CRT适应证的评价详解.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Compares the improvement between paired data in the BiV and RV groups for the six minute walk from pre-implant to six months. * * The BiV group had significantly better ejection fraction at six weeks (p=0.04) and at six months (p=0.01) than the RV group. The EF was not changed significantly between six weeks and six months within the BiV group. This was not unexpected due to the fact that the majority of BV pacing effect takes place immediately after implant. However, the EF within the RV group decreased between 6 weeks and 6 months while there was a slight improvement in EF within the BiV group. * * Over the 3 year study period, the mortality rate was 8.9% in BiV and 17.9% in RV (p=0.04). The number of deaths was more than twice as high in the RV group than BiV group. These results are consistent with the DAVID trial, where RV pacing in NYHA class I/II patients with no previous pacing indication experienced an increased rate of HF hospitalizations and death. * * * * * * * * * * * * * * * * * * * * The MIRACLE ICD study included NYHA II-IV patients. A separate analysis was done for Class II patients. Patient inclusion criteria was the same for all NYHA classes: Adult, moderate to severe systolic heart failure patients with evidence of ventricular dysynchrony. Stable heart failure medical regimen was required. If on a Beta Blocker, a therapeutic dose for 3-months prior to enrollment was necessary. Patients with an existing indication for a pacemaker or an ICD are excluded. Other exclusion criteria include: Baseline 6 minute walk distance ? 450 meters Unstable angina, acute MI, coronary artery revascularization/coronary angioplasty within last 3 months Chronic atrial arrhythmias, cardioversion from arrhythmia within previous month, paroxysmal atrial arrhythmia within previous month Supine systolic blood pressure 80 mm Hg or 170 mm Hg Supine resting rate 140 bpm Cerebral vascular event w