室性心律失常导管消融适应.pptVIP

室性心律失常导管消融适应证变迁;室性心律失常管理原则;室性心律失常治疗策略;药物治疗;循证医学对AAD的评判要求;1910s; ;;;恶化心功能； 不减少或增加死亡率;1 Moss AJ. N Engl J Med. 1996;335:1933-40. 2 Buxton AE. N Engl J Med. 1999;341:1882-90. 3 Moss AJ. N Engl J Med. 2002;346:877-83 4 Moss AJ. Presented before ACC 51st Annual Scientific Sessions, Late Breaking Clinical Trials, March 19, 2002. 5 The AVID Investigators. N Engl J Med. 1997;337:1576-83. 6 Kuck K. Circ. 2000;102:748-54. 7 Connolly S. Circ. 2000:101:1297-1302.;ICD植入弊端;导管消融;VAs消融适应证;VAs消融适应证;VAs消融适应证;器质性心脏病患者VAs消融适应证;器质性心脏病患者VAs消融适应证;器质性心脏病患者VAs消融适应证;无器质性心脏病患者VAs消融适应证;对于多种症状性、特发性PVCs/VT，SCD低危者，已作为一线治疗手段 对于器质性心脏病合并室性心律失常， SCD高危者，推荐消融为ICD植入的辅助手段以减少ICD放电，或考虑消融作为AADs替代 对于特发性VF及遗传性室性心律失常，推荐消融作为ICD植入的辅助手段;有效性和安全性 能否提高生活质量 能否降低死亡率 是否优于其它方法;消融特发性室早/室速具有较高成功率;缺血性心脏病VT消融;SMASH-VT研究;Reddy VY, et al. N Engl J Med. 2007;357(26):2657-65.;Reddy VY, et al. N Engl J Med. 2007;357(26):2657-65.;VTACH研究;预防性消融降低VT/VF发生率， 延长VT/VF复发时间(18.6月 vs 5.9月);仅LVEF30%患者从VT消融中获益; We believe there is evidence to support the early use of catheter ablation of VT (i.e., primary VT ablation) to decrease arrhythmia recurrence and ICD intervention in patients with coronary artery disease and malignant VAs,especially if novel and extended ablation techniques are utilized. Unfortunately, although the NNT is low, “we are not there yet” and ICD implantation cannot be deferred in these patients but potentially questioned. Available data do not allow conclusion on the impact of primary VT ablation on mortality and further studies are warranted.;非缺血性心脏病VT消融;消融时机;非器质性心脏病VF消融; 6个电生理中心，38例PVC触发VF患者 5年随访结果无复发82% 5例复发患者再次消融，其中4例PVC起源于新部位 再次消融的5例患者，随访28月无VF发生;Brugada综合征 —— RVOT前壁心外膜消融;器质性心脏病VF消融;展 望;Thank You;hy)Q$CAFf9R*wPT6)mGvPv+h!X#Dj#OT6igN)IL2HNXkprM0-y342ePh-b)Vw1bYUx+SgBnP-fadKwtg06t9TpdlUvRjil*9Qj7T%m9Yr2NjRiRlJXDq$Twjt(006DEyw6f+nK%TL6#VGXklDx6aR#cJB6MXxJb$t3y(JzYGzYBoGUY%C7leyCzh2xAu9Lfo!+Mt*R*2RIGcm$cj(5hJrECu-RG40bcuSwRbJwJgYYNfEHpsXUI+OrJfK(G#iQ6AmiRfjfxcOo%!3wud96)fxu%QxISSIcW((cHC1Y$0