CRT术后优化程控的认识与新理念_张萍.ppt

左房室间期 概念: LA-LV间期 形成 :是右房激动分别向左房、左室 两个方向传导及激动后形成。 左房先激动在前，左室激 动在后，先后形成左房 室间期 意义: 1.左房与左室之间无传导关系， 只是先后激动而形成 2.适当左室房间期是保证左房辅 助泵作用重要环节 P R P A(LA) 三、左房室间期正常值 左房收缩期： 心率75bpm，RR间期800ms时， 心房收缩期100ms，舒张期700ms 心室收缩期350ms，舒张期450ms 在心电图： 心室收缩期：QT间期 心房收缩期: PR间期（－60ms） 为保证左房的收缩，左房室间期需100ms 左房室间期 SAV 90ms SAV 100ms SAV 120ms SAV 150ms 50mm/s LA-LV110ms 左房室间期 LA-LV间期优化程控CRT的特点： 1.方便、快速、耗时短 2.真正反映左房到左室的激动传导 3.纠正部分CRT无反应或疗效不良 最佳AV与VV间期值在CRT植入后不同时间存在动态变化，意味每个CRT患者需要多次、反复测定AV与VV间期 3M 6M 9M 6W 2W 24h VV间期优化改善收缩功能 利尿+ACEI/ARB+?阻滞剂+洋地黄+CRT CRT术后药物治疗不可缺少 谢谢 * Let’s compare our heart to this donkey, and our body to the wagon that this donkey has to pull every day. A healthy heart is like an energetic donkey, which without fatigue, pulls the wagon full of weights. Conversely, a diseased heart will have difficulty meeting metabolic demands (or pulling the wagon). * * Truncated at short av delay need to lengthern EA ideal filling pattern early and late filling Fused not sufficient early filling mostly late * * * * Truncated at short av delay need to lengthern EA ideal filling pattern early and late filling Fused not sufficient early filling mostly late * * * * M-mode is obtained in Para Lax view with cursor perpendicular to base of LV This is an example of SPWD pre and post CRT, Pre demonstrates septal activation of septum 444 ms before posterior wall. Post crt demonstrates great improvement in synchrony with only a 40 msec. delay Pitzalis reported in patients with wide QRS and spwmd greater then 130 ms were positive responders to crt * * * CRT术后优化程控的认识与新理念 北京大学人民医院 张 萍 2007年ESC心脏起搏与CRT治疗指南 CRT治疗的I类适应证： 1.III－IV级心衰 2.已经合理药物治疗 3.EF35% 4.左室扩大（舒张末径55mm） 5.QRS≥120ms CRT术后药物治疗不可缺少 CRT随机对照试验累计病例数 EchoCRT MADIT-CRT PATH CHF MUSTIC SR MUSTIC AF MIRICLE CONTAK CD MIRICLE ICD COMPANION MIRICLE ICD II CARE HF RETHINQ PROSPECT REVERSE