宋尚明缓慢性心律失常的诊治PPT学习教案

1、会计学1宋尚明缓慢性心律失常的诊治宋尚明缓慢性心律失常的诊治2窦性心动过缓窦房阻滞房内阻滞房室阻滞室内阻滞缓慢性心律失常自律性降低：窦房结功能障碍（SND）激动传导异常变时功能不全窦性停搏房性停搏第1页/共59页3第2页/共59页4第3页/共59页5Brignole M, et al. Europace, 2004;6:467-537.第4页/共59页6第5页/共59页7第6页/共59页8第7页/共59页9Sensitivity 55-60%, specificity 80-88% 1500 mseccSNRT = SNRT SCL 525 msec第8页/共59页10第9页/共59页11第1

2、0页/共59页12第11页/共59页13第12页/共59页14HeartRateSlowStartActivityTimeUnstableMaxRestStopActivityQuick第13页/共59页15第14页/共59页16第15页/共59页17第16页/共59页18第17页/共59页19第18页/共59页20第19页/共59页21第20页/共59页22长间歇为短PP间期的2倍第21页/共59页23第22页/共59页24第23页/共59页25第24页/共59页26StudyStudyPacing Pacing ModeModeMean Mean Follow-Up Follow-Up T

3、imeTimeIncidence Incidence of AFof AFAnnualizeAnnualized d IncidenceIncidenceAndersen 1997AAI5 years8.8%1.8%Sutton 1986AAI3 years4.5%1.5%Brandt 1992AAI5 years7.0%1.4%PASE 1998DDDR only18 months19.0%12.7%CTOPP 2000DDDR/VVIR3 years16.6%5.5% (DDDR)第25页/共59页27Sweeney MO, et al. Circulation 2003第26页/共59页

4、28AtrialpacingVentricularpacingTime (years)024681000-20-40-60-81-0225例SND 患者平均随访年AAI起搏与VVI起搏比较第27页/共59页29Time (years)Atrial pacingVentricular pacing024681000-20-40-60-81-0Cumulative survival第28页/共59页3000-20-40-60-81-0AtrialpacingVentricularpacingTime (years)0246810Proportion without AF第29页/共59页31第30

5、页/共59页32第31页/共59页33StudyMean Follow-Up TimeIncidence of AVBAnnualized IncidenceRosenqvist 1989(literature review)3 yearsMedian 2.1%Range: 0-11.9%Median: 0.6%Range: 0-4.5%Andersen 19978 years3.6%0.6%Brandt 19925 years8.5%1.8%Sutton 19863 years8.4%2.8%Rosenqvist 19862 years4.0%2.0%Rosenqvist 19855 yea

6、rs3.3%0.7%Hayes 19843 years3.4%1.1%第32页/共59页34第33页/共59页35第34页/共59页36房颤发生率上升诱发心室诱发室性心律失常增加死亡率第35页/共59页370.550.60.650.70.750.80.850.90.951012243648MonthsProportion event-freeCum%VP 40%Cum%VP 40-70%Cum%VP 70-90%Randomized to DDDR mode, baseline QRSd 1 year.Independent risk assessment preceding ICD impl

7、antation is emphasized, including consideration of patient preference.Optimization of pacemaker programming to minimize unneeded RV pacing is encouraged.Pacemaker insertion is discouraged for asymptomatic bradycardia, particularly at night.A section has been added that addresses ICD and pacemaker pr

8、ogramming at end of life.第38页/共59页40第39页/共59页41第40页/共59页42第41页/共59页43第42页/共59页44第43页/共59页45第44页/共59页46EAAE等容收缩期等容舒张期正常P-R间期第45页/共59页47EAAE等容收缩期等容舒张期PRPR间期过长产生间期过长产生“假性起搏器综合征假性起搏器综合征”第46页/共59页48EAAE等容舒张期等容收缩期起搏治疗后房室顺序功能恢复起搏治疗后房室顺序功能恢复第47页/共59页49第48页/共59页50第49页/共59页51AP位心房电极放于高位房间膈心室电极放于高位室间膈主动固定电极第50页/共59页52主动固定电极第51页/共59页第52页/共59页54君药红参、淫羊藿臣药补骨脂、枸杞子佐药麻黄、细辛