生理性起搏课件.pptx

生理性起搏课程内容什么是生理性起搏起搏器生理化的发展历程80年代DDDR70年代DDD1、恢复房室同步2、获得变时功能60年代VVI恢复房室同步50年代VOO按需但房室不同步固定频率，竞争性心律失常 MOST CTOPP UKPACE进入21世纪…MOST研究N Engl J Med, 2002; 346: 1854-1862.MOST: 2,010 pts, DDDR vs.VVIR a median of 33.1 months Follow-upNO DIFFERENCE IN DEATH or STROKESMALL DECREASE IN HEART FAILURE AND PERMANENT AF N Engl J Med, 2002; 346: 1854-1862.MOST 研究结论对于病态窦房结综合征，双腔起搏可降低房颤发生率，减少心衰，轻度改善生活质量双腔起搏不减少全因死亡率或非致死性脑卒中CTOPP研究Circulation. 2004;109:357-362.CTOPP: 2,568 pts DDDR vs. VVIRDeath or Stroke at 6.4 yearsNO DIFFERENCE IN DEATH OR STROKECirculation. 2004;109:357-362.CTOPP: 2,568 pts DDDR vs. VVIR AF at 6.4 yearsVVIR=5.7% @ 6.4 yrsDDDR=4.5% @ 6.4 yrs For every 100 patients treated over this period, physiological pacing would be expected to prevent atrial fibrillation in 7 patients.Circulation. 2004;109:357-362.CTOPP 研究结论DDD起搏与VVI起搏比较，不降低心血管病死亡率和脑卒中发生率DDD起搏组房颤发生率较低UKPACE研究The United Kingdom PAcing and CardiovascularEvents N Engl J Med 2005;353:145-155.UKPACE: 2,021 pts, DDD vs.VVI(R) 4.6 Year Follow-upNO DIFFERENCE IN DEATH FROM ALL CAUSESN Engl J Med 2005;353:145-155.UKPACE: 2,021 pts, DDD vs.VVI(R) 4.6 Year Follow-upNO DIFFERENCE IN DEATH FROM CARDIOVASCULAR CAUSESN Engl J Med 2005;353:145-155.NO DIFFERENCE IN ATRIAL FIBRILLATION, STROKE,TIA, OTHER THROMBOEMBOLISH, AND HEART FAILUREUKPACE: 2,021 pts, DDD vs.VVI(R) 3 Year Follow-upN Engl J Med 2005;353:145-155.UKPACE 研究结论对于患高度房室传导阻滞的老年患者，起搏模式(DDD/VVI)不影响其5年全因死亡率及术后最初的3年心血管事件发生率N Engl J Med 2005;353:145-155.Circulation. 2004;109:357-362.N Engl J Med, 2002; 346: 1854-1862.CTOPPMOST一个相同结论：双腔起搏与VVI起搏相比不降低全因死亡率UKPACEN Engl J Med 2005;353:145-155.随机对照试验中双腔和单腔心室起搏的预后比较Europace. 2013 Aug;15(8):1070-1118.为什么双腔起搏的优势消失？Danish I1 and Danish II2 研究结果具有较高右室起搏比例的DDDR模式与AAIR模式相比，AF发生率显著增加与心室起搏相比，心房起搏时AF的发生率显著降低与心室起搏相比，心房起搏时HF的发生率显著降低1、Lancet. 1997;350:1210-12162、J Am Coll Cardiol 2003;42:614-623.DAVID研究JAMA. 2002;288:3115-3123..DAVID纳入506例患者LVEF≤40%，无缓慢性心律失常的起搏指证，无持续性房性心律失常植入双腔ICD后随机分为2组，分别程控为VVI后备起搏（40ppm）或DDDR（70ppm）平均随访1年JA