心脏起搏器植入指南.ppt

GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat年ACC/AHA/NASPE心脏起搏器植入指南GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat适应证分类I类:有明确证据或专家们一致认为起搏治疗对患者有益和有效。II类:起搏治疗是否给患者带来益处/有效的研究结果不一致/专家们的意见有分歧。IIa类:证据/意见偏向有用/有效。IIb类:证据/意见不能说明有用/有效。GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat适应证分类III类:根据病情状况，专家们一致认为起搏治疗无效，某些情况下甚至对患者有害。GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat为最有力的证据。结论源于包含大数量病例的多次随机临床试验。LevelB从含有较少量病人的有限次试验得出的数据或从设计较好的非随机研究分析得出的数据或登记观察的数据.LevelC专家共识是建议的主要来源.ACC/AHA临床证据分类GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat:成人获得性房室阻滞的起搏治疗GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat类适应证:获得性房室阻滞的起搏治疗1.任何阻滞部位的三度和高度房室阻滞伴:a)房室阻滞伴可能由心动过缓所致的症状(包括心力衰竭)b)需要药物治疗其他心律失常或其他疾病，而所用药物治疗导致症状性心动过缓c)清醒状态下虽无症状，但证实心室停搏3.0s或逸搏心律40bpmGregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat类适应证:获得性房室阻滞的起搏治疗d)射频消融后e)心脏外科手术后发生的不可逆性房室阻滞f)神经肌源性疾病伴发的房室阻滞，无论是否有症状2.任何阻滞部位和类型的二度房室阻滞产生的症状性心动过缓GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat类适应证:获得性房室阻滞的起搏治疗1.任何部位的无症状三度房室阻滞，清醒时平均心室率40bpm,尤其是合并心肌病或左心室功能不全2.无症状的二度II型房室阻滞，伴窄QRS波。倘若QRS为宽大畸形则属I类适应证。GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat类适应证:获得性房室阻滞的起搏治疗3.无症状性二度I型房室阻滞，因其他原因电生理检查发现阻滞部位在希氏束内或以下水平。4.一度或二度房室阻滞伴有类似起搏器综合征的临床表现。GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat类适应证:获得性房室阻滞的起搏治疗1.显著一度房室阻滞(0.30sec.)合并左室功能不全或充血性心力衰竭症状的，缩短AV间期可能降低左心房充盈压而改善心力衰竭症状者。2.神经肌源性疾病伴发的任何程度房室阻滞，无论是否有症状（因为无法预测AV传导病变加重）。GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat类适应证:获得性房室阻滞的起搏治疗1.无症状的一度房室阻滞。2.无症状二度I型房室阻滞，发生于希氏束以上或不知道发生在内或下。3.房室阻滞预期可以恢复且不再复发(如药物中毒，莱姆疾病等)，或发生于无症状OSAS患者低氧时。GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat:慢性双分支和三分支阻滞的起搏治疗GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat类适应证:慢性双分支和三分支阻滞的起搏治疗1.间歇性三度房室阻滞2.二度II型房室阻滞3.交替性双侧支阻滞GregoratosG.etal.ACC/AHA/NASPE2002guidelineupdateforimplantationofcardiacpacemakersandantiarrhythmiadevices:areportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines.2002.Availableat类适应证:慢性双分支和三分支阻滞的起搏治疗1.虽未证实晕厥由房室阻滞引起，但可排除可能的其它原因，尤其是室性心动过速后。2.无临床