器质性心脏病室性心动过速导管消融的循环支持课件

器质性心脏病室性心动过速导管消融的循环支持器质性心脏病室性心动过速

导管消融的循环支持器质性心脏病室性心动过速导管消融的循环支持内容

背景临时器械辅助的适应症临时器械辅助支持下室速导管消融小结器质性心脏病室性心动过速导管消融的循环支持背景器质性心脏病室性心动过速导管消融的循环支持背景器质性心脏病室性心动过速导管消融的循环支持背景器质性心脏病室性心动过速导管消融的循环支持背景器质性心脏病室性心动过速导管消融的循环支持背景器质性心脏病室性心动过速导管消融的循环支持循环支持的基本内容

药物

IABP

左心辅助（LVAD）体外膜肺（ECMO)器质性心脏病室性心动过速导管消融的循环支持临时器械辅助的适应症早期心源性休克无法用药物控制的心绞痛心脏手术后的低心排器质性心脏病室性心动过速导管消融的循环支持临时器械辅助的适应症近年应用指征进一步拓宽严重的左主干病人高危或失败的PCI病人

手术前后药物难以控制的室性心律失常的病人急性心梗所至的室间隔穿孔或急性二尖瓣关闭不全的病人器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融JCardiovascularElectrophysiology,2007;18(1):106–109器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融JCardiovascularElectrophysiology,2007;18(1):106–109TandemHeart(CardiacAssist,Inc.,Pittsburgh,PA,USA)器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融JCardiovascularElectrophysiology,2007;18(1):106–109器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融JCardiovascularElectrophysiology,2007;18(1):106–109器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融JCardiovascularElectrophysiology,2010;21:458–461器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融JCardiovascularElectrophysiology,2010;21:458–461器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融JCardiovascularElectrophysiology,2010;21:458–461器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融JCardiovascularElectrophysiology,2010;21:458–461Inthese3patientstherewasnoevidenceof:

ImpellaTM-relatedvalvulardisturbance

iatrogenicventriculararrhythmias

interferencewithmappingandablationcathetermovement器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融Herz2009;34:545–52Centrifugalcone-typepump(MedtronicBio-Medicus)Membraneoxygenatorcoupledwithaheatexchanger(MedtronicMaximaPlus)(BycourtesyofMedtronic,StPaul,MN,USA.)ECMO器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融Herz2009;34:545–52器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融Herz2009;34:545–52器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融Herz2009;34:545–52Age(years,mean±SD)61±6Gender,M/F(n)19/–Underlyingheartdisease[n(%)]Coronaryarterydisease11(58)Idiopathicdilatedcardiomyopathy6(31)Arrhythmogenicrightventriculardysplasia2(11)IndicationforCPS[n(%)]Cardiogenicshock12(63)FailedCAwithhemodynamicimpairment7(27)19例患者临床资料器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融Herz2009;34:545–52器质性心脏病室性心动过速导管消融的循环支持临时器械辅助支持下室速导管消融Herz2009;34:545–52ClassApatients[n(%)]10(52)ClassBpatients[n(%)]5(27)ClassCpatients[n(%)]4(21)In-hospital“VT-free”patients[n(%)]13(66)In-hospital“VTrecurrence”patients[n(%)]6(34)(Emergencycardiactransplant–death)[n(%)]1(5)消融结果器质性心脏病室性心动过速导管消融的循环支持小结JCardiovascularElectrophysiology,Articlefirstpublishedonline:19OCT2010PercutaneousLVADsasSupportforVTAblation器质性心脏病室性心动过速导管消融的循环支持小结JCardiovascularElectrophysiology,Articlefirstpublishedonline:19OCT2010DurableLVADstoSupporttheFailingHeart

withRecurrentVT器质性心脏病室性心动过速导管消融的循环支持小结JCardiovascularElectrophysiology,Articlefirstpublishedonline:19OCT2010CatheterAblationofVTinPatientswithSurgically

ImplantedVADsstudieshavereportedthatventriculararrhythmiasoccurin22–36%ofpatientsduringLVADsupportstudybyBediandcolleagues,ventriculararrhythmias,occurringwithinaweekofVADplacement,wereassociatedwithworsenedoutcomeandmortalityratesashighas54%.BediM,KormosR,WinowichS,:Ventriculararrhythmiasduringleftventricularassistdevicesupport.AmJCardiol2007;99:1151-1153.ZivO,DizonJ,ThosaniA,:Effectsofleftventricularassistdevicetherapyonentriculararrhythmias.JAmCollCardiol2