房颤如何择器械治疗.ppt

CRT：对新发房颤及阵发房颤负荷的影响 CARE-HF研究后续分析 研究目的 CRT对心衰患者新发房颤的作用 新发房颤对CRT功能的影响 随机分组 最佳药物治疗 (n=404); 最佳药物治疗 + CRT (n=409); 入选患者 缺血性或非缺血性心肌病 NYHA III – IV级 LVEF ≤ 35%; LVEDD ≥ 30mm/m QRS ≥ 120ms 若QRS 120-149ms，需具备两条心脏收缩不同步证据 Hoppe et al. Circulation 2006;114: 18-25 CRT对新发房颤的影响 CRT和最佳药物治疗组 新发房颤危险无差异 CRT和最佳药物治疗组 因房颤首次入院危险无差异 Hoppe et al. Circulation 2006;114: 18-25 CRT降低新发房颤患者总死亡危险 死亡率% 无论患者是否有AF, CRT均显著降低总死亡危险 36% P=0.002 Hay, et al. Circulation 2004;110: 3404-3410 84 例心衰患者 LVEF 24±7 % QRS 174 ± 25 ms NYHA II-IV CRT降低心衰患者房颤负荷 房颤 负荷 小时/天 房颤负荷: 房颤发作时间/天 Hügl et al. JCE 2006;17: 813-817 CRT降低房颤发作患者人数 Hügl et al. JCE 2006;17: 813-817 CRT有反应与否，均不减少AF发病率; 但延缓新发房颤的发生. Am J Cardiol 2007;100:268 –272 CRT：是否减少房颤负荷？ Daubert et al EHRA/HRS Statement on Cardiac Resynchronization Therapy. Heart Rhythm, Vol 9, No 9, September 2012 2012CRT专家共识中指出，就目前临床证据而言， CRT并不能减少房颤负荷. CRT：对持续或慢性房颤是否可能复律？ 研究背景 研究目的 CRT对于房颤心衰患者左房左室结构重塑和房颤转律的作用 入选患者 74例房颤患者 持续性房颤(n=20)；永久性房颤(n=54) NYHA III – IV级 LVEF ≤ 35%; LVEDD ≥ 30mm/m QRS ≥ 120ms 评估指标：治疗6个月后 NYHA分级、生活质量、6分钟步行距离 LVEF、LV直径、LA直径；房颤复律 Kiès et al.Heart 2006;92: 490-494 78％患者CRT治疗有效 CRT改善慢性房颤患者心功能 Kiès et al.Heart 2006;92: 490-494 * BACKGROUND: Atrial fibrillation/flutter (AF) and heart failure often coexist; however, the effect of cardiac resynchronization therapy (CRT) on the incidence of AF and on the outcome of patients with new-onset AF remains undefined. METHODS AND RESULTS: In the CArdiac REsynchronisation in Heart Failure (CARE-HF) trial, 813 patients with moderate or severe heart failure were randomly assigned to pharmacological therapy alone or with the addition of CRT. * The incidence of AF was assessed by adverse event reporting and by ECGs during follow-up, and the impact of new-onset AF on the outcome and efficacy of CRT was evaluated. By the end of the study (mean duration of follow-up 29.4 months), AF had been documented in 66 patients in the CRT group compared with 58 who received medical therapy only (16.1% versus 14.