cop[医药]04沈法荣-ICD植入术后管理-如何减少电击-20110305南京.ppt

ATP During Charging?3 If ATP During Charging therapy is successful, no shock is delivered. ATP During Charging is a feature in EnTrust? and Virtuoso? ICDs and Concerto? CRT-D. EnTrust 临床研究结果 * 222位患者 用ATP During Charge治疗71个VF区的自发事件- ATP成功终止53个事件 ATP治疗有效率70% ** 自动转换到ATP BC 减少充电36次 在ATP During Charging 治疗组合事件中没有晕厥或头昏报道 识别到第一次放电的平均时间4.9 *EnTrust Clinical Study Results presented at HRS (May 2005) by J?rg O. Schwab. ** 95% posterior credible interval = (57.74%, 80.50%) ATP Before/During Charging-临床研究 3 x Burst 3 x Ramp 治疗顺序 事件 1 事件 2 事件 3 事件 4 2 x Shock 减少无效ATP治疗的延误时间 ATP 优化 小 结 ICD术后如何减少不适当电击？ 减少误放电：（干扰、窦速/SVT/AF、NSVT）； 减少不必要的电击：ATP、ATP During Charging…… * * * * * Only Medtronic ICDs capable of programming an FVT detection zone defined within the ventricular fibrillation (VF) zone (FVT via VF) for a cycle length of 240 to 320 ms (250 to 188 bpm) were used. Primary prevention indication for ICD therapy was defined as (1) coronary artery disease (CAD), nonsustained VT, ejection fraction (EF) 40%, and inducible sustained VT/VF4,5; (2) CAD, prior myocardial infarction, and EF 30%12; or (3) other (CAD, nonsustained VT, EF 40%, and inducible VT/VF). Secondary prevention indication was defined as (1) VF or cardiac arrest without transient or reversible cause,1–3 (2) spontaneous sustained VT with structural heart disease,1,3 or (3) spontaneous syncopal VT or syncope of unknown etiology and inducible sustained VT/VF.3 Of 634 patients randomized, 248 had a primary prevention indication, 334 had a secondary prevention indication, and 52 had a nonstandard indication for ICD therapy. Therefore, 582 patients were the subjects of the present analysis. * 4-7%加速比例与在传统VT检测区中VT的ATP研究相同 2% 晕厥比例与其他ICD的研究相同 * PAINFREE Rx and PainFREE Rx II STUDY DETAILS _______________________________________________________________ PainFREE Rx Study Overview: Much of what we detect as “VF” is really pace-terminable fast VT. Objective of the study was to determine whether spontaneous FV