室性心律失常的处理与心源性猝死的预防(中英文）PPT.ppt

35 20 22 The majority of underlying arrhythmias of sudden cardiac arrest are ventricular tachyarrhythmias. The data from this study were collected were based on Holter recordings at the time of cardiac arrest. This graphic illustrates the cause of automaticity: abnormal acceleration of phase 4 of the action potential in a cardiac cell. This reduces the time of repolarization, and allows the cell to depolarize again. Automaticity enables some cardiac cells (ectopic cells) to act as backup pacemakers when the SA node malfunctions. Ectopic sites may generate impulses in addition to the impulses generated by the SA node, or the ectopic sites may generate impulses out of sync with the normal heart rhythm. Enhanced automaticity occurs when the SA node or ectopic sites generate electrical impulses too quickly, which may affect heart rhythm or rate. Ectopic sites may be located in the atria, AV node, or in the ventricles and can produce tachycardias reflective of the site of origination. Figure A illustrates the early afterdepolarizations in phase 3 of the action potential, responsible for pause-dependent triggered activity. Figure B illustrates late afterdepolarizations seen in late phase 3 or phase 4 of the action potential, responsible for catechol-dependent triggered activity. COMPANION：病死率或HF入院率（联合终点事件的％） CRT-D降低病死率 二级预防 国内31家医院选择1073例心脏猝死高危患者 144例植入ICD 929例未植入ICD 随访10.4个月 ICD死亡3例,非心源性死亡 非ICD死亡82例,是ICD组的4.2倍 健康报2007年2月 临床试验表明 ? I类AAD不能用于室性心律失常的远期防治 ? II类β受体阻滞剂，可用于远期防治猝死 ? III类胺碘酮可降低心律失常死亡，对总死亡影响不大，只用于二级预防。 ? 猝死防治中首选ICD，不能植入者应用胺碘酮,或ICD植入后持续性室速仍频发者，应用胺碘酮减少放电次数。 ?心功能差者，CRT + ICD 得益更大。 消融 (Ablation) ? SCD低风险 ? ? 束支折返性室速----消融右束支，成功率高，预后差 不主张 消融无症状、非频发室性早搏 持续性单形室速 非持续性单形室速（有症状） 频发室性早搏（有症状） 技术成熟 预激综合症房颤 室颤（心脏骤停幸存者） ? 消融浦肯野氏纤维电位--室性心律失常 风暴由形态相似的室性早搏诱发 ? 作为ICD 的辅助治疗—可以减少70%VT发作 消融 (Ablation) 近年尝试 Della Bella P and Riva S .Hybrid Therapies for Ventricular Arrhythmias