ICD一级预防程控参数设定的特殊教学课件.pptVIP

内 容 ICD一级预防概述 ICD一级预防患者心律失常特点 ICD一级预防程控探讨 正在进行的相关临床试验 ADVANCE III设计 N=1300，一级预防二级预防，延长检测时间 J Cardiovasc Electrophysiol, 2009;20:663 PROVIDE设计 N=1600，一级预防，提高检测频率，延长检测时间 Europace 2011;13:1648 MADIT-RIT设计 N=1500，一级预防，提高检测频率，延长检测时间 Ann Noninvasive Electrocardiol 2012;173:176 初步结果 程控设置减少不必要治疗 SJM PROVE: n=1674, 强化程控（提高检测频率，延长检测时间，SVT鉴别诊断及ATP治疗）可延长植入至第一次电击的时间（9.3±7.4 vs. 8.1±8.5月） Medtronic ADVANCEIII: n=1902（一级预防75%）, NID 30/40较18/24减少治疗37% BSC MADIT RIT: n=1500, 提高检测频率，延长检测时间。结果预计今年下半年公布 HR Scientific Session 2012, AB28-04 Heart Rhythm, 2012,9:1578 Ann Noninvasive Electrocardiol 2012,17:176 总 结 ICD一级预防，任重道远 提高检测频率，延长检测时间，大势所趋 近10年来奠定起来的ATP的作用，受到挑战 正在进行的大型临床试验的结果，令人期待 缺乏大样本的中国人的资料，何时赶超？ 美国，中国及欧洲SCD的发病率 * Figure 1. Absolute numbers of events and event rates of SCD in the general population and in specific subpopulations over 1 y. General population refers to unselected population age greater than or equal to 35 y, and high-risk subgroups to those with multiple risk factors for a first coronary event. Clinical trials that include specific subpopulations of patients are shown in the right side of the figure. AVID Antiarrhythmics Versus Implantable Defibrillators; CASH, Cardiac Arrest Study Hamburg; CIDS Canadian Implantable Defibrillator Study; EF ejection fraction; HF heart failure; MADIT Multicenter Automatic Defibrillator Implantation Trial; MI myocardial infarction; MUSTT Multicenter UnSustained Tachycardia Trial; SCD-HeFT Sudden Cardiac Death in Heart Failure Trial. Modified with permission from Myerburg RJ, Kessler KM, Castellanos A. SCD. Structure, function, and time-dependence of risk. Circulation 1992;85:I2–10. Phase II Sick Sinus Part II * Modified TABLE 11-3? ?--?Clinical Trials of ICD Therapy for Heart Failure or Left Ventricular Dysfunction Alone: Inclusion Criteria, Comparison Groups, and Main Results CABG, Coronary artery bypass graft surgery; EF, ejection fraction; MI, myocardial infarction; NSVT, nonsustained ventricular tachycardia; NYHA, New Yo