《crt相关知识》ppt课件.ppt

Let’s compare our heart to this donkey, and our body to the wagon that this donkey has to pull every day. A healthy heart is like an energetic donkey, which without fatigue, pulls the wagon full of weights. Conversely, a diseased heart will have difficulty meeting metabolic demands (or pulling the wagon). * * * * Cardiac Resynchronization is achieved through atrial based, biventricular pacing. Standard pacing leads are placed in the right atrium and right ventricle. A specially designed left ventricular pacing lead is passed through the coronary sinus and into a tributary of the Great Cardiac Vein. Atrial based pacing is performed through both ventricular leads simultaneously and can be programmed unipolar or bipolar if either ventricular lead is a bipolar lead. InSync was developed to provide true cathodal pacing to two ventricular leads simultaneously. InSync employs Medtronic’s longest lived battery with Medtronic’s lowest current-drain circuit technology. The expanded connector allows direct connection to one atrial and two ventricular leads without the need for adapters or splitters. * * 心力衰竭心脏再同步（CRT)治疗 杨月 （206） 时间：2016-08-20 地点：治疗二室 参加人员： CRT心脏再同步治疗(Cardiac Resynchronization Therapy) 又称为双心室起搏治疗(Biventricular Pacing)心力衰竭 限制患者日常生活能力… 好比减轻货车上的货物 限制毛驴速度, 从而节约能量 限制速度 最小 就像放在毛驴前面的萝卜，吸引毛驴快跑 Chronic Heart failure Drugs Devices 慢性心衰的治疗选择 Genes 探索中 没有新进展 CRT ICD LVAD Heart Transplantation 目前对心衰没有非常好的解决方案 心脏移植供体难求、手术复杂、术后排异、费用昂贵 LVAD（左室辅助系统）仍在探索研究中 CRT 有大量的循证医学支持(Insync,Insync ICD,Miracle) -改善血液动力学、运动能力 -改善生活质量、降低住院率 2002、2004 New England Journal of Medicine -降低死亡和住院联合终点 -极大方便优化药物治疗 -显著降低心脏移植 2003 J Heart Lung Transplant -降低因心衰进展导致的死亡率 2003 JAMA -降低所有原因的死亡率 2004 International Journal of Cardiology 2004 Annals of Internal Medicine NYHA III/IV QRS ?130 ms 左室舒张末期直径?55mm LVEF ?35% 药物治疗效果不佳，仍有症状 无论是缺血性心脏病（如冠心病等）或特发性扩张性心肌病、 AF 房颤病人均可。 ACC/