可植入设备在房颤中的应用ppt课件.ppt

IMPLANTABLEDEVICEFORTHETREATMENTOFATRIALFIBRILLATION 天马行空官方博客 Atrialfibrillationisacommonarrhythmia Commonsymptoms palpitationsDyspneafatigueAssociatedcomplications Strokeheartfailuredeath CooperJM etal NEJM 2002 346 26 2062 68 天马行空官方博客 CommonApproaches RatecontrolplusanticoagulationRhythmcontrolwithantiarrythmicmedicationsPacemakeranddefibrillator CooperJM etal NEJM 2002 346 26 2062 68 Ventricularpacingduringartrialfibrillation Symptomaticbradycardia permanentpacemakers TheatrioventricularnodeisbomdardedwithelectrialimpulsesThefactorsinfluencesonVentricularrateintrinsicconduction systemdiseasetakeingrate controllingpharmacologicagentswithhighavagaltone CooperJM etal NEJM 2002 346 26 2062 68 Ablationofatrioventricularnodeplusimplantationofpacemaker 1 decreasestheincidenceofpalpitations dyspnea etalincreasesexercisetoleranceelminatesrate controllingmedicationsimprovesthecardiovascularhemodynamic CooperJM etal NEJM 2002 346 26 2062 68 Ablationofatrioventricularnodeplusimplantationofpacemaker NoeffectonthefibrillationintheatriaNoeffectontheassociatedriskofthromboembolism CooperJM etal NEJM 2002 346 26 2062 68 适应证 症状严重的 药物无效或不能耐受药物治疗的慢性房颤和房扑患者一般均有不同类型的基础病 Preventionofatrialfibrillationwithatrialpacing Themechanismofatrialpacing AllowscoordinatedcontractionofthechambersLowersaverageatrialpressureDeacreasesanystretch relatedchangesPreventspausesandreducestheriskoftheatrialfibrillationassociatedwithincreasedvagaltoneandbraycardiaSupressectopicatrialbeats TheModeSelectionTrial Numberofpatients Morethan2000patientswiththeSSSTwogroups ventricularpacemaker dual chamberpacemakerTheprimaryendpoints mortality strokeResult nodifferencewithrespecttotheprimaryendpoint 50 decreaseinthelikehoodofafirstepisodeofatrialfibillationandareductioninkiskofprogressiontochronicatrialfibillationwithdual chamberpacing PressreleaseofNASP Natick Mass May 2001 Alternativesingle siteanddual siteatrialpaceng 房间传导阻滞 InterartrialConductionBlock 一般人群房间传导阻滞发生1 缓 速综合征患者发生率32 诊断标准 右房与左房间传导超过100ms体表心电图 P波增宽P波时限 120ms 导联P波常有明显切迹 切迹间双峰间距 0 04 导联P波双向 先负后正 Synchronizedatrialactivation Usualsingle siteofatrialpacing interatrialseptumcoronarysinusBachmann bundle Dual siteofatrialpcingtherightatrialappendageinteratrialseptumDual atrialpacingtherightatrialappendagecoronarysinus PatientsinwhomthetheatrialleadwasplacedatBachmann budleorontheinteratrialseptumhadalowerincidenceofparxymalandchronicatrialfibrillationthanthoseinwhomtheleadwasposisionedinthetraditionalrightatrialappendage BailinSJ etal JCE 2001 142 1047 55 双房同步起搏 双心房 右心室起搏 是三腔人工心脏起搏器的一种 用于防治与房间传导阻滞有关的某些快速性房性心律失常冠状窦起搏的最佳位电多选择在冠状窦中部 双房同步起搏方式 单腔起搏器 仅有房间传导阻滞及快速房性心律失常 选用双极AAT方式双腔DDD起搏器 同时合并缓慢性心律失常或房室传导阻滞 选用DDD R 方式Chorus6234或7034 elacorp AAT 房间水平 DDD 房室间水平 Overdriveatrialpacing Themechanismofoverdriveatrialpacing TheatrialpacingpredominateovertheintrinsicatrialactivitytoreducetheinitiationofatrialfibrillationSupressesprematrueatrialbeatsInfluncesthepatternofatrialdepolarizationLowerstheincidenceofatrialarrhythmiaDecreasethenumberofdaysduringwhichatrialfibrillationoccurred High frequencypacingandelectricalcardioversion Antitachycardiadevice 1 TheMetrixAtrioverter InControlTheJewelAFdevice MedtronicTheGEMAT Medtronic Antitachycardiadevice 2 Thedevicewasprogremmedtodetectartrialfibillation andadminsterashocktorestoresinusrythemTodeliverrapidatrialpacingtotreatatrialarrhythmiasTheoverefficacyofthrdeviceinteminatingatrialfibrillationwas90 1 3episodesrequiringmorethanoneshockSafty noinstenceofventricularproarrythmia TheGEMAT Medtronic TheshocksforatrialfibrillationcanbeactiveedbythepatientTobeprogrammedtooccurautomaticallyintheearlymorningwhilethepatentissleepToensurethattheshockisdeliveredwithin24hoursaftertheonsetofatrialfibrillation Conclutionand