室性心律失常的危险分层及评价方法.ppt

室性心律失常的危险分层及评价方法浙江大学医学院附属第一医院陶谦民

背景对于个人和家庭而言，因恶性室性心律失常导致的心脏性猝死完全可以称之是一次“地震”！目前对于心脏性猝死的预测，虽然经过了四十多年的努力，仍然没有实质性的、确切有效的方法。我们只是通过检出高危人群，预防性应用ICD，尽力去避免不幸的发生。

其实，在我们的身边，经常在出现……

图动态心电图记录的心脏性猝死

非侵入性检查评估方法

MicrovoltT-wavealternanstestingforventriculararrhythmiariskstratificationT-wavealternanstestsprognostichorizonexceedstwoyearsinanalysisThefindingaddressesapersistingquestionaboutthetestusedtoscreencandidatesforprimary-preventionICDs:ifitsnegative,howsoonshoulditberepeated?(ChanPSetal.AmJCardiol2008;102:280-284.)Coulditbethateasy?Clinical-riskscoremayfurtherstratifylow-LVEFICDcandidatesAretrospectiveanalysisofnoneotherthantheMADIT-2trialidentifiedfivefamiliarmarkersthatcouldpotentiallybeusedtoscreenoutpost-MI,low-LVEFpatientsunlikelytoneedthedevices.(GoldenbergIetal.JAmCollCardiol2008:51:288-296.)Markersofautonomictoneadvanceinpost-MIriskassessmentsIntwostudies,long-termprognosticmeasuresincludedbaroreflexsensitivity,heart-ratevariability,andheart-rateturbulence.OnefoundthattheriskassessmentdidntpredictCVeventsunlessitwasperformedlaterthanusual,10to14weeksaftertheMI.(DeFerrariGMetal.ExnerDVetal.JAmCollCardiol2007;50:2285-2290,2275-2284.)TrialsmixedmessagechallengesTWAtestsimageforpredictingsudden-deathriskAmountainofdatasupportsarisk-stratificationroleformicrovoltTWAtestingincandidatesforprimary-preventionICDs,sohowcouldtheMASTER1trialsuggestthatitdoesntpredictlife-threateningventriculararrhythmiasinpost-MIpatientswithpoorLVfunction?(AmericanHeartAssociation2007ScientificSessions.)MASTERI:DisappointmentforT-wavealternanstestingThetestdidnotpredictlife-threateningventriculartachyarrhythmiceventsinpatientswithMADIT-2criteriaforICDimplantationandthereforeshouldnotbeusedtostratifyICDuseinthisgroup,research