房颤如何择器械治疗.ppt

78％患者CRT治疗有效 CRT改善慢性房颤患者心功能 Kiès et al.Heart 2006;92: 490-494 CRT逆转房颤患者LV/LA结构重塑 Kiès et al.Heart 2006;92: 490-494 CRT对持续性房颤维持窦律的作用 例数 CRT治疗6个月后7％患者电复律后保持窦性心律 Kiès et al.Heart 2006;92: 490-494 CRT-P/CRT-D术中是否对房颤患者需植入右心房导线？ 尚无相应的循证及指南； 对阵发房颤者，应予植入右心房导线； 对于持续房颤或慢性房颤者，应根据具体情况而定：如具CRT适应证、房颤病程不长、左房内径未严重扩大及总体状况尚可，估计有复律可能者，可考虑植入；否则无需植入。 3、房颤：ICD及相关注意事项 DFT测试中AF转复发生率？ Permanent AF was noted in 12% of our patients undergoing ICD implantation, and SR return following defibrillation to terminate VF during testing after ICD implantation was seen in 36% of patients who underwent this test. N=671 Kardiologia Polska. 2011; 69, 1: 17–22 DFT测试与AF转复预测因子 Kardiologia Polska. 2011; 69, 1: 17–22 1.双线圈除颤导线 2.心功能 3.左房尺寸 4.胺碘酮 DFT测试：存在AF转复的可能 注意事项： 对AF需植入ICD的患者是否需抗凝及能否耐受术前的一些检查； 术前抗凝治疗？（时间？INR？） 术前检查？（TEE？CT？） ICD放电的常见原因 MADIT II. J Am Coll Cardiol. April 2008;51(14):1357-1365. Poster: Poole JE, et al. Analysis of ICD Shock Electrograms in the SCD-HeFT Trial. Heart Rhythm Society Conference. 2004. SVT中房颤是重要的房性心律失常，是引起ICD不恰当放电的常见原因之一，对于基础心律为窦性或有阵发房颤者选择双腔或单导线VDD除颤器可能可减少不恰当放电的发生率。 双腔ICD：提高阵发房颤的诊断能力 单导线VDD除颤器：提高房性心律失常的鉴别诊断能力 小 结 1、对于房颤或阵发房颤患者：抗心动过缓起搏器治疗选择主要为适应证、起搏方式及术后房性心律失常的监测管理； 2、CRT和ICD：有房颤患者适应证的选择及相应的注意事项。 谢 谢！ * * BACKGROUND: Atrial fibrillation/flutter (AF) and heart failure often coexist; however, the effect of cardiac resynchronization therapy (CRT) on the incidence of AF and on the outcome of patients with new-onset AF remains undefined. METHODS AND RESULTS: In the CArdiac REsynchronisation in Heart Failure (CARE-HF) trial, 813 patients with moderate or severe heart failure were randomly assigned to pharmacological therapy alone or with the addition of CRT. * The incidence of AF was assessed by adverse event reporting and by ECGs during follow-up, and the impact of new-onset AF on the outcome and efficacy of CRT was evaluated. By the end of the study (mean duration of follow-up 29.4 months), AF had been documented in 66 patients in the CRT group compared with 58 who