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Can J Cardiol:加拿大声明称电风暴优选非选择性β阻滞剂

2020-08-17 岱西 中国循环杂志

近期,加拿大心血管学会和加拿大心律失常学会就器质性心脏病患者室速和室颤的管理联合发布了一份立场声明文件,四川大学华西医院杨庆教授对此进行了解读。

近期,加拿大血管学会和加拿大心律失常学会就器质性心脏病患者室速和室颤的管理联合发布了一份立场声明文件,四川大学华西医院杨庆教授对此进行了解读

杨庆介绍,这份声明结合最新研究,对器质性心脏病患者室速和室颤的管理作出了比较全面系统的最新推荐,不过对外科手术后的室速、原发性离子通道病相关室速等未囊括其中。

评估和管理:强调使用磁共振和PET

对于器质性心脏病合并持续性室速/室颤患者的评估和管理,声明强调心脏钆增强磁共振成象及正电子发射断层扫描(PET)的应用。

声明指出,在初步评估后,必须考虑磁共振的应用。磁共振不但可以较为准确地对器质性心脏病患者心肌瘢痕的位置和数量进行判定,还可以了解心脏的炎症状况,如心肌炎。

此外,对于初步评估手段认为无器质性心脏病者若临床上怀疑到器质性心脏病,则应尽早行 磁共振确诊。

PET则用于怀疑有炎症反应(尤其是结节病)的患者,以指导抗炎/免疫抑制治疗。

急性治疗:优选非选择性β受体阻滞剂

在持续性多(单)形性室速/室颤的急性治疗中,在患者发生电风暴时,强调β受体阻滞剂的使用,优先选择非选择性的β受体阻滞剂。 

图1 持续性多(单)形性室速/室颤的急性治疗

强调患者心理评估和干预的重要性

由于疾病本身的心理压力、ICD 相关疑虑等均会增加患者死亡风险,合适的心理干预,包

筛查和治疗在ICD植入患者中更是必不可少。

PHQ-2和GAD-2等简单有效的筛查量表被用于评估患者心理状态,若患者任意一个得分≥3 分,需要进一步评估其心理状态。

长期药物控制:β受体阻滞剂、索他洛尔和胺碘酮获推

对器质性室速/室颤患者长期控制的药物治疗主要推荐了3个药物:即β受体阻滞剂、索他洛尔和胺碘酮。

β受体阻滞剂联合ICD治疗被推荐用于预防器质性心脏病患者再发室速及猝死。

索他洛尔一般不用于严重心衰患者,常与ICD治疗联合应用。

胺碘酮对减少已植入ICD的器质性室速患者复发最有效,但长期用副作用风险大。

导管消融治疗

推荐足量β受体阻滞剂+索他洛尔或胺碘酮治疗无效的缺血性心脏病合并反复发生的单形性室速的患者由有经验的术者行导管消融。

推荐接受索他洛尔和胺碘酮治疗效果欠佳的非缺血性心脏病的单形性室速患者由有心外膜

消融经验的术者行导管消融。

心脏交感神经切除术:条件性推荐

建议药物治疗无效、常规消融失败的难治性器质性室速患者可考虑行交感神经节切除。

原始出处:Deyell MW, AbdelWahab A, Angaran P, et al. 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society positions tatement on the management of ventricular tachycardia and fibrillation in patients with structural heart disease. Can J Cardiol,2020, 36(6): 822-836

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encryptionId=723a9e69383, topicName=阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Thu Oct 01 09:32:37 CST 2020, time=2020-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1782099, encodeId=85a01e8209951, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Thu Jan 28 07:32:37 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811065, encodeId=47f081106528, content=👍🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 16:27:03 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810866, encodeId=223b81086674, content=!, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:18 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810865, encodeId=02e9810865c7, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:17 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1312657, encodeId=0562131265e96, content=<a href='/topic/show?id=1aa333006b4' target=_blank style='color:#2F92EE;'>#加拿大#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33006, encryptionId=1aa333006b4, topicName=加拿大)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=279b407, createdName=shanyongle, createdTime=Wed Aug 19 05:32:37 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809904, encodeId=5d17809904b6, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fb682417917, createdName=1238d654m87暂无昵称, createdTime=Mon Aug 17 21:32:46 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-10-01 zhyy88
  5. 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time=2020-08-17, status=1, ipAttribution=)]
  6. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 16:27:03 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810866, encodeId=223b81086674, content=!, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:18 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810865, encodeId=02e9810865c7, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:17 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1312657, encodeId=0562131265e96, content=<a href='/topic/show?id=1aa333006b4' target=_blank style='color:#2F92EE;'>#加拿大#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33006, encryptionId=1aa333006b4, topicName=加拿大)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=279b407, createdName=shanyongle, createdTime=Wed Aug 19 05:32:37 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809904, encodeId=5d17809904b6, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fb682417917, createdName=1238d654m87暂无昵称, createdTime=Mon Aug 17 21:32:46 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-19 ms5000000741733160

    👍🏻

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1922962, encodeId=4f8c19229622b, content=<a href='/topic/show?id=78f794e800a' target=_blank style='color:#2F92EE;'>#选择性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94780, encryptionId=78f794e800a, topicName=选择性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0802500050, createdName=肉我只吃一口, createdTime=Sat Oct 31 09:32:37 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1718239, encodeId=03731e1823931, content=<a href='/topic/show?id=bf431925337' target=_blank style='color:#2F92EE;'>#β阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19253, encryptionId=bf431925337, topicName=β阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=null, 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 16:27:03 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810866, encodeId=223b81086674, content=!, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:18 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810865, encodeId=02e9810865c7, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:17 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1312657, encodeId=0562131265e96, content=<a href='/topic/show?id=1aa333006b4' target=_blank style='color:#2F92EE;'>#加拿大#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33006, encryptionId=1aa333006b4, topicName=加拿大)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=279b407, createdName=shanyongle, createdTime=Wed Aug 19 05:32:37 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809904, encodeId=5d17809904b6, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fb682417917, createdName=1238d654m87暂无昵称, createdTime=Mon Aug 17 21:32:46 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-19 ms5000000741733160

    0

  8. 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encryptionId=723a9e69383, topicName=阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Thu Oct 01 09:32:37 CST 2020, time=2020-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1782099, encodeId=85a01e8209951, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Thu Jan 28 07:32:37 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811065, encodeId=47f081106528, content=👍🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, 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19 15:58:17 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1312657, encodeId=0562131265e96, content=<a href='/topic/show?id=1aa333006b4' target=_blank style='color:#2F92EE;'>#加拿大#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33006, encryptionId=1aa333006b4, topicName=加拿大)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=279b407, createdName=shanyongle, createdTime=Wed Aug 19 05:32:37 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809904, encodeId=5d17809904b6, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=146, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fb682417917, createdName=1238d654m87暂无昵称, createdTime=Mon Aug 17 21:32:46 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-19 ms5000000741733160

    👍

    0

  9. 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time=2020-08-17, status=1, ipAttribution=)]
  10. 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time=2020-08-17, status=1, ipAttribution=)]
    2020-08-17 1238d654m87暂无昵称

    学习

    0

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