心脏起搏治疗和预防心衰一crt的新适应证_黄德嘉-课件演示文稿.pptVIP

心脏起搏治疗和预防心衰 一CRT的新适应证 黄德嘉 四川大学华西医院心内科 CRT11年：治疗目标的发展 治疗严重心衰，Ⅲ-Ⅳ级心功 从Mustic到Care-HF 预防心衰进展：Ⅰ-Ⅱ级心功 MADIT-CRT,REVERSE 预防心衰发生：无心衰症状，无左室功能障碍，但有常规起搏适应症或合并LBBB BIOPACE 2012 Patients with a previously implanted conventional pacing device and severe left ventricular dysfunction Chronic right ventricular pacing induces LV dyssyn chrony with deleterious effects on LV function. However, there are few data concerning the effects of device upgrading from only right ventricular to biventricular pacing.Therefore, the consensus is that in patients with chronic right ventricular pacing who also present an indication for CRT(right ventricular paced QRS,NYHA classIII,LVEF ≤35%,in optimized heart failure therapy) biventricular pacing is indicated.Upgrading to this pacing mode should partially revert heart failure symptoms and LV dysfunction. 过去植入常规心脏起搏器的病人，如果合并 严重的左心功能不全，长期右室起搏可导致 左心室失同步化而使左心功能恶化。 现在的共识是：对需要长期右室起搏的病 人，如果心功能Ⅲ级，EF≤35%，QRS波为 右室起搏图形，为双心室起搏的适应证。升 级后可部分改善心衰症状和左室功能。 Patients with indication for permanent pacing for bradyarrhythmia, with heart failure symptoms and severely compromised left ventricular function。 Studies specifically addressing this issue are lacking. It is important to distinguish what part of the clinical picture maybe secondary to the underlying bradyarrhythmia rather than LV dysfunction. Once severe reduction of functional capacity as well as LV dysfunction have been confirmed, then it is reasonable to consider biventricular pacing for the improvement of symptoms. Conversely, the detrimental effects of right ventricular pacing on symptoms and LV function in patients with heart failure of ischaemic origin have been demonstrated. The underlying rationale of recommending biventricular pacing should therefore aim at avoiding chronic right ventricular pacing in heart failure patients who already have LV dysfunction. 对有永久起搏适应症，合并心衰症状或严重左室功能障碍的病人，首先应区分其症状是由于心动过缓所致或由于心功不全所致。如果能证实症状主要是由于心功能不全所致，有