室上速的规范治疗2006NEJM-于泓.pptVIP

室上性心动过速（Superventricular Tachycardia, SVT） 同济大学附属同济医院心内科 于泓 Primum non nocere The first thing is to do no harm (Hippocratic oath) AVNRT AVRT Atrial flutter Atrial tachycardiastart after three sinus beats N Engl J Med 354:1039, March 9, 2006 Treatment Short-term therapy Long-term management Short-term therapy Vagal maneuvers Adenosine: 6mg 60-80%; 12mg 90-95% Complications: bronchospasm, VF, AF Contraindication: heart-transplant recipients, severe obstructive lung disease Other agents Wide-QRS-complex SVT Regular Tachycardia hemodynamically unstable Electrical cardioversion Rhythm strip and,if possible, 12-lead ECG Narrow QRS complex (120ms) Wide-QRS complex VT or unknow mechnism (VT with narrow QRS complex rare) Short-term therapy for VT SVT Vagal maneuvers IV adenosine, 6 mg Repeat with 12 mg IV verapamil(or alternative), IV diltiazem/BB Termination, unmasking of AFL, or AT Further analysis of ECG Definite SVT IV procainamide/propafenone/ Flecainide/ibutilide or electrical cardioversion Atrial fibrillation with preexcitation Hemodynamically stable Continuous 12-lead ECG recording No effect No effect No effect SVT+BBB SVT with preexcitation Long-term management Medication Prophylactic pharmacologic therapy Single-Dose Oral Therapy (Pill-in-the-pocket) SVT with WPWs Ablation N Engl J Med 354:1039, March 9, 2006 Prophylactic pharmacologic therapy Prophylactic pharmacologic therapy N Engl J Med 354:1039, March 9, 2006