CRT-2009年循证和指南【精美医学课件ppt】.pptVIP

第二届亚太心律学年会(APHRS2009)暨第五届亚太房颤论坛 第七届中国房颤论坛 时间：2009年10月22日-25日地点：北京国际会议中心 主办单位：亚太心律学会 协办单位：卫生部国际交流与合作中心 承办单位：中华医学会心电生理和起搏分会中国生物医学工程学会心律分会 * * * Main purpose: Show that a large number of patients have been studied in completed and ongoing randomized controlled studies of CRT. Use in conjunction with previous slide. Key messages: Nearly 4000 patients have been enrolled in randomized controlled clinical trials presented to date. A、PATH-CHF：The Pacing Therapies for Congestive Heart慢性心力衰竭起搏治疗临床研究 B、InSync研究：心室多部位起搏治疗慢性心力衰竭的多中心临床研究 C、MUSTIC：The Multisite Simulation in Cardiomyopathy Study 心肌病多部位起搏治疗临床研究 D、MIRACLE：The Multicenter InSync Randomized Clinical Evaluation Trial 多中心InSync随机临床研究 以病死率为研究目标：A、荟萃分析：汇总CONTAK-CD、InSync ICD、MIRACLE、MUSTIC 4项试验 B、COMPANION：Comparison of Medical Therapy，Pacing and Difibrillation in Chronic Heart Failure Trial 心衰患者药物，双心室起搏和除颤器（CRT-D）治疗对比研究 C、CARE-HF：Cardiac Resynchronisation in Heart Failure Study 心脏再同步-心力衰竭研究 * Patients censored at their 24-month follow-up. Some were before 24 months (730 days), hence the low number at risk. Some were after 24 months, hence the curves rising past 24 months. * * Design: The following items will be standardized to minimize confounding of results induced by variation in methodologies: LV lead location: Posterior-lateral, lateral cardiac vein preferred. Optimizations: A-V timing via Ritter method, and V-V timing set to nominal setting * * Background This trial was designed to determine whether cardiac-resynchronization therapy (CRT) with biventricular pacing would reduce the risk of death or heart-failure events in patients with mild cardiac symptoms, a reduced ejection fraction, and a wide QRS complex. Methods During a 4.5-year period, we enrolled and followed 1820 patients with ischemic or nonischemic cardiomyopathy, an ejection fraction of 30 per cent or less, a QRS duration of 130 msec or more, and New York Heart Association class I or II symptoms. Pati