crt的起搏参数的优化和程控ppt课件

1、 汪芳汪芳 史浩颖史浩颖 上海交通大学附属第一人民医院心内科上海交通大学附属第一人民医院心内科AV OPTVV OPTFrequencyPATH-CHF IIMandatoryNOPre-discharge. Every follow-upCARE HFMandatoryNOEvery follow up. Every 6 months. Or 6,9,12,18 monthsMIRACLEMandatoryNOPre-discharge. Every follow-upCOMPANION MandatoryNOPre-discharge. Every follow-up自动脉压自动脉压左心室

2、压左心室压心房收缩压心房收缩压P PR R起搏前起搏前PPPP左室收缩开场左室收缩开场起搏后起搏后舒张期二尖瓣返流舒张期二尖瓣返流AVAV优化的原理优化的原理CRT的机制的机制I-房室同步房室同步AAI with long PR VDD-AVD 60ms VDD-AVD 180msPeak AP in mid Din Sat onset of SEAEA fusionA A/TNL E-AD MRAVAV优化的方法优化的方法q Ritter 方法q自动脉或左室流出道速度时间积分q VTI q二尖瓣血流的速度时间积分q (EA VTI)q舒张充盈时间 (EA 时间)QA shortQA long

3、AV_long = 200 msQA_long = 62 msa = 200 + 62 = 262 msAV short = 50 msQA short = 142 msb = 50 + 142 = 192 msOptimal AVD= A - b + AV short= 262 192 + 50= 120 msAt baseline AVD = 100AVD = 50 QA = 130AVD = 200 QA = 50Optimal AVD = 120不正确不正确正确正确Get Parallel to FlowUse Your Road Map25 mm/sec 100 mm/sec50 m

4、m/sec扫描速度 Sawhney NS, Heart Rhythm. 2004; 1: 562-7Sawhney NS, Heart Rhythm. 2004; 1: 562-7AVD = 80 msAVD = 220 msTruncationFusion&SAV=120MSCase 1: Bi-V pacing AVD = 220AVD = 80AVD = 90AVD = 100AVD = 130Case 2: Bi-V PacingAVD =150 msAVD = 275 msAVD = 250 msAVD = 225 msAVD = 200 ms150 ms225 msAVAV

5、间期优化间期优化Jansen AH, Am J Cardiol. 2006 Feb 15;97(4):552-7. Jansen AH, Am J Cardiol. 2006 Feb 15;97(4):552-7. Jansen AH, Am J Cardiol. 2006 Feb 15;97(4):552-7. Jansen AH, Am J Cardiol. 2006 Feb 15;97(4):552-7. Jansen AH, Am J Cardiol. 2006 Feb 15;97(4):552-7. 1. Cinzia Valzania M.D. Cardiac Resynchron

6、ization Therapy: Variations in Echo-Guided Optimized Atrioventricular and Interventricular Delays During Follow-Up ECHOCARDIOGRAPHY, Volume 24, October 2007 P-waveR-waveAVRVLLV firstVV delayVVAVAV delayP-waveR-waveAVRVLV-V timingAAVRAVLAVRAVLVVVV间期优化的原理间期优化的原理窦房结房室结 改动CRT中左右心室电极刺激顺序 进一步改善收缩同步性 部分代偿电

7、极位置的不理想 使患者最大受害于CRT的治疗起搏治疗传导阻滞VVVV间期优化的原理间期优化的原理如何进展如何进展VVVV间期的优化间期的优化qM型超声q自动脉或左室流出道速度时间积分q VTI q组织多普勒评价心室功能或同步性qQRS宽度q有创的方法：左室dP/dtmaxLV 20LV 4RV 20-80-60-40-200204060 80 LV First RV FirstMaximum Output (VTI)0123456SLV preactivationRV preactivationSogaard Circulation 2002Mortensen PACE 2004Bordacher JACC 2004Porciani Am J Cardiol 2005Vanderheyden JACC 2005Source: Soggard P , Circulati