1 / 25

ARVC 的 ICD 治疗

ARVC 的 ICD 治疗. 浙江大学医学院附属第一医院心内科 郑良荣. ARVC 的定义. ARVD 的 ECG 诊断标准. ARVD 的二维超声诊断标准. Diagnostic Criteria for ARVC by MRI: Modified Task Force Criteria. Marcus et al. Circulation 2010; 121: 1533-1541. ARVC 诊断标准. ARVC 猝死的二级预防 -ICD. Circulation.2005;112:3823-3832. 随访 6 年. 60% 放电. I. IIa.

gisela
Download Presentation

ARVC 的 ICD 治疗

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ARVC的ICD治疗 浙江大学医学院附属第一医院心内科 郑良荣

  2. ARVC的定义

  3. ARVD的ECG诊断标准

  4. ARVD的二维超声诊断标准

  5. Diagnostic Criteria for ARVC by MRI: Modified Task Force Criteria Marcus et al. Circulation 2010; 121: 1533-1541

  6. ARVC诊断标准

  7. ARVC猝死的二级预防-ICD Circulation.2005;112:3823-3832 随访6年 60%放电

  8. I IIa IIb III Implantable Cardioverter-Defibrillators 2008年 伴有1个或更多危险因素的ARVD/C患者 危险因素：发病时（年龄<5岁）；男性；晕厥；EPS诱发VT；监护时有VTns；右室广泛受累； 左室受累；心跳骤停史；chromosome1q42-43 ACC/AHA/HRS2008GuidelinesforDevice-BasedTherapy OfCardiacRhythmAbnormalities Circulation2008;117:e350-e408;.

  9. Implantable Cardioverter Deibrillators in Arrhythmogenic Right Ventricular Dysplasia/C • 24个研究，610例ARVC，植入ICD，平均随访3.8年 • 包括一级和二级预防 • 危险因素：先兆晕厥 61%，晕厥31%，心跳骤停14%，VT 58%, Vf 6% • 服药：胺碘酮 14%, B-block 38% , Sotalol 30% Circ Arrhythm Electrophysiol. 2013;6:562-568.)

  10. ICD恰当放电率--ARVC Circ Arrhythm Electrophysiol. 2013;6:562-568.)

  11. ICD不恰当放电率--ARVC

  12. Mortality and ICD-related complications

  13. Risk Factors for Appropriate ICD Therapy-primary prevention 84例 ARVC, 植入ICD，随访4.7±3.4年 48%的患者得到ICD的恰当治疗。

  14. Incremental Risk of AppropriateICD Therapy With Multiple Risk Factors 100% 83% 21% 15% J Am Coll Cardiol 2011;58:1485-96

  15. Risk Factors for Appropriate ICD Therapy-primary prevention • 一级预防中，随访大约5年，有48%的患者得到ICD的合理治疗。 • 危险因素越多，发生心律失常和ICD治疗的概率越高。 • 电生理检查诱发室性心律失常和VTns是独立的预测因子。

  16. Primary Prevention: Genetic Conditions (Excludes Syncope and Sustained VT)

  17. Ablation of Ventricular Arrhythmias in ARVD/C Circ Arrhythm Electrophysiol. 2011;4:478-485

  18. Ablation of Ventricular Arrhythmias in ARVD/C ICD ？ Circ Arrhythm Electrophysiol. 2011;4:478-485.

  19. Genetic Diseases with Sustained VT/VF ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators and Cardiac ResynchronizationTherapy JACCVol.61,No.12,2013:1318-68

  20. Transvenous Lead Extraction in ARVC Multicenter Experience with Transvenous Lead Extraction in Arrhythmogenic Right Ventricular Cardiomyopathy(ARVC) PACE 2013;36:1280-1283

  21. Reduction in Inappropriate Therapy and Mortality through ICD Programming N Engl J Med 2012;367:2275-83.

  22. Reduction in Inappropriate Therapy and Mortality through ICD Programming N Engl J Med 2012;367:2275-83.

  23. 小 结 • ICD是降低ARVC患者死亡率的有效手段（一级或二级预防） • 患者选择应谨慎（年轻、ICD相关的并发症、对生活质量和精神的影响） • 植入时关注R波的幅度 • 植入后经验性程控（MADIT-RIT，>=200次/分，延迟放电治疗，有利于减少不必要的放电及全因死亡率）

  24. 谢谢

More Related