培训课件-室性心律失常与ICD适应证.ppt

VT requires a more circumspect approach. Because VT can be hemodynamically stable there are more treatment options available. Hemodynamically compromised patients should be treated early with Cardioversion with adjunctive pharmacological therapy. Patients whose VT is stable can be treated less aggressively, given consideration of underlying causes such as acute myocardial ischemia/infarction or electrolyte imbalances. A 12-lead ECG should be obtained during sustained stable monomorphic VT and can be used to differentiate between VT, SVT with aberrant conduction, and preexcited tachycardia. Prior to electrophysiological intervention assessment must be of the patient’s underlying condition. Whenever ischemia is present in patients with suspected ventricular arrhythmias it should be corrected when possible. Coronary revascularization is indicated to reduce the risk of SCD in patients with VF when direct, clear evidence of acute myocardial ischemia is documented to immediately precede the onset of VF. Also, any patient who is being considered for ICD implantation because of impaired LV function should be on stable pharmacological therapy to correct the dysfunction. Aggressive attempts should be made to treat HF that may be present in some patients with LV dysfunction due to prior MI and ventricular tachyarrhythmias. During an average follow-up of 20 months, the mortality rates were 19.8 percent in the conventional- therapy group and 14.2 percent in the defibrillator group. Activity Instructions: Indications Worksheet (5-10 minutes) Take 5 minutes to review the worksheet and the six cases presented and determine whether each is primary or secondary prevention indication for ICD therapy, or whether it is not indicated. and Then we’ll discuss the answers. Patients experiencing cardiac arrest due to VF that does not occur within the first 24 to 48 h of AMI may be at risk for recurrent cardiac arrest. The patient should be evaluated and treated for myocard