特发性室颤的诊治现状课件.ppt

There is a growing body of evidence that the Purkinje network plays a pivotal role in both the initiation and perpetuation of VF. 没有明确的疤痕区， * Clinical VPBs triggering VF arose from the right Purkinje system in 16 patients, the left Purkinje in 14 patients, in both the left and right Purkinje system in 3 patients, and in the myocardium in 5 patients (including the right ventricular outflow track in 4 patients) * Catheter ablation of triggering PVCs therefore does not currently appear to be a cure for VF or a substitute for an ICD, although it has a useful role to play in controlling electrical storm. * Practical considerations for ablation. A previous report suggested that the success of VF ablation improves when patients have clinical ectopy at the time of the procedure (9), yet the absence of frequent VPB at the time of ablation did not predict an unfavorable outcome in our study. Nevertheless, when clinical VPBs are infrequent or absent at the time of the procedure, localizing the Purkinje network remains of primary importance for procedural success. Notably, ipsilateral intraventricular conduction delay was the only independent predictor of success because once this occurs, it masks ipsilateral Purkinje potentials in sinus rhythm. The specificity of this index awaits further study. * 60% MUSTT5 5 years 54% MADIT4 2 years 20% CIDS3 3 years 37% CASH2 2 years 31% AVID1 3 years ICD与抗心律失常药物治疗在降低总死亡率方面的对照 0% 10% 20% 30% 40% 50% 60% % Mortality Reduction 1 The AVID Investigators. N Engl J Med. 1997;337:1576-1583. 2 Kuck, et al. Circulation. 2000; 102:748-754. 3 Connolly, et al. Circulation. 2000; 101:1247-1302. 4 Moss AJ. N Engl J Med. 1996;335:1933-1940. 5 Buxton AE. N Engl J Med. 1999;341:1882-1890. 6 Moss. Investor Conference Call. November 27, 2001. 30% MADIT II6 2 years ICD治疗 I C D是预防IVF猝死最有效方法 有学者认为是唯一的有效措施 指南推荐的I类指证 长期奎尼丁、RFCA治疗虽取得可喜疗效，仍只能做为辅助性治疗 新型：皮下植入型ICD 完全皮下植入的自动复律除颤器 新型：皮下植入型ICD 2013年《Circulation》公布了Weiss等针对S-ICD进行了一项前瞻性、多中心、非随机的研究，为期11个月，入组314例患者，