Marquis DR7274 室速鉴别诊断课件.pptx

Marquis DR7274 室速鉴别诊断患者信息男；心梗后三月，发生室速；植入美敦力Marquis DR 7274 双腔ICD术后10月，发生ICD治疗事件；入院观察；调出当时的记录心电图；事件描述：心房频率162bpm心室频率162bpm持续时间三次ATP治疗鉴别诊断方法房扑房颤鉴别窦速鉴别室上速鉴别上限频率：250bpm事件发生时心电图：模拟体表图心室腔内图第一次ATP治疗：治疗成功VP（心室起搏）体表图VT体表图Vs体表图:窦律第二次ATP治疗：治疗成功VPVSV T第三次ATP治疗：治疗成功为什么心房率，心室率一致？心室和心房间期140ms左右，应该是心室逆传的心房波；多个独立临床研究进行ICD功能比较电击原因和解决方案：SVT的鉴别Poster: Poole JE, et al. Analysis of ICD Shock Electrograms in the SCD-HeFT Trial. Heart Rhythm Society Conference. 2004.MADIT II. J Am Coll Cardiol. April 2008;51(14):1357-1365.Head-To-Head Comparison of Arrhythmia Discrimination Performance of Subcutaneous and Transvenous ICD Arrhythmia Detection Algorithms: The START StudyMICHAEL R. GOLD, MD, PhD; DOMINIC A. THEUNS, PhD; BRADLEY P. KNIGHT, MD; J. LACY STURDIVANT, MD; RICK SANGHERA, BSEE; KENNETH A. ELLENBOGEN, MD; MARK A. WOOD, MD; and MARTIN C. BURKE, DOGold MR, Theuns DA, Knight BP, et al. Medtronic analysis of Head-to-Head Comparison of Arrhythmia Discrimination Performance of Subcutaneous and Transvenous ICD Arrhythmia Detection Algorithms; The START Study. J Cardiovasc Electrophysiol. Published online October 28, 2011START Study Design and Methods22Patients Undergoing TV-ICD Implant; n = 64前瞻，多中心两个阶段建立记录诱发的房性和室性心动过速的测试库直接比较受试ICD系统对测试库中心律失常分类*两个研究者的团队对事件进行分类Induce ArrhythmiasAtrial n = 50Ventricular n = 46Create Electronic Arrhythmia LibraryCompare Classification S-ICD vs. 3 TV-ICD* Performance from simulated testing may not reflect actual clinical performance.TV-ICD = Transvenous ICD; S-ICD = Subcutaneous ICD START Study Transvenous ResultsSingle-Chamber ICDDual-Chamber ICDBSCSJMMDTBSCSJMMDTEpisodes (n)505050494949 Appropriate352146391644 Inappropriate1529410335 Specificity70.0%42.0%92.0%79.6%32.7%89.8%Prospective Comparison of Discrimination Algorithms to PreventInappropriate ICD Therapy: Primary Results of the Rhythm IDGoing Head to Head Trial (RIGHT)Michael R. Gold, Saleem Ahmad, Kevin Browne, Kellie Chase Berg, Lisa Thackeray, Ronald D. BergerFunding Sources: This trial is sponso