ICD+CRT+CRTD的临床应用.ppt

CRTD适应证的发展 2005年ESC心力衰竭治疗指南 NYHA心功能Ⅲ～Ⅳ级、LVEF≤35%、QRS时限120ms 的症状性心力衰竭患者 2006年心脏性猝死防治指南 NYHA心功能Ⅲ～Ⅳ级、窦性心律、QRS时限≥120ms、 预期寿命长于1年的心力衰竭患者 IIa类适应证，证据级别B级 CRTD适应证 2007年ESC心脏起搏和再同步治疗指南 符合ICD的I类适应证（首次植入或升级） 标准抗心力衰竭药物治疗基础上NYHA心功能III～IV级； LVEF≤35%, 左心室扩大； 窦性心律； 心脏运动不同步（QRS时限≥120ms） I类适应证，证据级别B级 I IIa 猝死高危患者合并运动不同步 心衰合并冠脉病变、心梗 心衰合并室性心律失常 需要ICD联合起搏的心衰患者 CRT治疗的年轻患者 CRTD适应证 中国专家共识 * The chance of a successful resuscitation declines by about 7–10% each minute. The actual relationship between defibrillation success and time is a non-linear one, with the best chance for success probably occurring in the first 3–4 minutes. * * * 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) * CHF-STAT: Singh SN, et al. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. N Engl J Med 1995; 333: 77-82. GESICA: Doval, HC. Lancet. 1994. SOLVD: Cooper H, et al. Dirueticsand Risk of Arrhythmic Death in Patients with Left Ventricularl Dysfunction. Circulation. 1999; 100: 1311-1315. V-HEFT I: Goldman S, Johnson G, Cohn JN, Cintron G, Smith R, Francis G. Mechanism of death in heart failure. The Vasodilator-Heart Failure Trials. The V-HeFT VA Cooperative Studies Group. Circulation. 1993 Jun;87(6 Suppl):VI24-31 MERIT-HF: Effect of metoprolol CR/XL in chronic heart failure: metoprolol CR/XL randomized intervention trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353: 2001-07. CIBIS II: The Cardiac Insufficiency Bisoprolol Study II (CIBIS II): a randomized trial. THE LANCET: 353: 9-13. CARVEDILOL-US: The Effect of Carvedilol on Mo