心肌梗死伴室速的处理策略和时机.pptVIP

谢 谢！ * 心肌梗死伴室速的处理策略和时机 CARISMA STUDY 心脏死亡率增加2倍 影响策略选择的因素 ICD PCI 心梗后的时间 LVEF 1.病变适宜于PCI且有自发或诱发缺血表现（IB） 2.病变适宜于PCI且有再发心梗表现（IC） 3病变适宜于PCI且有心源性休克或血流动力学不稳定（IB） 4.LVEF40%,心力衰竭，严重室性心律失常，常规PCI（ＩＩＡ－Ｃ） 48小时内 48小时-40天 40天以上 LVEF35-40% LVEF40% Post-MI NSVT the proximity of the NSVT to MI The first 48 hours Related to ischemia or reperfusion No prognostic significance 在心肌梗死后患者和透壁性心肌梗死急性期发生的心脏骤停幸存者中进行的研究表明， 梗死后24～48小时发生的致命性室速并不意味着随时间延长危险持续 Prevalence, characteristics and significance of ventricular tachycardia detected by 24-hour continuous electrocardiographic recordings in the late hospital phase of acute myocardial infarction.?Bigger JT Jr et al. Am J Cardiol. (1986) Incidence of and Outcomes Associated With Ventricular Tachycardia or Fibrillation in Patients Undergoing PrimaryPercutaneous Coronary Intervention 329/5745例STEMI 发生VT/Vf (5.7%) 早期VT/Vf 延迟VT/Vf 25例在PCI之前 117例在术后(3-63h) 180例在术中 90%在48小时之内，64%发生在PCI结束之前 另7例时间不详 JAMA. 2009;301(17):1779-1789 Incidence of and Outcomes Associated With Ventricular Tachycardia or Fibrillation in Patients Undergoing PrimaryPercutaneous Coronary Intervention 33.3% 17.2% 3.6% Factors related to lateVT/VF Conclusions In this study, occurrence of VT/VF before or after the end of cardiac catheterization in patients presenting for primary PCI was associated with increased 90-day mortality. JAMA. 2009;301(17):1779-1789 提示：1.PPCI后仍有部分患者会发生延迟TV/Vf，并伴有90天的死亡率增高。 2. 对那些5个以上危险因素、TIMI3、ST段回落70%的患者是否需要ICD一级预防？ STEMI Management--primary PCI Assessment of Left Ventricular Function --transthoracic echocardiogram 2 days after PPCI Electrophysiological Study--If sustained monomorphic VT with a cycle length (CL) 200 ms was induced by 4 extra stimuli, the EPS result was considered positive for inducible VT ICD Implantation Outcomes of Early Risk Stratification and Targeted Implantable Cardioverter-Defibrillator Implantation After ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention Zaman, S. et al. Circulatio