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ARVC 的 ICD 治疗

ARVC 的 ICD 治疗. 浙江大学医学院附属第一医院心内科 郑良荣. ARVC 的定义. ARVD 的 ECG 诊断标准. ARVD 的二维超声诊断标准. Diagnostic Criteria for ARVC by MRI: Modified Task Force Criteria. Marcus et al. Circulation 2010; 121: 1533-1541. ARVC 诊断标准. ARVC 猝死的二级预防 -ICD. Circulation.2005;112:3823-3832. 随访 6 年. 60% 放电. I. IIa.

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ARVC 的 ICD 治疗

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  1. ARVC的ICD治疗 浙江大学医学院附属第一医院心内科 郑良荣

  2. ARVC的定义

  3. ARVD的ECG诊断标准

  4. ARVD的二维超声诊断标准

  5. Diagnostic Criteria for ARVC by MRI: Modified Task Force Criteria Marcus et al. Circulation 2010; 121: 1533-1541

  6. ARVC诊断标准

  7. ARVC猝死的二级预防-ICD Circulation.2005;112:3823-3832 随访6年 60%放电

  8. I IIa IIb III Implantable Cardioverter-Defibrillators 2008年 伴有1个或更多危险因素的ARVD/C患者 危险因素：发病时（年龄<5岁）；男性；晕厥；EPS诱发VT；监护时有VTns；右室广泛受累； 左室受累；心跳骤停史；chromosome1q42-43 ACC/AHA/HRS2008GuidelinesforDevice-BasedTherapy OfCardiacRhythmAbnormalities Circulation2008;117:e350-e408;.

  9. Implantable Cardioverter Deibrillators in Arrhythmogenic Right Ventricular Dysplasia/C • 24个研究，610例ARVC，植入ICD，平均随访3.8年 • 包括一级和二级预防 • 危险因素：先兆晕厥 61%，晕厥31%，心跳骤停14%，VT 58%, Vf 6% • 服药：胺碘酮 14%, B-block 38% , Sotalol 30% Circ Arrhythm Electrophysiol. 2013;6:562-568.)

  10. ICD恰当放电率--ARVC Circ Arrhythm Electrophysiol. 2013;6:562-568.)

  11. ICD不恰当放电率--ARVC

  12. Mortality and ICD-related complications

  13. Risk Factors for Appropriate ICD Therapy-primary prevention 84例 ARVC, 植入ICD，随访4.7±3.4年 48%的患者得到ICD的恰当治疗。

  14. Incremental Risk of AppropriateICD Therapy With Multiple Risk Factors 100% 83% 21% 15% J Am Coll Cardiol 2011;58:1485-96

  15. Risk Factors for Appropriate ICD Therapy-primary prevention • 一级预防中，随访大约5年，有48%的患者得到ICD的合理治疗。 • 危险因素越多，发生心律失常和ICD治疗的概率越高。 • 电生理检查诱发室性心律失常和VTns是独立的预测因子。

  16. Primary Prevention: Genetic Conditions (Excludes Syncope and Sustained VT)

  17. Ablation of Ventricular Arrhythmias in ARVD/C Circ Arrhythm Electrophysiol. 2011;4:478-485

  18. Ablation of Ventricular Arrhythmias in ARVD/C ICD ？ Circ Arrhythm Electrophysiol. 2011;4:478-485.

  19. Genetic Diseases with Sustained VT/VF ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators and Cardiac ResynchronizationTherapy JACCVol.61,No.12,2013:1318-68

  20. Transvenous Lead Extraction in ARVC Multicenter Experience with Transvenous Lead Extraction in Arrhythmogenic Right Ventricular Cardiomyopathy(ARVC) PACE 2013;36:1280-1283

  21. Reduction in Inappropriate Therapy and Mortality through ICD Programming N Engl J Med 2012;367:2275-83.

  22. Reduction in Inappropriate Therapy and Mortality through ICD Programming N Engl J Med 2012;367:2275-83.

  23. 小 结 • ICD是降低ARVC患者死亡率的有效手段（一级或二级预防） • 患者选择应谨慎（年轻、ICD相关的并发症、对生活质量和精神的影响） • 植入时关注R波的幅度 • 植入后经验性程控（MADIT-RIT，>=200次/分，延迟放电治疗，有利于减少不必要的放电及全因死亡率）

  24. 谢谢

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