心肌梗死后左心室壁瘤相关室性心律失常的形成机制与治疗进展  

Mechanism and Progress in Treatment of Post-infarction Left Ventricular Aneurysm with Ventricular Arrhythmias

作　　者：刘磊 杨震[1] LIU Lei;YANG Zhen(Department of Cardiology,General Hospital of Ningxia Medical University,Yinchuan 750000,Ningxia,China)

机构地区：[1]宁夏医科大学总医院心内科

出　　处：《心血管病学进展》2020年第1期46-50,共5页Advances in Cardiovascular Diseases

摘　　要：左心室壁瘤是大面积急性透壁心肌梗死后的机械并发症,常因改变左心室正常解剖结构而促进折返环通路的形成,诱发反复性和难治性的室性心律失常,导致心脏性猝死。近年来研究提示参与心肌梗死后左心室壁瘤相关室性心律失常的形成机制众多,左心室壁瘤除导致机械性心室壁和心脏传导系统的改变外,还涉及离子通道、细胞外基质、缝隙连接通道和交感神经重构等多种因素,故而单纯内科药物保守治疗和传统手术的效果欠佳。非体外循环下冠状动脉旁路移植术加室壁瘤成形术并联合双极射频消融是近年来针对该类患者的新治疗方法,较以往的治疗方式具有明显的优势。现对心肌梗死后左心室壁瘤相关室性心律失常的形成机制与治疗进展做简要综述。Left ventricular aneurysm is one of the mechanical complications secondary to massive acute myocardial infarction. Left ventricular aneurysm can lead to the changes of the anatomic structure of left ventricle,facilitating the formation of reentrant circuit,which provide the substrate for recurrent and intractable ventricular arrhythmias and consequently lead to sudden cardiac death. Recent researches demonstrated that the mechanisms of ventricular arrhythmias related to post-infarction left ventricular aneurysm are complicated and multifactorial. In addition to the changes of both ventricular structure and cardiac conduction system,many other factors are involved,such as ion channels,extracellular matrix,gap junction and sympathetic nerve system. Therefore,the effects of medicines and conventional surgery are not ideal. In recent years,off-pump coronary artery bypass grafting in combination with ventricular aneurysm plasty and bipolar radiofrequency ablation is a new treatment strategy for these patients which provide obvious advantages over the previous methods. This paper briefly reviewed the developmental mechanisms and therapeutic progresses of post-infarction ventricular aneurysm-related ventricular arrhythmias.

关 键 词：左心室壁瘤 室性心律失常 机制 治疗 

分 类 号：R542.22[医药卫生—心血管疾病] R541.7[医药卫生—内科学]