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ARRITMIAS Ignacio Fernández Lozano. Javier Alzueta.

ARRITMIAS Ignacio Fernández Lozano. Javier Alzueta. En el año 2009…. Clase funcional II-III NYHA FE ≤ 30% QRS ≥ 120 msec o QRS estimulado ≥ 200 msec. DAI convencional o DAI Resincronizador Objetivo principal: Hospitalización o muerte de cualquier causa. Clase II NYHA 80% FA 12,7%

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ARRITMIAS Ignacio Fernández Lozano. Javier Alzueta.

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  1. ARRITMIAS Ignacio Fernández Lozano.Javier Alzueta.

  2. En el año 2009…..

  3. Clase funcional II-III NYHA • FE ≤ 30% • QRS ≥ 120 msec o QRS estimulado ≥ 200 msec. • DAI convencional o DAI Resincronizador • Objetivo principal: Hospitalización o muerte de cualquier causa.

  4. Clase II NYHA 80% FA 12,7% QRS medio 157 msec. BRI 72% MP 7,5%

  5. QRS > 150 msec FE < 20% BRI

  6. Criterios de inclusión del MADIT-II IM con onda Q > 4 semanas FEVI < 0.30 > 21 años de edad; sin límite superior de edad No se requiere TVNS ni EEF Moss AJ. N Engl J Med. 2002;346:877-83.

  7. MADIT-II: Resultados de supervivencia 1.0 0.9 Desfibrilador 0.8 Probabilidad de supervivencia 0.7 Convencional P = 0,007 0.6 0.0 0 1 2 3 4 Año N.° en riesgo Desfibrilador 742 502 (0,91) 274 (0,94) 110 (0,78) 9 Convencional 490 329 (0,90) 170 (0,78) 65 (0,69) 3 Moss AJ. N Engl J Med. 2002;346:877-83.

  8. Mortalidad total No DAI 62% DAI: 49% P < 0.001

  9. Circulation 2010 122: 1144-52

  10. 1029 pacientes en 4 paises europeos Circulation 2010 121: 635-643

  11. Y ademas • Biventricular verus right ventricular antitachycardia pacing to terminate ventricular tachyarrhythmias in patients receiving cardiac resynchronization therapy: The Advance CRT-D trial. Gasparini M, Anselme F. Clementy J et al. Am Heart J 2010: 16, 1113-23. • A randomized double-blind comparison of biventricular versus left ventriclar stimulation for cardiac resynchonization therapy: The Biventricular versus Left Univentricular Pacing with ICD Back-up in Heart Failurre (B-LEFT HF) trial. Boriani G, Kraning W, Donal E y cols Am Heart J 2010: 159: 1052-58 • Identification and charasterization of super-responders afther cardiac resynchronitazation therapy. Raen P, Zaroui A, Mignot A y cols. Am J Cardiol 2010: 105; 1327-35

  12. Update 2010 Fuengirola, Málaga

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