arvc单形性室速：导管消融还是icd.ppt

* * 通常的做法是植入ICD之后室速反复发作，药物控制不佳，ATP治疗成功率低，再行导管消融。导管消融难度大，以及费用上的考虑都是这种做法的依据。但是这种做法存在一定的风险，引入病例。 * 首次DFT测试，18J，失败。2010年3月15日植入ICD * 第二次，22J成功。 * 病例刘汉东，ARVC室速，2010年3月15日植入ICD Marquis VR 7230，术中测试除颤阈值高DFT 22J。 2010年4月8日，发作39次室速，在送往医院途中死亡。 * 反复放电不能终止室颤，患者死亡。 * Abstract BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy/dysplasia?(ARVC/D) is a condition associated with the risk of?sudden death?(SD). METHODS AND RESULTS: We conducted a multicenter study of the impact of the?implantable cardioverter-defibrillator?(ICD) for?prevention?of SD in 132?patients?(93 males and 39 females, age 40+/-15 years) with ARVC/D. Implant indications were a history of cardiac arrest in 13?patients?(10%), sustained?ventricular?tachycardia in 82 (62%), syncope in 21 (16%), and other in 16 (12%). During a mean follow-up of 39+/-25 months, 64?patients(48%) had appropriate ICD interventions, 21 (16%) had inappropriate interventions, and 19 (14%) had ICD-related complications. Fifty-three (83%) of the 64?patients?with appropriate interventions received antiarrhythmic drug?therapy?at the time of first ICD discharge. Programmed?ventricularstimulation was of limited value in identifying?patients?at risk of tachyarrhythmias during the follow-up (positive predictive value 49%, negative predictive value 54%). Four?patients?(3%) died, and 32 (24%) experienced?ventricular?fibrillation/flutter that in all likelihood would have been fatal in the absence of the device. At 36 months, the actual patient survival rate was 96% compared with the?ventricular?fibrillation/flutter-free survival rate of 72% (P0.001).?Patients?who received implants because of?ventricular?tachycardia without hemodynamic compromise had a significantly lower incidence of?ventricular?fibrillation/flutter (log rank=0.01). History of cardiac arrest or?ventricular?tachycardia with hemodynamic compromise, younger age, and left?ventricular?involvement were independent predictors of?ventricular?fibrillation/flutter. CONCLUSIONS: In?pati