ICD治疗的临床适应症与预防知识PPT课件.ppt

III类适应证 充分的证据和/或公认，治疗是无效和无用的，某些情况甚至是有害的 . III类适应证 原因不明的晕厥，没有可诱发的室性快速心律失常。（依据等级：C） 无休止的室速或室颤。（依据等级：C） 室速或室颤，其起源处可被外科手术或导管消融所消除，例如伴随预激综合征的房性心律失常、右心室流出道室速、特发性左心室室速或分支性室速。（依据等级：C） 由于一过性或可逆性病征（如急性心肌梗死、电解质紊乱、药物、创伤）所致的室性快速心律失常。（依据等级：B） . III类适应证 明显的精神性疾患，可能被器械植入术所加重或是不能进行系统的随访。（依据等级：C） 预期生存期≤6个月的终末期疾病。（依据等级：C） 有左心室功能不良和QRS时限延长而无自发的和可诱发的持续或非持续性室速的、准备进行紧急冠状动脉搭桥手术的冠心病患者。（依据等级：B） NYHA分级IV级的、非等候心脏移植术的药物难治性充血性心力衰竭者。（依据等级：C） 新千年内，ICD治疗的主要目的 ICD治疗的临床适应症与预防 谢 谢 ! ! * * * * Patients- 300 patients intended but only 196 enrolled---95 ICD, 101 AAD Results- In patients with prior MI who are at high risk (nonsustained VT, prior Q wave MI, EF 35%, inducible sustained VT not suppressed by antiarrhythmic drug at EP study) for VT, prophylactic therapy with an implanted defibrillator leads to improved survival as compared with conventional medical therapy. ICDs reduced cardiac mortality by 57% over AAD therapy 60% of the ICD patients had a shock discharge within 2 years of enrollment Subanalyses from the MADIT database 2-year mortality of 8% in MADIT non-inducible patients 20% in MADIT inducible and suppressible patients 25% in inducible non-suppressible patients, who refused randomization into the study Trial terminated in 1996 with an average follow-up time of 27 months. Concerns- large number of conventional patients not taking antiarrhythmic drugs at the time of death (23% not taking AADs) large number of ICD patients taking concomitant antiarrhythmics (44% of ICD group were taking an antiarrhythmic including beta blockers) lack of a control group References- New England Journal of Medicine 1996;335:1933-40. Journal of Cardiac Electrophysiology Review 1998; 2:6-7; 9:880. * 196 patients (95 ICDs, 101 AADs) * Objective: Primary- determine if EP study-guided antiarrhythmic and/or ICD therapy will reduce the risk of arrhythmic death or cardiac arrest in patients with unsustained VT and left ventricular dysfunction. Secondary- determine if an antiarrhythm