心源性猝死的预防和治疗.ppt
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• Half of these early survivors die before discharge
Risk Factors of SCD
• Left ventricular failure
– CHD, cardiomyopathy
• Sudden cardiac death syndromes
– A total of 15% of CHF patients die of SCD
% SCD Victims
8
7.5%
7
6
5
4
3
2•
1
0
0-30%
LVEF and SCD
5.1%
2.8%
31-40%
41-50%
LVEF
Gorgels, PMA. Eur Heart J .2019;24:1204-1209.
• SCD (caused by sudden cardiac arrest) is the most common cause of death in Western societies
• Incidence: 300,000 to 400,000 each year (U.S.) only 2% – 15% reach the hospital
*ion-channel abnormalities, valvular or congenital heart disease, other causes
Prevalence of arrhythmia at SCD
TdP 13%
Monomorphic VT 62%
Bradycardia 17% Primary VF 8%
1.4%
>50%
Causes of deaths in HF: mainly SCD in NYHA II-III, heart failure in NYHA IV
12%
64%
24%
59%
26% 15%
NYHA Class II n = 103
33% 11%
56%
NYHA Class III n = 103
• The most important criterion is reduced left ventricular function
– LVEF<35% and 40 days after MI
Prevention of SCD
– Anti-arrhythmic drugs
• Amiodarone is probably the most effective drug for secondary prevention of VT – Marginally reduce SCD and mortality
– Chronic phase: structural remodelling of the LV, leading to re-entry or heart failure
Risk stratification of SCD
• Risk assessment – Clinical data
• Aetiology; family history; LVEF
– EPS
• T wave alternans • QT dispersion • Arrhythmia during Holter monitoring or
stress test
Ideka T, et al JACC 2019; 48:2268
Predictive values of positive TWA, nonsustained VT and ventricular Late potentials
– ICD
• Most effec来自百度文库ive when LVEF<30%
Sudden Cardiac Death: Prevention and Treatment
Lexin Wang, M.D., Ph.D. Professor of Clinical Pharmacology
Head, Cardiovascular Research
Incidence of SCD
15% cardiomyopathy
80% CAD
Huikuri HV. N Engl J Med. 2019;345:1473-1482.
Myerburg RJ. Heart Disease, A Textbook of Cardiovascular Medicine. 6th ed. W.B. Saunders, Co. 2019.
– Long QT syndromes – Brugada syndrome – Polymorphic catecholaminergic VT – Isolated ventricular fibrillation
CAD has become a main cause of SCD
5% other*
Sensitivity Specificity PPV
NPV
PA
Microvolt -TWA 83%
83%
9%
99.6%
83%
Nonsustained 44%
83%
7%
98.8%
88%
VT
Ventricular late 35%
91%
7%
98.6%
90%
potentials
So what we do?
CHF Other Sudden Death
MERIT-HFStudy Group. LANCET. 2019;353:2019-2019.
NYHA Class IV n = 27
• Myocardial infarction and SCD
– Acute phase: ischemia-provoked VF; or mechanical dysfunctions (e.g. ventricular or papillary rupture)
Bayés de Luna A. Am Heart J. 1989;117:151-159.
Heart Failure and SCD
• More than one million new heart failure patients every year in the USA – 25% mortality in 2.5 years in moderate to severe CHF
Risk Factors of SCD
• Left ventricular failure
– CHD, cardiomyopathy
• Sudden cardiac death syndromes
– A total of 15% of CHF patients die of SCD
% SCD Victims
8
7.5%
7
6
5
4
3
2•
1
0
0-30%
LVEF and SCD
5.1%
2.8%
31-40%
41-50%
LVEF
Gorgels, PMA. Eur Heart J .2019;24:1204-1209.
• SCD (caused by sudden cardiac arrest) is the most common cause of death in Western societies
• Incidence: 300,000 to 400,000 each year (U.S.) only 2% – 15% reach the hospital
*ion-channel abnormalities, valvular or congenital heart disease, other causes
Prevalence of arrhythmia at SCD
TdP 13%
Monomorphic VT 62%
Bradycardia 17% Primary VF 8%
1.4%
>50%
Causes of deaths in HF: mainly SCD in NYHA II-III, heart failure in NYHA IV
12%
64%
24%
59%
26% 15%
NYHA Class II n = 103
33% 11%
56%
NYHA Class III n = 103
• The most important criterion is reduced left ventricular function
– LVEF<35% and 40 days after MI
Prevention of SCD
– Anti-arrhythmic drugs
• Amiodarone is probably the most effective drug for secondary prevention of VT – Marginally reduce SCD and mortality
– Chronic phase: structural remodelling of the LV, leading to re-entry or heart failure
Risk stratification of SCD
• Risk assessment – Clinical data
• Aetiology; family history; LVEF
– EPS
• T wave alternans • QT dispersion • Arrhythmia during Holter monitoring or
stress test
Ideka T, et al JACC 2019; 48:2268
Predictive values of positive TWA, nonsustained VT and ventricular Late potentials
– ICD
• Most effec来自百度文库ive when LVEF<30%
Sudden Cardiac Death: Prevention and Treatment
Lexin Wang, M.D., Ph.D. Professor of Clinical Pharmacology
Head, Cardiovascular Research
Incidence of SCD
15% cardiomyopathy
80% CAD
Huikuri HV. N Engl J Med. 2019;345:1473-1482.
Myerburg RJ. Heart Disease, A Textbook of Cardiovascular Medicine. 6th ed. W.B. Saunders, Co. 2019.
– Long QT syndromes – Brugada syndrome – Polymorphic catecholaminergic VT – Isolated ventricular fibrillation
CAD has become a main cause of SCD
5% other*
Sensitivity Specificity PPV
NPV
PA
Microvolt -TWA 83%
83%
9%
99.6%
83%
Nonsustained 44%
83%
7%
98.8%
88%
VT
Ventricular late 35%
91%
7%
98.6%
90%
potentials
So what we do?
CHF Other Sudden Death
MERIT-HFStudy Group. LANCET. 2019;353:2019-2019.
NYHA Class IV n = 27
• Myocardial infarction and SCD
– Acute phase: ischemia-provoked VF; or mechanical dysfunctions (e.g. ventricular or papillary rupture)
Bayés de Luna A. Am Heart J. 1989;117:151-159.
Heart Failure and SCD
• More than one million new heart failure patients every year in the USA – 25% mortality in 2.5 years in moderate to severe CHF