室性心律失常：成功与失败PPT课件.ppt

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1、VentricularArrhythmias:AGeneralCardiologist’sAssessmentofTherapiesin2004C.RichardContiM.D.MACCEvaluationofPVCsStartwiththeHistoryandphysicalexamination.Documentationofthearrhythmiaiscritical.ECG.Holtermonitor.Eventmonitor.Revealmonitor.ManagementManagementofPVCsdiffersinpatientswithandwith

2、outstructuralheartdisease.Todefinestructuralheartdisease,consider:Echocardiography.ETT.Leftheartcatheterization.PVCsintheAbsenceofStructuralHeartDiseaseIntheabsenceofstructuralheartdisease,ventricularectopyisgenerallybenign,carryingnoprognosticsignificance.Treatmentwithantiarrhythmictherap

3、yisnotindicatedunlessthepatientisunacceptablysymptomatic.PVCsintheAbsenceofStructuralHeartDiseaseTreatmentReassurance.Avoidanceofstimulants.Caffeine.Cigarettes.Betablockers.Antiarrhythmicdrugsasalastresort.PVCsintheAbsenceofStructuralHeartDiseaseIfantiarrhythmicdrugsarenecessary:Class1C:Fl

4、ecainide.Propafenone.Mexilitene.Amiodaroneisrarely,ifever,indicated.ManagementofVentricularEctopyinthePresenceofStructuralHeartDiseaseAVIDAntiarrhythmicsVersusImplantableDefibrillatorsSponsoredby:–NationalInstitutesofHealthEntryCriteria:–VF–VTwithsyncope–VTwithoutsyncope,withEF<.40,andSB

5、P<80mmHg,chestpain,CHF,ornearsyncopeTreatment:–ICDvs.empiricamiodaroneorHolter/EP-guidedsotalolPrimaryendpoint:–TotalmortalityAVIDInvestigators.NEnglJMed.1997;337(22):1576-1583.SurvivalinAVIDPatientsAdaptedfrom:DomanskiMJ,etal.JAmCollCardiol1999;34:1090-1095.LVEF<0.20(Group1)LVEF0.20-0.34(

6、Group2)LVEF>0.34(Group3)1.0.9.8.7.6.4.3.2.1001224Survival.5DeviceDrug1.0.9.8.7.6.4.3.2.10.5CumulativeSurvival01224DeviceDrug1.0.9.8.7.6.4.3.2.10.5CumulativeSurvival01224DeviceDrugICDTherapyforSustainedVentricularArrhythmias:SecondaryPreventionConclusionsTheresultsofAVIDsupportusingtheICDas

7、front-linetherapytoprolongtotalandsuddendeathsurvivalinpatientsathighriskforsuddendeathe.g.PoorLVfunction.Thistrialincludedpatientswithbothischemicandnonischemicsubstrates.ICDTherapyPrimaryPreventionICMMADITMulticenterAutomaticDefibrillatorImplantationTrialHyp