课件：器质性心脏病vt：rfcaoricd.ppt

Reductions in mortality with ICDs vs. drugs: VT/VF Patients 1 AVID: 31% at 3 years and 39% at 1 year (ICD versus empiric amiodarone or sotalol) 2 CASH: 37% at 2 years (ICD versus amiodarone, metoprolol or propafenone) 3 CIDS: 20% at 3 years (ICD versus amiodarone) Post-MI Patients 4 MADIT: 54% at 2 years (ICDs versus conventional treatment – mostly amiodarone) 5 MUSTT: 60% at 5 years (ICDs versus conventional treatment – sotalol or amiodarone) * * * * * (A) AP view of a epicardial electroanatomical voltage map (CARTO, Biosense Webster,Inc.) in a patient with no detectable structural heart disease based on available image modalities (such as Echo, MRI, LV and RV angiogram, and endocardial RV and LV voltage mapping) who presented with a monomorphic VT. Bipolar electrogram amplitudes are color coded according to the color bar. Normal voltage (amplitude: 1.5 mV) areas are displayed in purple. Epicardial mapping revealed a large low voltage area consistent with scar and findings consistent with scar-related macroreenty. The anterior small low voltage area that extends to the basis of the LV perhaps indicates the location of the left anterior descending artery (LAD). The grey EUS areas indicate electrical unexcitable scar (unipolar pacing with 10 mA and 2 ms impulse width). (B) Modified AP view (tilted and shifted to a more rightward and inferior projection) of the epicardial activation map during the clinical VT (CL 260 ms). Activation time is color-coded according to the corresponding color bar. The activation map demonstrates a figure-of-eight pattern of the VT with two wavefronts propagating around two areas of EUS. Linear RF lesion connecting these two areas of EUS rendered the VT noninducible. (C) Twelve-lead ECG of the VT * * 观察，结果显示室速发作次数由术前11次减少到术后0次；67%患者室速发作频率减少超过75% * * * * * * * * * * * A: Forest plot of relative risk of VT recurrences after catheter ablation versus medical therapy, all studies included. B: Forest plot of relative risk of VT recurrence