再同步治疗的挑战和思考幻灯.pptxVIP

再同步治疗的挑战和思考王东琦西安交通大学医学院第一附属医院Evidence For Heart Failure在美国，每年因心衰就诊3.4百万，死亡30万。一年再住院率50%，中重度心衰年死亡率近30%。≥65岁者患病率6~10%。QRS≥120ms患者全因死亡率增加约33%。……Evidence For CRTEF≤35%， QRS≥120ms ， 经理想药物治疗, NYHA III~IV : 提高心功能分级，改善生活质量，增加活动耐量。降低死亡率和住院率。提高生存率。如何让更多患者受益？IMPROVE HF To examine patient and cardiology practice characteristics predictive of CRT use in eligible patients in an outpatient registry of systolic heart failure patients Fonarow GC, et al. Circ Heart Fail. 2008;1:98–106.IMPROVE HF Baseline Performance on CRTPercent of Indicated PatientsReceiving CRT (CRT-D/CRT-P) at Baseline39.39%Percent of Indicated Patients (%)All Practices (Baseline Review)Fonarow GC, et al. Circ Heart Fail. 2008;1:98–106. IMPROVE HF Registry Less than 40% of CRT-eligible patients received a device at baseline assessment? In 1/3 of IMPROVE HF outpatient practices, not a single eligible patient received a CRT deviceat baseline手术成功率在RCTS纳入的4000多例中，CRT（经CS植入LV电极技术）的成功率88％－92％：鞘管难以插入CS冠状静脉狭窄或闭锁难以进入靶血管分支或脱位膈肌刺激115°Amp CSAmp CS115°60°135°60°135°StraightAttain StarFix?First active fixation left-heart leadMore placement optionsVein sizesVein locationsSoft, polyurethane deployable lobes5 Fr lead body, 5.3 Fr electrode with tip sealPacing Vector ProgrammabilityFor CRT-D devices, the available LV pace polarities are:LV tip to LV ringLV tip to RV coilLV ring to RV coilFor CRT-P devices, the available LV pace polarities are:LV tip/RV ringUnipolar (LV tip/Can)Bipolar (LV tip/LV ring)LV环至RV线圈LV头端至RV线圈LV头端至LV环Non-responder, true or false ?40 consecutive CRT-D patients admitted to Cleveland Clinic HF ICUMet CRT indications at implantImplanted for at least 3 months (mean 19 months)Increased LVEDV from pre-implant baselineAveraged 1.2 HF hospitalizations87.5% with LV lead in lateral or postero-lateral positionBiventricular paced 96% of timeAcute, serial echo and invasive hemodynamic measurements in CRT ON and CRT OFF modesHidden benefit: when CRT turned off, hemodynamic, ECG echo parameters worsenedCardiac OutputPCW