心衰心脏再同步crt治疗.ppt

* Main purpose: Explain the risks of a CRT system implant to referral clinicians. Based on MIRACLE study. Key messages: Chiefly due to varying anatomy, implants have been unsuccessful in 5% to 10% of patients atempted. Coronary sinus dissection or perforation occurred in 6% of the cases in MIRACLE, all were resolved without further complication. Two patients in MIRACLE (0.3%) died from procedure related complications as adjudicated by the Clinical Events Review Committee. During follow-up left ventricular lead dislodgement or other comlication required revision (replacement or repositioning) in nearly 6% of patients. All were successfully revised There is a learning curve. Implant times came down with increased center-based experience. Additional information: * Main purpose: Address safety concern that CRT is pro-arrhythmic Key messages: No difference between CRT and no CRT in the number of patients with VT/VF events Additional information: These data come from a meta-analysis of CRT. The two studies combined assessed CRT in patients with a pre-existing indication fro an ICD. VT/VF events are collected in the devices’ (InSync ICD, Contak CD) diagnostics. * Mean two-year outcomes of CRT in patients with HF of ischemic vs nonischemic etiology Outcome Ischemic (n=34) IDCM (n=40) HF hospitalization (days/y) 0.5 0.6 Hospitalizations per patient annually 0.1 0.2 Survival rate (%) 88.3 87.5 All differences nonsignificant . Am J Cardiol 2004; 93:860-863. 心脏再同步治疗会增加室性心律失常吗？ 心脏再同步治疗不增加室性心律失常 分析1044患者 CONTAK CD MIRACLE ICD Odds ratio (CI): 0.92 (0.67 – 1.27) Bradley DJ, et al. JAMA 2003;289:730-740 在随访期间VT/VF的发生率 American Journal of Cardiology 2004 ,94:130-132 CRT可以显著降低室性心律发生 American Journal of Cardiology 2004 ,94:130-132 有了CRT治疗就可以不需要药物治疗了吗？ CRT治疗和药物治疗的关系 Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris