心律失常诊治策略-王利宏.pptVIP

* provides accurate diagnosis of myocardial,valvular, and congenital heart disorders associated with ventricular arrhythmias and SCD. In addition, LV systolic function and regional wall motion can be evaluated and, in a majority of patients, EF can be determined. Echocardiography is therefore indicatedor in patients with ventricular arrhythmias suspected of having structural heart disease and in the subset of patients at high risk for the development of serious ventricular arrhythmias or SCD, such as those with dilated, hypertrophic or RV cardiomyopathies, AMI survivors, or relatives of patients with inherited disorders associated with SCD. The combination of echocardiography with exercise or pharmacological stress (commonly known as “stress echo”) is applicable to a selected group of patients who are suspected of having ventricular arrhythmias triggered by ischemia and who are unable to exercise or have resting ECG abnormalities that limit the accuracy of ECG for ischemia detection.Anomalous origin of coronary arteries can be detected byechocardiography or other imaging techniques. * 室性心律失常是心脏疾病的最常见表现，在心律失常中占第一位，同时其又可能是潜在的最重要最凶险的危及生命的问题。及时识别致命性室性心律失常，采取有效积极的预防和治疗措施，挽救病人的生命，并对不同的室性心律失常作出危险性评价，提出合适的治疗策略(药物治疗？消融治疗？ICD治疗？外科治疗？)。是心内科临床上极端重要而又较为棘手问题，值得重视、研究和思考。 * * Reductions in mortality with ICDs vs. drugs: VT/VF Patients 1 AVID: 31% at 3 years and 39% at 1 year (ICD versus empiric amiodarone or sotalol) 2 CASH: 37% at 2 years (ICD versus amiodarone, metoprolol or propafenone) 3 CIDS: 20% at 3 years (ICD versus amiodarone) Post-MI Patients 4 MADIT: 54% at 2 years (ICDs versus conventional treatment – mostly amiodarone) 5 MUSTT: 60% at 5 years (ICDs versus conventional treatment – sotalol or amiodarone) * 室性心律失常是心脏疾病的最常见表现，在心律失常中占第一位，同时其又可能是潜在的最重要最凶险的危及生命的问题。及时识别致命性室性心律失常，采取有效积极的预防和治疗措施，挽救病人的生命，并对不同的室性心律失常作出危险性评价，提出合适的治疗策略(药物治疗？消融治疗？ICD治疗？外科治疗？)。是心内科临床上极端重要而又较为棘手问题，值得重视、研究和思考。 * 室性心律失常是心脏疾病的最常见表现，在心律失常中占第一位，同时其又可能是潜在的最重要最凶险的危及生命的问题。及时识别致命性室性心律失常，采取有效积极的预防和治疗措施，挽