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心脏再同步化治疗(CRT)是近年来慢性心力衰竭领域的重要进展之一,但同时已经陆续出现CRT后恶性室性心律失常的报道。CRT致心律失常的可能作用机理一方面是手术操作加重心力衰竭的影响,另一方面是对心室肌复极顺序、跨室壁复极离散、QT间期等电生理参数的影响。加强术前评估、术前准备,轻柔术中操作,优化术后药物治疗可减少CRT所致室性心律失常。对大部分患者置入CRT-D是最佳治疗方案。
Cardiac resynchronization therapy (CRT) is one of the important advances in the field of chronic heart failure in recent years, but at the same time, there have been reports of malignant ventricular arrhythmias after CRT. The possible mechanism of CRT induced arrhythmia is that the surgical operation aggravates the influence of heart failure and on the electrophysiological parameters such as ventricular repolarization sequence, transseptal repolarization dispersion and QT interval on the other hand. To strengthen the preoperative assessment, preoperative preparation, gentle intraoperative manipulation, optimization of postoperative medication can reduce CRT induced ventricular arrhythmias. CRT-D is the best treatment for most patients.