心脏起搏治疗和预防心衰一crt的新适应证--黄德嘉.ppt

BIOPACE实验的意义和启示 在植入普通起搏器人群中，通过双室起搏，纠正右室起搏导致的心室不同步及心脏重构可能改善长期依赖右室起搏病人的预后 在已有心衰或LVEF降低，有常规起搏适应症，或更换起搏器的病人，双室起搏可作为首选（Ⅱa） Upgrade from RV to BiVPacingRD-CHF Study: Design CazeauS, LeclercqC, LelloucheD, FossatiF, AnselmeF, SiotPH, MolloL, DaubertC Cardiostim2004 SCREENING CHF, PM at ERI LV dys-synchrony n = 56 SUCCESSFUL IMPLANT N = 44 NYHA III (37)/IV (7) LVEF 25 ±9% IV Delay 57 ±24ms LVPE Delay 202 ±38ms 23 DDDR (SR) 21 VVIR (AF) M0 RANDOMIZATION RV BiV M3 EVALUATION BiV RV M6 EVALUATION Upgrade at Battery Depletion, Randomized Crossover Trial Upgrade from RV to BiVPacingRD-CHF Study: Results CazeauS, LeclercqC, LelloucheD, FossatiF, AnselmeF, SiotPH, MolloL, DaubertC Cardiostim2004 将常规起搏器升级为CRT后减少房性心律失常 CRT前 CRT后 P 房性心律失常发作次数（次/年） 181±50 50±20.2 0.05 EF 26±5.3% 31±7% 0.001 ——Yannopoulos Detal . JACC 2007 ;50:1246 关于升级的建议 尽早考虑 慢性心衰，心功Ⅲ/Ⅳ级。 心室起搏依赖。 电池耗竭时考虑 心功Ⅱ级。 LVEF降低。 3. 一般情况尚可，预期存活期较长。 暂不考虑 长期右室起搏后，心功能良好，LVEF正常。 2 .DDD可经常转换为AAI工作模式。 3. 其他疾病导致预后差。 心脏起搏治疗和预防心衰 一CRT的新适应证 黄德嘉 四川大学华西医院心内科 CRT11年：治疗目标的发展 治疗严重心衰，Ⅲ-Ⅳ级心功 从Mustic到Care-HF 预防心衰进展：Ⅰ-Ⅱ级心功 MADIT-CRT,REVERSE 预防心衰发生：无心衰症状，无左室功能障碍，但有常规起搏适应症或合并LBBB BIOPACE 2012 Patients with a previously implanted conventional pacing device and severe left ventricular dysfunction Chronic right ventricular pacing induces LV dyssyn chrony with deleterious effects on LV function. However, there are few data concerning the effects of device upgrading from only right ventricular to biventricular pacing.Therefore, the consensus is that in patients with chronic right ventricular pacing who also present an indication for CRT(right ventricular paced QRS,NYHA classIII,LVEF ≤35%,in optimized heart failure therapy) biventricular pacing is indicated.Upgrading to this pacing mode shou