起搏器在晕厥治疗中地位于波.pptVIP

SYNPACE(Vasovagal SYNcope and PACing) Raviele A, et al. Eur Heart J. 2004;25:1741-1748. Results: 50% with pacing ON had recurrence vs. 38% with pacing OFF(not statistically significant) 0.6 0.7 0.8 0.9 1.0 0 200 400 600 800 1000 Pacemaker OFF % Syncope-Free p=0.58 0.5 0.4 0.3 0.2 0.1 0.0 Pacemaker ON Days Since Randomization INVASY(INotropy Controlled Pacing in VAsovagal Syncope) 评估应用RV阻抗的闭环刺激(CLS)预防VVS复发 多中心、单盲、前瞻性研究 第一阶段：n=26 17例 CLS（DDD-CLS ） 9例 对照组（DDI，40次/分） 终点：晕厥复发 Occhetta E, et al. Europace. 2004;6:538-547. 第二阶段：n=50 17＋24例: CLS（DDD-CLS ） 原对照组9例设置为DDD-CLS模式。未再设对照 INVASY(INotropy Controlled Pacing in VAsovagal SYncope) 20 40 60 0 100 % Syncope-Free P 0.0001 Closed Loop Stimulation (CLS) Control (DDI only) Time Since Randomization 3m 6m 9m 1y 2y 3y Results: Patients with CLS had no syncope recurrence and improved quality of life Occhetta E, et al. Europace. 2004;6:538-547. * Syncope should be considered as a symptom not as a diagnosis. The basis of syncopal symptoms should be sought through careful evaluation. Only after a cause is established can an effective treatment regimen be developed. Impact of Syncope Syncope result in substantial cost to patients and to society. For example, syncope patients live with lifestyle altering restrictions that affect daily activities, mobility, and employment. In addition, syncope and falling in the elderly commonly cause injury, institutionalization and premature death. Falls directly or indirectly cause 12% of deaths in geriatric population. (Baraff 1997). ____________________ Linzer M, Pontinen M, Gold DT, et al. Impairment of physical and psychological function in recurrent syncope. J Clin Epidemiol. 1991;44:1037-1043. Linzer M, Gold DT, Pontinen M, et al. Recurrent syncope as a chronic disease: Preliminary validation of a disease-specific measure of functional impairment. J Gen Int Med. 1994;9:181-186. * This slide provides a simple classification of the principal cause