北大人民医院心脏起搏器基础与临床研讨班课件 03Pacemaker .ppt

Indications for Device Therapy 起搏器治疗适应证 Causes of Conduction Defects Coronary Artery Disease Idiopathic Degeneration Calcification Endocarditis Heart Surgery RF Ablation 传导缺陷的病因 冠状动脉疾病 特发性退化 钙化 心内膜炎 心脏手术 射频消融 Symptoms May be varied and can include: Irritability Fatigue Forgetfulness Palpitations Chest Pain Dyspnea 症状 可能有所不同，但可以包括: 易怒 易疲劳 健忘 心悸 胸痛 呼吸困难 Documented Events 24-hour Holter Moniter Tilt Table Test EP Testing Temporary Pacing 记录的事件 24h Holter监测 倾斜试验 EP测试 临时起搏 Diagnosing Indications Noninvasive History ECG Ambulatory Monitoring Stress Test Carotid Massage 诊断 非侵入性 病史 心电图 动态心电图（Holter） 负荷试验 颈动脉按摩 Diagnosing Indications Invasive Catheterization Lab EP Lab 诊断 侵入性 心导管检查 EP检查 ACC/AHA/HRS 起搏适应证指南 美国心脏病学会 （American College of Cardiology – ACC) 美国心脏协会 （American Heart Assioation – AHA) 美国心律协会 （Heart Rhythm Society – HRS) ACC/AHA Guidelinesfor Pacemaker and ICD Implant Class I: conditions for which there is good evidence and/or general agreement that the therapy is appropriate Class II: conflicting evidence or divergence of opinion IIa: favor of usefulness/efficacy IIb: less well established Class III: evidence and/ or general agreement that the therapy is not useful or effective ACC/AHA/HRS指南 – 起搏器和ICD植入 ACC/AHA Guidelinesfor Pacemaker and ICD Implant Level of Evidence (Cardiology) data derived from multicenter randomizedtrials data from limited or non-randomized studiesor observational studies expert consensus but no formal studies ACC/AHA/HRS指南 – 起搏器和ICD植入 Sinus Node Dysfunction Class I Symptomatic bradycardia, even drug induced if medication cannot be discontinued (Level of evidence: C) Symptomatic chronotropic incompetence (Level of evidence: C) 窦房结功能障碍 I类 有症状的心动过缓，包括必需药物治疗所导致的 (C) 有症状的变时性功能不全 (C) Sinus Node Dysfunction Class II a SND occurring spontaneously or as a consequence of Rx with heart rates below 40 with a clear association with symptoms (Level of evidence: C) Syncope of unexplained origin when SND is discovered o