ICD导线植入部位的选择对除颤成功率的影响演示课件文.pptVIP

结论 除颤电极植入RV中位间隔与植入心尖部生存情况存在轻微的差异 ICD导线植入部位的选择对除颤成功率的影响 提纲 ICD 导线的传统植入部位： 对ICD 导线传统植入部位改变的思考 ICD 导线植入部位选择：目前的认识 ICD导线的传统植入部位 传统方案： 右室心尖部 Right Ventricular Apex, RVA 最佳的除颤阈值 最佳的导线稳定性 潜在的危害！！！ 除颤导线植入RVA的潜在危害 部分患者心室起搏依赖 持续右室心尖部起搏可能带来 左室重构[1] 房颤发生率增加[2,3] 死亡率增加[3] [1] Thambo, J.B., et al., Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation, 2004. 110(25): p. 3766-72 [2] Sweeney, M.O., et al., Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation, 2003. 107(23): p. 2932-7. [3] Wilkoff, B.L., et al., Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA, 2002. 288(24): p. 3115-23. RV Non-Apical vs. Apical Pacing 纳入14个随机对照临床试验，共754例患者 RV Non-Apical vs. Apical Pacing 非心尖部起搏组在随访终点的LVEF均高于心尖部起搏组 思考：改变传统的除颤导线植入部位 提出新的除颤导线的植入部位 避免长期RVA起搏损害左室结构及功能 右室流出道 Right Ventricular Outflow Tract, RVOT 中低位室间隔 Mid or low septum A. 后前位 B. 左前斜30度 RVNA 优于RVA 血流动力学 减轻左室重构 保护心功能 安全角度：RVNA优于RVA？ RVNA能否保证良好的除颤效果？ RV Non-Apical vs. Apical Pacing 2014年，Christof Kolb等, Safety of mid-septal electrode placement in implantable cardioverter defibrillator recipients — Results of the SPICE (Septal Positioning of ventricular ICD Electrodes) study, International Journal of Cardiology 2015年，Gerald C等，A comparison of right ventricular non-apical defibrillator lead position with traditional right ventricular apical position: a single centre experience 2016年，Amit G等， Apical vs. non-apical lead: is ICD lead position important for successful defibrillation?. J Cardiovasc Electrophysiol RV Non-Apical vs. Apical Defibrillator Lead除颤成功率对比的相关研究 Right ventricular outflow tract placement of defibrillation leads: five year experience2004年 纳入112例植入ICD的患者