心力衰竭的同步化治疗CRT CRT-D.ppt

* LVEF越低，心脏骤停发生率越高。 * 在多个临床研究中，心衰左室功能不全患者中的猝死率占总死亡率的50%左右！！！ References: CHF-STAT: Singh SN. N Engl J Med .1995;333:77-82. GESICA: Doval, HC. Lancet. 1994;344:493-498. SOLVD: Cooper H. Circulation. 1999;100:1311-1315. V-HEFT I: Goldman S. Circulation. 1993;87(6 Suppl):VI24-31 MERIT-HF Investigators. Lancet 1999;353:2001-2007. CIBIS II Investigators. Lancet:353:9-13. USCHFT. Packer M. N Engl J Med 1996; 334:1349-1355. * * * On June 23rd of 2009, the principle investigators of the MADIT-CRT trial reported a 29% reduction with a p-value of 0.003 in mortality or heart failure interventions when compared to traditional ICDs over the duration of the trial. It is important to note that since these results are only preliminary, we must wait until the final publication to be able to draw any firm conclusions about the results of the trial. * * * * * * * * * * * * * * * * Inject contrast in order to verify location, thereafter inflate the balloon. Do not use to much pressure. See to that the catheter tip is not blocked against the vein wall. Avoid inflating the balloon where it possible could damage the vein As an alternative, use a guide wire for identification of position. * * * * * * QuickSite 1056T Bipolar LV lead, 5F “S”shape curve fixation mechanism driven by stylet and / or Guidewire 放置左室电极导线 确定好靶静脉，通过STYLET或GUIDEWIRE导引左室电极到达合适位置。 * RAO LAO “S” shape curve 放置左室电极导线 植入右室、右房导线 按常规方法植入右房和右室导线，测试，固定。（右室和左室导线的位置尽量远） 如果是LBBB的患者，推荐置入导线顺序为RVRALV,以免出现房室传导阻滞 * Left Ventricular Lead Stabilized in the Proximal Part of a Cardiac Vein左心室电极稳定在心脏静脉的近端 植入左室导线（撤鞘管） 如都满意则下一步是撤鞘管，这是一种可撕开鞘管。 （把 鞘撕开1厘米左右，止血阀就会分离。） 退出止血阀：止血阀可通过下面任一种方法撤离： 固定止血阀推进导线 固定导线回撤止血阀 * 谢谢！ * * * * * * * * What to say: Dr. Tavazzi’s editorial is a good reference on the three potential causes of ventricular dysynchrony. Approximately 15% of all HF patients have an inter- or intraventricular conduction delay (QRS 120 msec).1,2 Over 30% of moderate to severe HF patients have a prolonged QR