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时间:2018-07-13
《心脏起搏治疗和预防心衰一crt的新适应证--黄德嘉》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、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LBBBBIOPACE2012PatientswithapreviouslyimplantedconventionalpacingdeviceandsevereleftventriculardysfunctionChronicrightventricularpacinginduces
2、LVdyssynchronywithdeleteriouseffectsonLVfunction.However,therearefewdataconcerningtheeffectsofdeviceupgradingfromonlyrightventriculartobiventricularpacing.Therefore,theconsensusisthatinpatientswithchronicrightventricularpacingwhoalsopresentanindicationforCRT(rightventricularpacedQ
3、RS,NYHAclassIII,LVEF≤35%,inoptimizedheartfailuretherapy)biventricularpacingisindicated.UpgradingtothispacingmodeshouldpartiallyrevertheartfailuresymptomsandLVdysfunction.过去植入常规心脏起搏器的病人,如果合并严重的左心功能不全,长期右室起搏可导致左心室失同步化而使左心功能恶化。现在的共识是:对需要长期右室起搏的病人,如果心功能Ⅲ级,EF≤35%,QRS波为右室起搏图形,为双心室起搏的适应证
4、。升级后可部分改善心衰症状和左室功能。Patientswithindicationforpermanentpacingforbradyarrhythmia,withheartfailuresymptomsandseverelycompromisedleftventricularfunction。Studiesspecificallyaddressingthisissuearelacking.Itisimportanttodistinguishwhatpartoftheclinicalpicturemaybesecondarytotheunderlyingb
5、radyarrhythmiaratherthanLVdysfunction.OnceseverereductionoffunctionalcapacityaswellasLVdysfunctionhavebeenconfirmed,thenitisreasonabletoconsiderbiventricularpacingfortheimprovementofsymptoms.Conversely,thedetrimentaleffectsofrightventricularpacingonsymptomsandLVfunctioninpatientsw
6、ithheartfailureofischaemicoriginhavebeendemonstrated.TheunderlyingrationaleofrecommendingbiventricularpacingshouldthereforeaimatavoidingchronicrightventricularpacinginheartfailurepatientswhoalreadyhaveLVdysfunction.对有永久起搏适应症,合并心衰症状或严重左室功能障碍的病人,首先应区分其症状是由于心动过缓所致或由于心功不全所致。如果能证实症状主要是
7、由于心功能不全所致,有理由相信双室起搏可以改善症状。……双心室起搏还可避免长期右心室起搏带来的危害。RecommendationsfortheuseofbiventricularpacinginheartfailurepatientswithaconcomitantindicationforpermanentpacingHeartfailurepatientswithNYHAclassesIII-Vsymptoms,lowLVEF≤35%,LVdilatationandaconcomitantindicationforpermanentpacing(fir
8、stimplantorupgradingofconventiona
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