CRT治疗之弃车保帅课件.ppt

His pacing vs Biv pacing His pacing可以使QRS变窄，改善心功能 指南并没有推荐His pacing用于心力衰竭的再同步化治疗 His pacing + Biv pacing 治疗疗效 1 + 1 = 1~1.1 Biv pacing无应答时， His pacing 是否可以替代？ 手术时间 1 + 1 = 2 手术难度 1 + 1 = 2 His 电极放置时间的不确定性 AVN消融需要同步进行，并且要在远离His的房室结部位消融 近期/远期生存率 1 + 1 = ？ 谢 谢 CRT治疗之弃车保帅 Braunwald’s heart disease 9th Radiofrequency catheter ablation of the AV node results in complete AV nodal block and substitutes a regular, paced rhythm for an irregular and rapid native rhythm. It is a useful strategy in patients who are symptomatic from AF because of a rapid ventricular rate that cannot be adequately controlled pharmacologically as a result of either inefficacy of or intolerance to rate-control drugs and who either are not good candidates for ablation of the AF or already have undergone an unsuccessful attempt at catheter ablation of the AF. Because of the better success rate with catheter ablation of paroxysmal AF than of persistent AF, AV node ablation is more often performed in patients with persistent than with paroxysmal AF. Ablation of the Atrioventricular Node 国内状况 很少因为室律难以控制行AVN消融 + 起搏器植入 多数是有CRT适应症的AF患者，植入CRT后因双室起搏比例低而行AVN消融 病史资料 女，60岁 有肥厚型梗阻性心肌病史，2015.3行左室流出道疏通术加二尖瓣置换术，未行外科房颤消融，术后发现有阵发性房颤，予胺碘酮 0.2 qd 维持窦律。 此次因活动后胸闷气促3月，加重1周入院 夜间不能平卧 有HTN史3年 BPmax160/90mmHg PE：BP120/70mmHg 神清、气平、高枕卧位，两肺呼吸音清，肺底可及少量湿罗音，心界向两侧扩大，HR 132 BPM，齐，心尖部II级SM。腹（-）。双下肢轻度浮肿。 辅助检查 血Rt：WBC 3.9?109/L N45.9% Hgb 99 g/L 生化：ALT：32U/L ALB 41 g/L K＋ 3.5 mmol/L Na－ 145 mmol/L Cl－ 91mmol/L Cr 134 ?mol/L HbA1C 6.6% BNP： 2926 ng/L Digoxin血浓度：1.52?g/L INR: 2.58 血气：PH7.37 PO2 94.1mmHg PCO2 36.9mmHg BE-B -2.4 ECG 2016.9.22 AFL 2:1 HR 122BPM CLBBB QRS 172ms LA 54*66mm RA 48*55mm LV 38*70mm RV 38*55mm LA（前后径） 60 mm 双平面LVEF 42 % PASP 60 mmHg 二尖瓣置换术后轻度瓣周漏 LVOT未见梗阻 治疗经过 入院后给予强心、利尿等治疗后症状好转 继续华法林抗凝 地高辛0.125mg QD 美托洛尔缓释片 47