Ventricular arrhythmias in patients with chronic total occlusion of coronary arteries: a review focused on interventional treatments.

IF 2.7 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Nikitas Katsillis, Ourania Kariki, Gerasimos Gavrielatos, Antonios Dimopoulos, Nikolaos Papakonstantinou, Elena Bousoula, Sarantos Linardakis, Athanasios Saplaouras, John Malakos, Stylianos Dragasis, Konstantinos P Letsas, Michael Efremidis, Nikolaos Patsourakos
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引用次数: 0

Abstract

A chronic total occlusion (CTO) of a coronary artery is present in almost one-fifth of patients undergoing a scheduled coronary angiography. A CTO may be classified as infarct related when there is evidence of myocardial dysfunction in the territory of the obstructed vessel or as non-infarct related when the myocardial substrate has preserved its systolic function. The presence of a CTO has been associated with an increased risk of malignant ventricular arrhythmias (VAs), appropriate ICD shocks, and cardiac mortality, with infarct-related CTOs exhibiting a worse prognosis. During the last decade, technological advancements have improved the success rates of transcatheter revascularization, a treatment that has been proven valuable for persistently symptomatic patients. However, the role of revascularization in reducing the arrhythmic burden is unclear. On the contrary, catheter ablation of VAs has been suggested to be effective, despite the presence of a CTO. As for device therapies, an increased prevalence of appropriate ICD shocks should be expected in this population, bringing into consideration the implementation of the presence of CTO as a risk modifier in sudden cardiac death prevention algorithms. The aim of this review is to present the existing literature on the role of all kinds of interventions in the management of patients with CTOs and VAs.

慢性冠状动脉全闭塞患者室性心律失常:介入治疗综述
慢性冠状动脉全闭塞(CTO)存在于几乎五分之一的患者接受预定的冠状动脉造影。当存在心肌功能障碍的证据时,CTO可归类为梗死相关;当心肌底物保留其收缩功能时,CTO可归类为非梗死相关。CTO的存在与恶性室性心律失常(VAs)的风险增加、适当的ICD电击和梗死相关CTO预后较差的心脏死亡率相关。在过去十年中,技术进步提高了经导管血运重建术的成功率,这种治疗方法已被证明对持续有症状的患者很有价值。然而,血运重建在减轻心律失常负担中的作用尚不清楚。相反,尽管存在CTO,仍认为导管消融VAs是有效的。至于设备治疗,考虑到CTO作为心源性猝死预防算法中的风险调节剂的实施,应该预计该人群中适当的ICD电击的流行率会增加。本综述的目的是介绍各种干预措施在cto和VAs患者管理中的作用的现有文献。
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来源期刊
Hellenic Journal of Cardiology
Hellenic Journal of Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.90
自引率
7.30%
发文量
86
审稿时长
56 days
期刊介绍: The Hellenic Journal of Cardiology (International Edition, ISSN 1109-9666) is the official journal of the Hellenic Society of Cardiology and aims to publish high-quality articles on all aspects of cardiovascular medicine. A primary goal is to publish in each issue a number of original articles related to clinical and basic research. Many of these will be accompanied by invited editorial comments. Hot topics, such as molecular cardiology, and innovative cardiac imaging and electrophysiological mapping techniques, will appear frequently in the journal in the form of invited expert articles or special reports. The Editorial Committee also attaches great importance to subjects related to continuing medical education, the implementation of guidelines and cost effectiveness in cardiology.
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