Koji bolesnici s hipertrofičnom kardiomiopatijom trebaju kardioverter defibrilator?
| Autor: | Petrač, Dubravko |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2005 |
| Předmět: |
Cardiomyopathy - therapy
Defibrillators - implantable Cardiovascular diseases - complications Risk factors Kardiomiopatija hipertrofična Kardiomiopatija hipertrofična - terapija Defibrilatori - ugradivi Kardiovaskularne bolesti - komplikacije Rizični čimbenici cardiomyopathy-therapy defibrillators-implantable risk factors cardiovascular system |
| Zdroj: | Acta clinica Croatica Volume 44 Issue 4 |
| ISSN: | 1333-9451 0353-9466 |
| Popis: | Ventricular tachyarrhythmias are the most common cause of sudden cardiac death in hypertrophic cardiomyopathy. Cardioverter defibrillator (ICD) therapy therefore presents a reasonable concept of improving prognosis in selected patients with hypertrophic cardiomyopathy. Recently published studies have confirmed this concept and demonstrated that ICD therapy provides life-saving protection by effectively terminating ventricular tachycardia or fibrillation in patients with hypertrophic cardiomyopathy. Since hypertrophic cardiomyopathy has a low risk of sudden cardiac death in the general population, the decision to implant an ICD depends on the patient symptoms and level of risk. ICD is strongly warranted for secondary prevention of sudden death in patients who have survived cardiac arrest or spontaneous sustained ventricular tachycardia. Because the presence of two or more risk factors confers an annual mortality rate of sudden death of 3%-6% or more, their presence in patients with hypertrophic cardiomyopathy justifies prophylactic therapy with ICD for primary prevention of sudden death. Decisions regarding prophylactic ICD therapy in patients with a single risk factor should be individualized depending on patient age and perceived risk factor severity. A young patient with an extreme left ventricular hypertrophy or a family history of sudden death due to hypertrophic cardiomyopathy should be considered as a candidate for ICD, or should be informed on the potential life-saving protection offered by ICD. Ventrikulske tahiaritmije su najčešći uzrok iznenadne srčane smrti u bolesnika s hipertrofičnom kardiomiopatijom. Stoga liječenje kardioverterom defibrilatorom (ICD) predstavlja prihvatljiv koncept za poboljšanje prognoze u izabranih bolesnika s hipertrofičnom kardiomiopatijom. Nedavno objavljene studije potvrđuju ovaj koncept i pokazuju da ICD djelotvornim prekidanjem ventrikulske tahikardije ili fibrilacije zaštićuje život u bolesnika s hipertrofičnom kardiomiopatijom. Budući da hipertrofična kardiomiopatija ima nizak rizik od iznenadne srčane smrti u općoj populaciji, odluka o liječenju ICDom ovisi o bolesnikovim simptomima i stupnju rizika. Liječenje ICDom je nedvojbeno indicirano u sekundarnoj prevenciji iznenadne smrti u bolesnika koji su preživjeli srčani arest ili spontanu postojanu ventrikulsku tahikardiju. S obzirom na to da prisutnost dvaju ili više čimbenika rizika ima godišnju smrtnost od iznenadne smrti od 3%-6%, njihova prisutnost u bolesnika s hipertrofičnom kardiomiopatijom opravdava profilaktičnu ugradnju ICDa u primarnoj prevenciji iznenadne smrti. Odluka o profilaktičnoj ugradnji ICDa u bolesnika s jednim čimbenikom rizika treba biti individualizirana s obzirom na dob i uočenu težinu samog čimbenika rizika. Mlađeg bolesnika s ekstremnom hipertrofijom lijevog ventrikula ili obiteljskom anamnezom iznenadne srčane smrti uslijed hipertrofične kardiomiopatije treba razmotriti kao kandidata za ugradnju ICDa i obavijestiti ga o mogućnostima koje ICD pruža u zaštiti života. |
| Databáze: | OpenAIRE |
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