器械术后的房颤治疗.pptVIP

* Sales / Marketing Message AT500 is not build because we had the technology anyway, it is build because there is a rationale! * * * 与VVIR相比，DDDR明显减少房颤危险性 (hazard ratio 0.79; 95% CI 0.66 to 0.94; p=0.008). * Sweeney, et al. retrospectively studied the cumulative percent of ventricular pacing and the associated relative risk for developing new onset AF. The best models demonstrated a linearly increasing risk of AF with Cum%VP in DDDR and VVIR modes up to approximately 80-85%. The magnitude of increased risk was approximately 1% for each 1% increase in Cum%VP, and was similar between pacing modes. Key take-away: The rates of AF increased in both the DDDR and VVIR pacing modes. The overall rate of AF was slightly higher in the VVIR group. In the DDDR group the risk of AF increased by 1% for each 1% increase in cumulative %VP (up to 85%). * * * ？？PREPARE Study:有待于研究 * Empiric 研究设计 前瞻,单盲,平行，非劣效性 1: 1随机入选 经验的固定的程控vs医生设定 1类及2类推荐ICD指征 2：1年随访 3：入选的机型为美敦力DR ICD 及电极 4：所有时间经过至少两名专家的评估 结论：医生不必要花很多时间去程控，可以减少误放电 * 入选病人大部分曾经心梗，心功能I-III之间 * FVT区设定一阵ATP治疗。两组都允许在随访时药物调整时改变参数 * * * * 持续性房颤的成功率。 * EMPIRIC 程控方案 PR Logic On: AF/Afl, Sinus Tach (1:1 VT-ST = 66%) SVT Limit = 200 bpm Zone Rate # beats Therapies VF 250 bpm 18 of 24 30J x 6 FVT 201 - 250 Burst(1), 30J x 6 VT ? 150 - 200 16 Burst(2), Ramp(1), 20J, 30J x 3 医生个体程控组Physician Tailored Arm Programming 医生根据主观决定程控方案 两组均:允许在随访药物调整时改变参数 EMPIRIC 结论 通过对许多临床结果评估，VT/VF标准经验性ICD程控与患者个性化、医生设定的程控至少是一样有效的 简单，非个性化的程控是可行的，没有增加相关电击的发生率 ICD/CRT-D术后房颤应对 对于有房颤的ICD/CRT-D患者，在确保心房感知准确的前提下，Medtronic推荐将诊断参数根据EMPIRIC Trial结果进行设置。以达到保证ICD治疗效果，减少不必要放电的效果。 XUGENG 2009-12-12 房颤心衰互为影响 心衰 房颤 心房电生理的异常 心房结构改变 容量和压力负荷 房颤 心衰 AV失同步 心室率控制欠佳 心率变异 一般人群中房颤的发生率为0.4% 心血管病患者的房颤的发生率为4% 心衰患者中的房颤的发生率为10-50% Maisel WH,Stevenson LW Atrial fibrillation in heart failure:epidemiolody,pathopyhsiology and rationale for therapy. Am J Cardio.2003;91(6A):2D-8D XUGENG 2009-12-12 房颤心衰常常同时存在 心功能 房颤发生率 NYHA I 5% NYHA II~IV 40% NYHA II~III W