心脏性猝死一级预防__培训课件.ppt

病例三 患者 男 57岁 1998年2月马凡氏综合征，升主动脉瘤样扩张，主动脉瓣关闭不全在上海行主动脉瓣置换术，术前超声心动图示左室心肌明显肥厚，室间隔26mm，LVWP22mm，LVED48mm,LVEF46%，流出道无梗阻 2007年3月12日因发作性心慌，胸闷，呼吸困难，濒死感入院，入院心电监护示阵发性房颤，频发室性早搏，短阵室速，心脏超声心动图示左室心肌明显肥厚，室间隔22mm，LVWP20mm，LVED58mm,LVEF41%，流出道无梗阻，电解质等检查均正常i 病程中无晕厥，黑朦。家族中无猝死病史 . 诊断：为肥厚性心肌病，左心功能不全，阵发性房颤，非持久性室速 入院后给用抗心衰和可达龙治疗，治疗中出现窦性停搏，长间歇〉4秒，显著窦性心动过缓，心率40次/分左右 该患者符合起搏适应征但是不是ICD适应症吗? 考虑该患者是猝死的高危人群，同时具有缓慢性心律失常的 适应证 该患者2007年4月13日植入ST JUDE ATLAS DR V243 ICD (一级预防) 谢 谢！ * It must be emphasized that ACC, AHA, and NASPE, when developing guidelines for indications, attached different conditions and levels of evidence to consider before implanting an ICD. Broadly speaking, ICDs are indicated for ventricular tachycardias and ventricular fibrillation. However, VT in most patients with normal hearts can be treated with drugs or ablation, consequently, the guidelines, as we shall see, are more complex than simply saying VT or VF. You may also refer to Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at /clinical/guidelines/pacemaker/pacemaker.pdf * #5 is a new recommendation (new in 2002) that is related to #2 on the previous slide. When drug therapy or ablation are not options for the patient with sustained VT and a normal heart, an ICD is indicated. * Class IIa indication: #1 is a new recommendation which was a result of the MADIT-II study that showed a 31% reduction in mortality in patients over optimal medical therapy: Beta-blockers, ACE inhibitors, statins, etc., and a 5.6% absolute difference over an average follow-up of 20 months. * * Patients with LV dysfunction had higher rates of sudden cardiac death, than patients without LV dysfunction in the GISSI-2 Trial. Patients with more frequent P