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1、室性心律失常的危险分层与治疗策略RiskStratificationandManagementofVentricularArrhythmias兵团农一师医院刘山室性心律失常包括室性早搏室性心动过速单形性室速:持续性与非持续性多形性室速:持续性与非持续性心室扑动与颤动心脏猝死(SCD)的发病率全球:9,000,000/年;平均生还率小于1%西欧:300,000/年;平均生还率2-3%美国:250,000-350,000/年中国:心血管疾病致死1,500,000/年心脏猝死是美国主要致死病症一050,000100,00
2、0150,000200,000250,000300,000爱滋病IS乳腺癌肺癌中风心脏猝死Source:StatisticalAbstractoftheU.S.1998,Hoover’sBusinessPress,118thEditionPrimaryVF8%心脏猝死分类AdaptedfromBayésdeLunaA.AmHeartJ.1989;117:151-159.TorsadesdePointes13%Bradycardia17%VT62%心脏猝死危险因素发生过心脏猝死事件发生过室性心动过速(VT)心肌梗塞后
3、的患者(MI)冠状动脉疾病(CAD)心衰患者肥厚性心肌病(HCM)LQT和Brugada综合症MyerburgRJ.HeartDisease,ATextbookofCardiovascularMedicine,5thed,Vol1.Philadelphia:WBSaundersCo;1997:ch24.FogorosRN.PracticalCardiacDiagnosis:ElectrophysiologicTesting,2nded.BlackwellScience,pp172.TheAVIDInvestiga
4、tors.NEnglJMed.1997;337:1576-1583.MyerburgRJ.AnnInternMed..1993;119:1187-1197.DemirovicJ.ProgrCardiovascDis.1994;37:39-48.FriedlanderY.Circulation.1998;97:155-160.心脏猝死幸存者发生过心脏猝死事件是心脏猝死最危险因素一年内,30-50%的心脏猝死幸存者仍将发生心脏猝死事件心脏猝死患者与心梗和心脏骤停密切相关MyerburgRJ.HeartDisease,A
5、TextbookofCardiovascularMedicine,5thed,Vol1.Philadelphia:WBSaundersCo;1997:ch24.FogorosRN.PracticalCardiacDiagnosis:ElectrophysiologicTesting,2nded.BlackwellScience,pp172.TheAVIDInvestigators.NEnglJMed.1997;337:1576-1583.已发生VT事件的患者VT伴晕厥或低射血分数(LVEF<40%)增加心脏猝死的
6、危险性该类患者的心脏猝死的危险性是20-50%MyerburgRJ.HeartDisease,AtextbookofCardiovascularMedicine.5thed,Vol1.Philadelphia:WBSaundersCo;1997:ch24.DeVreede-SwagemakersJJ.JAmCollCardiol.1997;30:1500-1505.KannelWB.Circulation.1975;51:606-613.ShenWK.MayoClinProc.1991;66:950-962.Bi
7、ggerJT.Circulation.1984;69:250-258.RubermanW.Circulation.1981;64:297-305.BuxtonAE.NEnglJMed.1999;341:1882-1890.心肌梗塞后患者研究表明75%的心脏猝死患者确认为心肌梗塞后患者心肌梗塞后因素可提高其它单个危险因素的一年危险性5%心梗后、非持续性、可诱发、不可抑制VT、左室射血分数<40%的病人的五年危险性为32%FuttermanLG.AmJCritCare.1997;6:472-482.DemirovicJ
8、.ProgrCardiovascDis.1994;37:39-48.MossAJ.NEnglJMed.1996;335:1933-1940.FriedlanderY.Circulation.1998;97:155-160.冠心病患者尸检显示90%的心脏猝死者存在冠心病在突然死亡事件前,大于50%的心脏猝死者无明显冠心病表现MyerburgRJ.HeartDi