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慢性心力衰竭(心衰)患者中有30%~50%会发生猝死,为了改善预后不仅要关注心衰本身引起的死亡,还要重视对猝死的对策。β受体阻断剂、血管紧张素转换酶抑制剂和胺碘酮能降低猝死的危险,但效果不能令人满意。心衰患者的猝死很难预测时,植入型心律转复除颤器(ICD)会发挥难以替代的作用。欧洲和美国的大型试验已证明,ICD对猝死有一级和二级预防作用,ICD的适用范围正在变宽。此外,心衰患者中伴室内传导阻滞者,心室收缩的同步性发生障碍,而ICD恰好能使两心室电活动同步,所以在欧美ICD的应用已比较普及。考虑到医疗费用的同时,今后ICD在日本应用的适应证,即对心衰患者发生猝死危险的评价变得尤为重要。
In 30% to 50% of patients with chronic heart failure (CHF), sudden death occurs. To improve the prognosis, we must not only pay attention to the death caused by heart failure itself, but also pay attention to the measures for sudden death. Beta blockers, angiotensin converting enzyme inhibitors, and amiodarone reduce the risk of sudden death, but the effect is unsatisfactory. Implantable cardioverter-defibrillators (ICDs) play an irreplaceable role in sudden death in patients with heart failure that is difficult to predict. Large-scale trials in Europe and the United States have demonstrated that ICD has primary and secondary prevention against sudden death and the ICD is becoming more widely available. In addition, patients with heart failure in patients with intraventricular conduction block, synchronization of ventricular contraction occurs obstacles, and ICD just to synchronize the two ventricular electrical activity, so the application of ICD in Europe and America has become more common. In view of the medical expenses, the application of ICD in Japan in the future, that is, the evaluation of the risk of sudden death in patients with heart failure has become particularly important.