谁应在2009年获得转复除颤器心脏猝死的一级及二级预防（英文）课件.pptVIP

Who Should Receive a Defibrillator in 2009?Primary and Secondary Prevention of Sudden Cardiac Death  ;CP1270808-8;Pathophysiology and Epidemiology of Sudden Death from Cardiac Causes;Secondary prevention trialsall patients had aborted cardiac arrest or syncope;AVID Antiarrhythmics Versus Implantable Defibrillatorssecondary sudden death prevention trial;Antiarrhythmic-drug group;ICD Primary Prevention;MADIT II Multicenter Automatic Defibrillator Implantation Trial;MADIT II: Survival with ICD vs Conventional Therapy;Inclusion: recent MI (6-40 days) LVEF ? 35 % depressed HRV (SDNN ? 70 msec or 24 h mean RR ? 750 msec) Exclusion: CABG/PCI expected within 4 weeks after randomization N: 674 Therapy: Conventional vs. ICD Primary outcome: mortality from all causes;CP1242180-13;SCD-HeFT Amiodarone or an ICD for Congestive Heart Failure;No. at risk Placebo 847 797 724 505 304 89 Amiodarone 845 772 715 484 280 97 ICD therapy 829 778 733 501 304 103;Kaplan-Meier Estimates of Death from Any Cause; 10 ICD Primary Prevention Randomized Trials; total n mortality ------------------------------------------------------------------------ Non-ICD therapy 3,723 26.4% ICD therapy 3,530 18.5% Absolute mortality reduction 8% Relative mortality reduction 25% ;ICD efficacy in risk subgroups ;In ICD primary prevention of sudden death trials, patients with NYHA class IV were excluded.;Reprinted with permission from Elsevier Science (The Lancet, 1999;353:2001-2007). MERIT-HF study group. Effect of metoprolol CR/XL in chronic heart failure: metoprolol CR/XL randomized intervention trial in congestive heart failure (MERIT-HF). LANCET. 1999;353:2005. ;ICD indication….Class I;ICD indication….Class III;Causes of Death in HCM744 Patients – 125 Deaths;Hypertrophic Cardiomyopathy;A 30 yo male with a FH sudden death and LVH 27mm, received a ICD 4-month later…. ;Arrhythmogenic Right Ventricular Cardiomyopathy; ;Case #1;What would you do next?