资源描述:
《T波电交替——曹克将》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、T波电交替预警恶性室性心律失常的价值EvaluationofTWAinthePredictionofMalignantVentricularArrhythmias南京医科大学第一附属医院江苏心血管病临床医学中心曹克将LeadingCausesofDeathintheUSSCDisaleadingcauseofdeathintheU.S.,secondtoallcancerscombinedSuddenCardiacDeath(SCD)SepticemiaNephritisAlzheimer’sDiseaseInfluenz
2、a/PneumoniaDiabetesAccidents/InjuriesChronicLowerRespiratoryDiseasesCerebrovascularDiseaseOtherCardiacCausesAllCancers20%25%NationalVitalStatisticsReport,Vol49(11),Oct.12,2001.State-specificmortalityfromsuddencardiacdeath–UnitedStates1999.MMWR.2002,51:123-126.15%5%
3、10%ArrhythmicCauseofSCDAlbertCM.Circulation2003,107:2096-2101.12%OtherCardiacCause88%ArrhythmicCauseUnderlyingArrhythmiasofSuddenCardiacArrestTorsadesdePointes13%VT62%Bradycardia17%PrimaryVF8%BayésdeLunaA.AmHeartJ1989,117:151-159.RiskFactorsforFatalArrhyth
4、mias80%CoronaryArteryDisease15%Cardiomyopathy5%Other*Heikkietal.NEnglJMed2001,345.*ion-channelabnormalities,valvularorcongenitalheartdisease,othercauses.TreatmentsofPotentialUtilitytoReduceSCDCorrectingIschemiaRevascularizationBeta-blockerPreventingPlaqueRuptureS
5、tatinACEinhibitorAspirinStabilizingAutonomicBalanceBeta-BlockerACEinhibitorImprovingPumpFunctionACEinhibitorBeta-BlockerPreventionofArrhythmiasBeta-BlockerAmiodaroneTerminatingArrhythmiasICDsAEDsBlocksEffectsofResidualAldosteroneAldosteronereceptorblockadeZipesDP.C
6、irculation1998,98:2334-2351.PittB.NEnglJMed2003,348:1309-1321.然而,ICD植入患者的绝对获益值相对较小,且ICD本身有潜在的不良反应MADITII5.6%20months18ICDsSCD-HeFT7.2%5years14ICDs最大获益于ICD治疗的最高危人群更理想的危险分层方案?MADIT-II:ICD对VT/VF的一次或一次以上准确治疗36%年电击复律的比例SCDHeFT:从植入至VT/VF电击复律时间0.000.050.100.150.200.250.30
7、01234581170740162223679NumberatriskConsumerReports.org10overusedtestsandtreatments1.BACKSURGERY2.HEARTBURNSURGERY3.PROSTATETREATMENTS4.IMPLANTEDDEFIBRILLATORS.Thisdevices,whichautomaticallyshocktheheartbacktonormalrhythm,costsome$90000overalifetime.Yetone-thirdofpe
8、oplewhogetthemmightnotreallyneedthem,accordingtoresearchreportedin2007.ThisyearMedicarewillpayforanestimated50000ofthedevices.5.CORONARYSTENTS6.…