我的課件華偉crt進(jìn)展2012

1、 Men (n = 237) Women (n = 230) 1 Framingham Heart Study (1948 1988) in Atlas of Heart Diseases. 2 American Heart Association. Heart Disease and Stroke Statistics2003 Update. 3.New England Journal of Medicine 2002 80% 男性男性 70% 女性會(huì)在女性會(huì)在8 年內(nèi)死亡年內(nèi)死亡2 有癥狀的進(jìn)展性心衰 患者一年的死亡率 可以高達(dá)45%3 導(dǎo)致心衰病理生理鏈的危險(xiǎn)因素導(dǎo)致心衰病理生理鏈的危險(xiǎn)

2、因素 Dzau and Braunwald. Am Heart Journal 1991 危險(xiǎn)因子危險(xiǎn)因子 (血脂血脂,血壓血壓,糖尿病等糖尿病等.) 粥樣硬化粥樣硬化 左室肥大左室肥大 冠心病冠心病 心肌缺血心肌缺血 冠狀動(dòng)脈栓塞冠狀動(dòng)脈栓塞 心肌梗死心肌梗死 心律失常心律失常 26Pt. II: 137143 LVEF/LVFS降低 LVEDD增加 ESV增加 左室重構(gòu) 左房直徑增加 引起二尖瓣反流 右室起搏右室起搏 房室結(jié)房室結(jié) 竇房結(jié)竇房結(jié) 右室心尖部起搏導(dǎo)致心臟失同步 右室起搏的風(fēng)險(xiǎn) 導(dǎo)致電學(xué)失同步 （三）輕度心衰患者再同步治療 REVERSE試驗(yàn) Lind C et al.J Am

3、 Coll Cardiol. 2008;52(23):1834-43. REVERSE 研究 Lind C et al.J Am Coll Cardiol. 2008;52(23):1834-43. Tang AS, Wells GA, Talajic M, et al.Cardiac-resynchronization therapy for mild-to-moderate heart failure. Engl J Med. 2010 Dec 16;363(25):2385-95 基線評(píng)估 隨機(jī) 1:1 雙盲 ICD Only (N = 904) CRT-D (N = 894) 平均隨訪

4、平均隨訪40個(gè)月個(gè)月 25% reduction with CRT Death or HF Hospitalization: 27% Risk Reduction with CRT-D P=0.001 0% 20% 40% 60% 80% 100% 0123456 Years of Follow-up Event-free Survival Death: 29% Risk Reduction with CRT-D P=0.006 0% 20% 40% 60% 80% 100% 0123456 Years of Follow-up Event-free Survival CRT-D ICD HR

5、 (95% CI): 0.73 (0.61, 0.88) CRT-D ICD HR (95% CI): 0.71 (0.56, 0.91) No. at Risk CRT-D ICD 708 730 640 638 488 465 315 299 181 146 70 57 15 6 No. at Risk CRT-D ICD 708 730 679 687 530 533 361 366 206 189 89 83 20 13 Tang AS, et al. N Engl J Med. 2010;363: 2385-95 Cardiac-Resynchronization Therapy f

6、or the Preventionof Heart-Failure Events（MADIT-CRT) （心臟再同步化治療預(yù)防心衰事件）（心臟再同步化治療預(yù)防心衰事件）2009，10 October 1, 2009 vol. 361 no. 14 N=1820 p0.001 ICD CRT-D 1.0 0.9 0.8 0.7 0.6 0.0 Heart Failure Free Survival Probability 01234 Years from Randomization Patients at risk CRT-D ICD-only Kaplan-Meier Estimate of

7、Heart Failure Free Survival Probability Curves diverge within the 2 first months CRT-D = CRT with defibrillator function; HF = heart failure; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association; SR sinus rhythm. HFSA CRT Guideline Update Indications for Cardiac Resynchroniza

8、tion Therapy: 2011 Update From the Heart Failure Society of America (HFSA) Guideline Committee Journal of Cardiac Failure Vol. 18 No. 2 ,2012 HFSA CRT Guideline Update 32# Sudden death Sudden death Sudden death Class II=103Class III=232Class IV=27 Data from MERIT trial 心室顫動(dòng)心室顫動(dòng) 電擊電擊 規(guī)則心律規(guī)則心律 Implant

9、able Cardioverter Defibrillator (probability of survival) 0.78 0.690.69 (probability of survival) P=0.007 Kaplan-Meier Survival by Treatment Group SCD-HeFT 2003年美國(guó)年美國(guó)ICD植入量超過(guò)植入量超過(guò)12萬(wàn)臺(tái)萬(wàn)臺(tái) 2005年植入量達(dá)到年植入量達(dá)到18萬(wàn)臺(tái)萬(wàn)臺(tái) 2007年心臟植入性電子設(shè)備應(yīng)用情況年心臟植入性電子設(shè)備應(yīng)用情況 Heart Rhythm, June 2008 CRT年植入量（2010/2011） CRT-D所占比例(2010/

10、2011) 1 Assumes a 0.4 ms pulse width, DDD mode, 100% biventricular pacing and 50% atrial pacing at 60 min-1 with the remainder at 70 min-1 atrial tracking (amplitudes of 2.5 V for the A/RV and 3.0 V for the LV, at 700 ohms), and semiannual full-energy charges. 2 Assumes fully-formed capacitors, Charge to full output, first time is BOL, second time is ERI 主要特性 心衰惡化肺部充血 胸腔內(nèi)阻抗 下降 阻抗下降阻抗下降 肺部水腫肺部水腫 一旦液體在肺內(nèi)積聚，胸腔內(nèi)阻抗下降一旦液體在肺內(nèi)積聚，胸腔內(nèi)阻抗下降 4.7 Fr Isodiametric Lead Body 4Fr Steroid Eluting Lead Tip Optim Isolation Lenght 75cm, 86cm und 92cm New