慢性心衰CRT治疗的适应证及进展.ppt

（四）QRS时限＜120ms并符合I类适应证其他条件者的CRT治疗 针对窄QRS时限心衰患者是否因该接受CRT治疗仍有待大规模临床研究的进一步证实。临床实践中推荐根据具体情况进行个体化的评价 相关临床研究 RethinQ研究显示：CRT治疗未能使窄QRS心力衰竭患者获益 （五）右心室起搏依赖合并心功能不全者的CRT治疗 长期右心室起搏将导致心功能恶化，尤其是那些心室起搏依赖者，对于起搏器植入前即已存在心功能不全，同时预期属于心室起搏依赖的患者，为避免右心室起搏导致心功能进一步恶化，CRT是值得推荐的方法 相关临床研究 BLOCK HF，BIOPACE，RD-CHF CRT病人的选择 Right AtrialLead Right VentricularLead Left VentricularLead 总结 心力衰竭药物疗效不理想 CRT已经被证实能提高合并有室内阻滞的心力衰竭患者的心功能、生活质量和生存率，并具有逆转心肌重构的远期效应 CRT治疗指南也随着循证医学研究的进展而不断完善。正在进行的临床研究将会在未来的2-3年内公布，其结果将会对今后指南的制定产生影响 * 心力衰竭是由一系列因素引起的包括许多症状、体征的综合征 心力衰竭通常定义为心输出量差，但是这一定义没有将一些无关的症状考虑在内，包括心动过缓，低血容量等。 这一定义描述了心力衰竭的定义及基本定义应排除的问题。 * These are the results of the CHARM-Added trial. There was a 15% relative risk reduction in the primary endpoint of cardiovascular death or heart failure hospitalization. This was about a 4% absolute benefit. It was statistically significant with a p-value of 0.01. Again there was an important clinical benefit for mortality and morbidity on top of an ACE inhibitor. * * Electrical: Inter- and/or intraventricular conduction delay usually manifested as left bundle branch block Structural: disruption of myocardial collagen matrix impairing electrical conduction and mechanical efficiency Mechanical: Regional wall motion abnormalities with increased workload and stress—compromising ventricular mechanics Cardiac Resynchronization Therapeutic intent of atrial synchronized biventricular pacing Through the modification of interventricular, intraventricular, and atrial-ventricular activation sequences In patients with ventricular dysynchrony Ventricular dysynchrony is defined as the effect caused by intra and inter-ventricular conduction defects or bundle branch block. Read Dr. Tavazzi’s editorial referenced here for a summary of the three potential causes of ventricular dyssynchrony. Interventricular dysynchrony is delay in the LV as compared to the RV. Intraventricular dysynchrony is delay in the lateral free wall as compared to the septum. Cardiac resynchron