起搏器培训课件：Clinical Evidence AdaptivCRT 临床基础.pptxVIP

AdaptivCRTTM Clinical EvidenceAdaptivCRT 临床基础 ;生理性起搏的发展历程;为什么要 AdaptivCRTTM?;;同步单LV起搏;动态BiV起搏;左室同步起搏;LV vs. BiV: CRT 早期研究;CRT同步治疗的自身传导意义;Kurzidim et al., PACE 2005; 28: 754-761. ;Vollman D, et al. Circulation. 2006;113:953-959.;;优化AV间期——LV起搏;LV Only;;;;优化AV间期——BiV起搏;优化的SAV = 120?30 ms (80 - 230 ms);;根据P波宽度调整AV间期优化CRT;BiV SAV = 170 ms;LV Only;Determining Optimal VV Delays;能否产生融合? 基于自身传导和起搏AV设置决定;; VV间期优化很少在临床研究中应用。而一些随机研究结果也出现了不一致的结果。所以2012年的EHRA/HRS专家共识也不再推荐进行VV间期优化1，2 AV间期优化对血流动力学的影响比VV间期优化更加显著.3;Intrinsic AV conduction present? Any HR?;AdaptivCRTTM: Dynamic Adaptation;AdaptivCRT功能的临床依据;Brief Statement Viva? XT CRT-D Model DTBA1D4, Viva XT CRT-D Model DTBA1D1 Indications for Use: The Viva XT CRT-D system is indicated for ventricular antitachycardia pacing and ventricular defibrillation for automated treatment of life threatening ventricular arrhythmias and for providing cardiac resynchronization therapy in heart failure patients who remain symptomatic despite optimal medical therapy and meet any of the following classifications: New York Heart Association (NYHA) Functional Class III or IV and who have a left ventricular ejection fraction ≤ 35% and a prolonged QRS duration. Left bundle branch block (LBBB) with a QRS duration ≥ 130 ms, left ventricular ejection fraction ≤ 30%, and NYHA Functional Class II. The system is also indicated for use in patients with atrial tachyarrhythmias, or those patients who are at significant risk for developing atrial tachyarrhythmias. Lead Integrity Alert The RV Lead Integrity Alert feature is intended primarily for patients who have a Medtronic ICD or CRT-D device and a Sprint Fidelis lead (Models 6949, 6948, 6931, and 6930). At the discretion of the clinician, the feature may be used with other RV leads manufactured by Medtronic. Contraindications: The Viva XT CRT-D system is contraindicated for patients experiencing tachyarrhythmias with transient or reversible causes including, but not limited to, the following: acute myoc