心源性猝死的预防和治疗.ppt

Summary Most SCD are due to coronary artery disease and heart failure LVEF is the most reliable non-invasive predictor for SCD SCD under 30 years of age is usually due to inherited heart disease Summary Anti-arrhythmic drugs to prevent sudden death are not as important as once thought β-blockers are more effective than amiodarone or sotalol in pts with CHF or CHD Summary ICD is the most effective prevention for SCD Prophylactic ICD therapy is ready for prime-time use in patients with CHD and CHF ICDs prolong life substantially in patients with hypertrophic cardiomyopathy at high risk Questions? Saxon LA et al. Circulation. 2006;114:2766-72. Maron: JAMA 2007; 98(July): 405–412 Prevention of Sudden Cardiac Death in HCM * The majority of underlying arrhythmias of sudden cardiac arrest are ventricular tachyarrhythmias. The data from this study were collected were based on Holter recordings at the time of cardiac arrest. Historical data suggest that the most important risk factor for cardiac mortality and sudden death after MI is the extent of myocardial injury, characterized by a reduction in ejection fraction and increased end-systolic and end-diastolic volumes. These indexes of left ventricular function have been shown to be consistent, although nonspecific, predictors of mortality after MI.19,20 Other factors associated with risk of sudden cardiac death include the QRS width, ventricular arrhythmias at electrophysiological testing or during 24-hour ambulatory monitoring, T-wave alternans, exaggerated QT dispersion, heart rate variability, and persistently elevated neurohormone and troponin levels.21 However, because of inconsistency in the accurate prediction of subsequent clinical events, these factors are difficult to use alone and may theoretically be best applied in a multifactorial model, although such models have major limitations.22,23 Unfortunately, we have to accept that currently available techniques are unable to effectively risk stratify patients