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1、ARVC单形性室速：导管消融还是ICD?南京医科大学第一附属医院邹建刚5thVAS-CHINAARVC：并不罕见的心肌病ARVC诊断标准20101.心脏整体和/或局部运动障碍和结构改变2.室壁病理组织学特征3.复极障碍4.除极或传导异常5.心律失常6.家族史Circulation.2010;121:1533-1541ARVC室速ARVC室性心律失常主要条件持续性或非持续性左束支传导阻滞型室性心动过速,伴电轴向上(II、III、aVFQRS负向或不确定,aVL正向)次要条件持续性或非持续性右室流出
2、道型室性心动过速,LBBB型室性心动过速,伴电轴向下(II、III、aVFQRS正向或不确定,aVL负向),或电轴不明确Holter显示室性早搏24h>500个ARVC：ICD植入指证----ARVC-SCD的一级、二级预防ICDtherapyisindicatedinpatientswithstructuralheartdiseaseandspontaneoussustainedVT,whetherhemodynamicallystableorunstable.ICDimplantationi
3、sreasonableforthepreventionofSCDinpatientswitharrhythmogenicrightventriculardysplasia/cardiomyopathy(ARVD/C)whohave1ormoreriskfactorsforSCD.IIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbII
4、IIIIIIIBIIIaIIbIII(ClassⅠ，LevelofEvidence:B)(ClassⅡa，LevelofEvidence:C)IIaACC/AHA/HRS2008guidelinesfordevice-basedtherapyofcardiacrhythm2012年指南关于ARVC猝死二级预防未作调整指南关于ARVC猝死的一级预防SCD危险因素：有1个以上者植入ICD作为SCD的一级预防电生理检查诱发室性心动过速(VT)心电监护的非持续性VT男性严重右室扩大,广泛右室受累发病很早
5、(<5岁)累及左室心脏骤停史不能解释的晕厥ARVC-VT/SCD：ICD植入的循证证据BACKGROUND:Arrhythmogenicrightventricularcardiomyopathy/dysplasia (ARVC/D)isaconditionassociatedwiththeriskof suddendeath (SD).METHODSANDRESULTS:Weconductedamulticenterstudyoftheimpactofthe implantablecardio
6、verter-defibrillator (ICD)for prevention ofSDin132 patients (93malesand39females,age40+/-15years)withARVC/D.Implantindicationswereahistoryofcardiacarrestin13 patients (10%),sustained ventricular tachycardiain82(62%),syncopein21(16%),andotherin16(12%)
7、.Duringameanfollow-upof39+/-25months,64 patients(48%)hadappropriateICDinterventions,21(16%)hadinappropriateinterventions,and19(14%)hadICD-relatedcomplications.Fifty-three(83%)ofthe64 patients withappropriateinterventionsreceivedantiarrhythmicdrug the
8、rapy atthetimeoffirstICDdischarge.Programmed ventricularstimulationwasoflimitedvalueinidentifying patients atriskoftachyarrhythmiasduringthefollow-up(positivepredictivevalue49%,negativepredictivevalue54%).Four patients (3%)died,and32(24%)experienced
