Treatment of patients with different heart failure

Chronic heart failure (CHF) is the final stage of patients with various organic heart diseases, and intractable heart failure and arrhythmia are the two main causes of death. Epidemiological data show that there are about 5 million patients with heart failure in the United States, with more than 500000 new cases every year, nearly 23 million patients with heart failure worldwide, and about 2 million new cases every year. The data of 2003 also showed that the incidence rate of heart failure was about 0.9% in 35~74 year old population. According to this calculation, there are more than 4 million patients with heart failure in this age group in China. With the incidence rate of CHF diseases increasing, such as coronary heart disease and hypertension, the number of CHF has been increasing year by year.

although the rapid development of evidence-based medicine has brought epoch-making progress to the standardized treatment of CHF in recent years, the treatment mode of CHF has changed from hemodynamic intervention modes such as cardiac strengthening, diuresis and vasodilation to neuroendocrine intervention for renin angiotensin aldosterone system (RAAS) and sympathetic nervous system The comprehensive treatment mode of anti myocardial remodeling as the cornerstone of treatment and combined with hemodynamic intervention has significantly improved the mortality and survival of CHF, but the mortality of CHF is still very high. Under this historical background, implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) have become a reality. Therefore, this paper will elaborate the device treatment status and selection strategy of patients with heart failure from many aspects.

value and indication progress of ICD in patients with heart failure

sudden death is the main cause of death in patients with CHF, which is significantly higher than the deterioration of heart failure in the composition of death in patients with CHF, and the main cause of sudden death is malignant arrhythmia, such as ventricular tachycardia, ventricular flutter or ventricular fibrillation. Electric defibrillation is the most effective way to stop malignant arrhythmia attack and reduce arrhythmia death. Therefore, ICD has become the most important means to prevent sudden cardiac death outside the hospital.

the indications of ICD in patients with heart failure were first written into the guidelines in 1998, the arrhythmia instrument treatment guidelines formulated by AHA / acc. The guideline clearly points out in class I indications that patients with non persistent ventricular tachycardia complicated with left ventricular dysfunction of coronary heart disease and old myocardial infarction have inducible persistent ventricular tachycardia / ventricular fibrillation that is not inhibited by class I antiarrhythmic drugs during electrophysiological examination, or ventricular tachycardia / ventricular fibrillation can be induced by electrophysiological examination, which are class I (class B evidence) and class IIB indications of ICD implantation respectively.

with the publication of MADIT-II study in 2002, when AHA / ACC / NASPE updated the arrhythmia device treatment guidelines in that year, in the guidelines, the above class I indications were retained and class B evidence was raised to class a evidence. At the same time, class IIa indication appeared for the first time, which was tailored according to the results of MADIT-II research. It is pointed out that in patients with coronary heart disease at least 1 month after myocardial infarction and at least 3 months after coronary revascularization, if left ventricular ejection fraction (LVEF).