室颤和心脏除颤(英文）.ppt

* * * * * * * * * * * * * * * * Ventricular Fibrillation and Defibrillation Jian Huang, MD, PhD University of Alabama at Birmingham Wiggers VI stage VF Wiggers CJ, Am Heart J 5:351, 1930 Undulatory Stage Convulsive Stage Tremulous Stage Atonic Stage 1-2’’ 10-20’’ 2-4’ 2-5’ Epicardial Activation during VF Huang J. et al. Am J Physiol 2004; 286:H1193 Jian Huang et al. Am J Physiol 2004; 286:H1193 Jian Huang et al. Am J Physiol 2004; 286:H1193 Jian Huang et al. Am J Physiol 2004; 286:H1193 J. Huang et al. Am J Physiol 2004; 286:H1193 J. Huang et al. Am J Physiol 2004; 286:H1193 Type I and Type II VF Type I VF APDR cause instabilities (steep APDR) Normal exitability Multiple wavelets Type II VF Flat APDR Low exitability Broad conduction velocity (CV) restitution promotes instabilites Spatiotemporal periodicity with intermittent wavebreaks 3-Phase Time-Sensitive Model The electrical phase (0-4 min) Defibrillation Class I recommendation from ILCOR 8%-10% decreased survival rate ICD vs Amiodarone trials The circulaotry phase (4-10 min) Immediately shock 30% successful defibrillation, 0% return of spontaneous circulation. 1 min CPR + epinephrine before shock 70% successful defibrillation and 40% return spontaneous circulation. CPR – partial restoration of substrates including O2 or washout of deleterious metablic factors The metabolic phase (after 10 min) The effectiveness of both immediate shock or CPR followed by shock are poor. It is unknown whether irreversible injury occurs or whether therapeutic approaches fail to correct important factor EPI Endo P1 (4, 5) P1 (3, 4) Successful Defibrillation Shock Enough strength of energy Not too low Not too high Optimal waveform Optimal lead configuration Extinguish most of VF activation front Without creating an environment that promotes susceptibility to reinitiation of fibrillation Mono