心力衰竭最终死亡原因主要是进行性心力衰竭加重和／或心脏性猝死（SCD）。

Implantable cardioverter defibrillator is primary prophylactic therapy for sudden cardiac death in patients with heart failure

The menace of progressive cardiac systolic dysfunction and sudden cardiac death(SCD)still hover threateningly over the patient with heart failure.Despite available phagnlacological treatment is utilized.it is still proven lowly effective in the prevention of SCD caused by fatal ventricular arrhythmia.Data from AHA indicated that evaluation and management of patients at risk for SCD (primary prevention)has higher efficacy in reducing mortality than secondary prevention.Unfortunately,present risk stratifiers,such as HRV,QT interval dispersion and late potential testing,does not offer accurate and timely alarms in primary prevention of SCD.Nowadays,randomized muhicenter trials(AVID、CASH、CIDS)and clinical practice have proven t11at conventional implantable cardioverter defibrillator(ICD)implantation has become the standard even optimal treatment in the secondary prevention for SCD.Is primary prophylactic ICD therapy for SCD in patients with heart failure eriective?Positive results from MADIT Ⅱ trial seems give us a promising fotare.It indicated that comparing with pharmacological treatment.ICD has substantial advances in lowering all cause mortality for patients after infarction with LVEF＜0.30 even without history of tachycardia.As with the MADIT Ⅱ trial.subsequent DEFINITE trial and SCD-HeFT trial also confirmed ICD.is an effective treatment.and increased survival in selected patients.Based on results of these trials.ACC/AHA/HRS revised the content of latest clinical guideline.It expand the indication of ICD implantation for potentially eligible patients are screened on the basis of LVEF＜0.30 or＜0.35 and anticipated survival with good functional capacity bevond 1 year.The report in present press bv GUO Hong-xia.XU Wei,et al also demonstrated that ICD implantation is a safe and effective therapy in primary prevention of SCD in 22 patients with heart failure.It may be the first report about evaluation of primary prevention of SCD by ICD in China.It could suggest that 1CD become a commonplace management for primary prophylactic therapy.Hence,it implicates that prophylactic ICD therapy could be upgraded to first line strategy for SCD.In addition.in view of the fact that CRT is also deftnite preventive solution for progression of heart failure.we suggest that making CRT-D as optimal strategy for primary prevention of SCD.