1、室性心律失常合并慢性心力衰竭和猝死防治浙江大学医学院附属第二医院 心脏中心王建安概况l 心脏猝死发生率 12/10万人 /年l 90%的心脏猝死继发于室性心律失常（室速、室扑、室颤、 TDP、无脉性电活动）l 猝死可以发生于任何人群，尤其是器质性心脏病（特别是缺血性心脏病）合并心衰人群。 充血性心力衰竭与猝死l 自 ACE阻滞剂， 阻滞剂等药物的应用，病死于泵衰竭的患者明显减少l 然而，有症状的心力衰竭患者在确诊后2.5年内，仍有 20%-25%患者发生意外死亡，而其主要原因（超过 50%）为VT/VF引起的猝死。Care-HF 患者死亡原因CARE-HF Extension StudyTim
2、e to Sudden DeathCRTMedicalTherapy0 16000.000.250.500.751.00SurvivalTime (days)400 800 1200CRT = 32 sudden deaths (7.8%)Medical Therapy = 54 sudden deaths (13.4%)Hazard Ratio 0.54 (95% CI 0.35 to 0.84; P=0.006)Main Study 平均随访时间： 29.4mExtension Study 平均随访时间： 37.6mMain Study：CRT = 29 sudden deaths （ 7
3、.1%）Medical Therapy = 38 sudden deaths (9.4%）两年的随访中两条曲线趋势一致Longer-term effects of cardiac resynchronization therapy on mortality in heart failure the Cardiac Resynchronziation-Heart Failure (CARE-HF) trial extension phase. Eur Heart J 2006; 16: 1928 32 Gorgels, PMA Out-of-hospital cardiac arrest-the
4、 relevance of heart failure.The Maastricht Circulatory Arrest Registry.European Heart Journal.2003;24:1204-1209.LVEF% SCA Victims7.5%5.1%2.8%1.4%LVEF与 SCA的相关性左室功能不全的 CHF患者中 SCD率总死亡率 15-40%; SCD 占总死亡的 50%.12 months 16 months41.4 months 27 months 13 months45 months 6 monthsControl Group Mortality %尽管给
5、予理想的药物治疗，心衰患者的猝死率仍非常高1 MERIT-HF Study Group.Effect of metroprolol CR/XL in chronic heart failure.Lancet.1999;353:2001-2007.2 CIBIS Investigations and Committees.The cardiac insufficiency bisprolol study II (CIBIS-II).Lancet.1999;353:9-13.3 Packer M,Bristow MR,Cohn JN,et al.The effect of carvedilol o
6、n morbitity and nortality in patients with chronic heart failure.U.S.Carvedilol Heart Failure Study Group.N Engl J Med.1996;334:1349-1355.4 The RALE Investigators.Effectiveness of spironolactone added to an aniotensin-converting enzyme inhibitor and a loop diuretic for severe chronic congestive heart failure(the Randomized Aldactone Evaluation StudyRALES.Am J Cardiol.1997;78:902.
