室性心律失常的临床处理原则.pptVIP

室性心律失常的临床处理 贵州省人民医院 杨 龙 内容 特发性室性早搏 特发性室性心动过速 获得性尖端扭转型室速 急性心肌梗死相关室速 慢性心力衰竭相关室速 一、特发性室性早搏 治疗与否？ 药物？消融？ （一）选择治疗的理由 症状。 心脏重构：导致心脏扩大、心功能减退。 In patients with frequent PVCs and no organic heart disease, who are at low risk of sudden cardiac death, a decrease in QOL(Quality Of Life) and severity of symptoms are the main indications for treatment with antiarrhythmic agents . 室早频率与心室重构 Two hundred and thirty-nine consecutive?patients?presenting with?frequent?PVCs (1000 beats/day)?originating?from the RVOT or?LVOT?without any detectable heart disease were enrolled in the study. During an observation period of 5.6 (1.7) years, there was a significant negative correlation between the PVC prevalence and Delta LVEF (p0.001) and positive correlation between the PVC prevalence and Delta LVDd (p0.001). 室早频率与心室重构 Studies have documented that highly frequent PVCs ( 20,000 beats/day) or baseline decreased LVEF exhibit a significant decrease in LVEF during long-term follow-up. （二）药物治疗 The use of metoprolol, propafenone and verapamil is recommended in patients with PVCs of RVOT origin. Beta-blockers have been tested in patients with idiopathic PVCs. Their efficacy was modest (25% for metoprolol) or not superior to a placebo (atenolol) . Patients were included in the study if they had: (1) symptomatic ( 4 weeks) monomorphic PVCs 2,500/24 h; or (2) persistent ( 3 months) monomorphic PVCs 2,500/24 h with similar PVCs ( 20% difference) on two repeated Holter monitorings, but severe symptoms clearly associated with PVCs. Stec S, et al.Kardiol Pol. 2012. Stec S, et al.Kardiol Pol. 2012. In the group of patients who underwent RFCA, long-term efficacy of 88% was achieved during long-term (48 ± 10 months) follow-up. 对频发症状性PVCs有效消融治疗能明显改善心功能多重参数、提高运动耐力、改善症状和生活质量。 Yokokawa M. et al. Heart Rhythm.2012 Oct 23 87 例左室功能不全患者(平均 EF 40%±10%)；消融使75例PVC 减少至消融前20% 以下。 平均随访5±6 月EF值恢复正常. 68%患者EF值 在4月内正常化。 二、特发性室速 （一）特发性右心室流出道室性心动过速（RVOT-VT） 运动诱发的室速、腺苷敏感性室速、反复单形室速、儿茶酚胺敏感性室速 RVOT-VT约占所有IVT的80％ 均对腺苷