临床医学心衰器械治疗选择CRT-P还是CRT-D.ppt

By examining the Kaplan-Meier survival curves, we note that the ICD benefit began after approximately one year. Importantly, as demonstrated by the widening of the curves over time, the ICD benefit appears to increase over time. In an important recent analysis, Dr. Moss announced that there was a 40% cumulative probability of appropriate ICD therapy (ATP or shock) for VT or VF during the 4-year follow-up after ICD implantation. This finding clearly shows the improving cost-effectiveness of ICD therapy with longer follow-up periods.[i]  [i] Moss, Arthur. MADIT I and MADIT II. Journal of Cardiovascular Electrophysiology. Vol. 14, No. 9, September 2003 * Buxton AE. N Engl J Med. 1999;341:1882-90. Time after Enrollment (Years) 0 0.1 0.2 0.3 0.4 0.5 0.6 心律失常死亡和心脏骤停发生率 1 2 3 4 5 0 p 0.001 EP-指导的抗心律失常药物治疗 没有抗心律失常药物治疗 EP-指导的ICD治疗 MUSTT 研究MI, EF0.40, NSVT或EP诱发VT 与EP指导AAD治疗组和无AAD治疗组相比 ICD能够明显降低总死亡率55%，心律失常死亡率73% MADIT-II 的结果 除颤器组14.2% 传统组19.8% P = 0.007 0.9 0.8 0.7 0.6 0.0 生存率 0 1 2 3 4 Year No. At Risk 除颤器组 742 502 (0.91) 274 (0.94) 110 (0.78) 9 传统组 490 329 (0.90) 170 (0.78) 65 (0.69) 3 Moss AJ. N Engl J Med. 2002;346:877-83. ICD与对照组相比，总死亡率减少30% 平均随访12个月 MI后至少1个月，LVEF≤0.3 Endpoints (median 45.5 months): All-cause mortality SCD-HeFT 2,521 patients with moderately symptomatic CHF (NYHA Class II or III) and LVEF ≤35% Randomized, double-blind, multicenter Conventional CHF Treatment + Placebo Conventional CHF Treatment + ICD Single lead implantable cardioverter defibrillator programmed for ventricular fibrillation (VF) treatment only Treatment Conventional CHF Treatment + Amiodarone Antiarrhythmic agent 800 mg Week 1, 400 mg Week 2-4 Chronic therapy: 200 mg/day if 150 lbs 300 mg/day if 150-200 lbs 400 mg/day if 200 lbs N ENG J MED 2005 0.4 0.3 0.2 0.1 0 Mortality 0 6 12 18 24 30 36 42 48 54 60 Months of follow-up Amiodarone ICD Therapy Placebo HR 97.5% Cl P-Value Amiodarone vs. Placebo 1.06 0.86, 1.30 0.529 ICD Therapy vs. Placebo 0.77 0.62, 0.96 0.007 SCD-HeFT 结