心力衰竭和心源性猝死的电治疗要点.pptVIP

* * American Heart Association. 2002 Heart and Stroke Statistical Update 5,000,000 diagnosed with symptomatic HF; millions are undiagnosed * Main purpose: Establish the problem of ventricular dysynchrony. Key messages: Ventricular dysynchrony as manifested by a wide QRS is more common in patients with moderate to severe impaired ventricular systolic function (LVSF); A wide QRS is associated with a poor prognosis, and impaired cardiac function. Ventricular dysynchrony impairs diastolic and systolic function 4-6: Reduced LV filling time; Increased mitral regurgitation; Depressed dP/dt 4. Grines, et al. Circulation 1989;79:845-53 5. Xiao, et al. Br Heart J 1991;66:443-7 6. Xiao et al. Br Heart J 1992;68:403-7 Additional information: Masoudi and colleagues used retrospective medical chart data of 19,710 pts Medicare beneficiaries hospitalized w/ HF and for whom LV systolic function was confirmed. LBBB present in 8% of those with preserved LV systolic function (diastolic HF) and in 24% of those with EF 50% (p0.001). Aaronson developed and validated a multivariable survival model for ambulatory advanced heart failure patients wait listed for a heart transplant. IVCD (QRS 120 ms) present in 27% of the 268 pts in derivation sample, and in 53% of the 199 pts in validation sample. IVCD identified as contributing risk factor. Other studies have shown that fro the entire HF population about 15% have a wide QRS. Iuliano: 669 HF pts (ischemic or nonischemic cardiomyopathy, NYHA II-IV heart failure. Median followup of 45 mo. Prolonged QRS was associated w/ increase in mortality (49.3% vs 34.0%) and sudden death (24.8% vs 17.4%). LBBB was associated w/ worse survival but not sudden death. * The first issue of heart failure is the ventricular activation delay. This delay impairs lateral wall depolarization resulting in an overall disorganized ventricular contraction. Pumping efficiency is also reduced due to the delayed sequence. * * * Obstuction of L sublavia vein