美敦力起搏器的选择精编版.ppt

* * * This presentation is developed for Physician-to-Peer discussions on the therapeutic role of managing ventricular pacing in an effort to reduce heart failure hospitalizations and reduce the incidence of AF. * Since its approval in 1985, the implantable cardioverter- defibrillator (ICD) has supplanted antiarrhythmic drugs as the standard of care for patients with potentially lethal ventricular arrhythmias. The increased popularity of ICDs stems primarily from their safety and tolerability compared with commonly used medications notorious for adverse drug reactions. As ICD indications have broadened, the number of implantations has increased substantially, and more attention has been directed to sequelae of implantation, particularly after ICD firing. * * * Two hundred twenty patients with CAD and standard indications for ICD therapy were enrolled at 25 centers from April 1998 through November 1999. All patients underwent implantation of pectoral ICD systems with a transvenous endocardial lead positioned at the right ventricular apex. Each patient was followed up for 6 to 12 months, * Of 131 patients with episodes detected in the FVT zone (including inappropriate detections), 98 completed SF-36 measurements at baseline and 12 months (ATP, 43 of 63; shock, 55 of 68). Baseline values were similar (P≥0.05) between arms for each subscale and summary score. The shock arm had significantly improved bodily pain scores at 12 months without improvement in the other 9 measures. The ATP arm had significant improvement in 5 subscales— physical functioning, role physical, bodily pain, social functioning, and role emotional—and the 2 summaries, mental and physical. None of the subscale measurements were significantly reduced at 12 months in either arm. compares the change in scores at 12 months. The ATP group had statistically greater improvement in physical functioning (P=0.02), role physical (P=0.04), and mental summary (P=0.03), whereas social functioning was of borderl