Báo cáo Chỉ định đặt máy phá rung ICD

CHỈ ĐỊNH ĐẶT MAÙY<br /> PHAÙ RUNG ICD<br /> <br /> TS.BS. LÊ THANH LIÊM<br /> TK TIM MẠCH BV CHỢ RẪY<br /> <br /> TAÀM QUAN TROÏNG CUÛA ÑOÄT TÖÛ<br /> Leading Causes of Death in the US in 1999<br /> Cerebrovascular Disease<br /> 7.0%<br /> 23.0%<br /> Chronic Lower<br /> 5.2%<br /> Malignant Neoplasms<br /> <br /> Respiratory Diseases<br /> 4.1% Accidents, injuries<br /> Diabetes<br /> 2.9%<br /> Influenza/<br /> 2.7%<br /> pneumonia<br /> 1.9%<br /> Alzheimer’s<br /> 1.5%<br /> 1.3%<br /> Disease<br /> Nephritis<br /> Septicemia<br /> <br /> All Other Causes<br /> 20.2%<br /> <br /> 11.2%<br /> 1 National<br /> <br /> Vital Statistics Report,<br /> Vol 49 (11), Oct. 12, 2001<br /> 2 MMWR. State-specific mortality from sudden<br /> 19.1%<br /> cardiac death – US 1999.Feb 15, 2002;51:123-126.<br /> <br /> SCD<br /> <br /> 2<br /> <br /> Other cardiac<br /> causes<br /> <br /> ĐOÄT TÖÛ LAØ MOÄT TRONG NHÖÕNG NGUYEÂN NHAÂN<br /> GAÂY TÖÛ VONG HAØNG ÑAÀU TAÏI MYÕ<br /> <br /> 3 00,000<br /> 250,000<br /> 2 00, 000<br /> 150,000<br /> <br /> 100,000<br /> 50,000<br /> 0<br /> <br /> AIDS<br /> <br /> K VUÙ<br /> <br /> K PHOÅI<br /> <br /> TBMMN<br /> <br /> Source: Statistical Abstract of the U.S. 1998, Hoover’s Business Press 118th Edition<br /> <br /> ÑT<br /> <br /> LÒCH SÖÛ ICD<br /> <br /> 1975 ICD ñaët thöû nghieäm treân choù<br /> <br /> 1980 ICD ñaàu tieân treân ngöôøi<br /> <br /> Dr. Michel Mirowski<br /> 1929 – 1990<br /> Dr Harry Heller<br /> <br /> C NC veà ICD trong phoøng ngöøa ÑT<br /> Trial<br /> <br /> Year<br /> <br /> Patients<br /> (n)<br /> <br /> LVEF<br /> <br /> Additional Study<br /> Features<br /> <br /> Hazard<br /> Ratio*<br /> <br /> 95% CI<br /> <br /> p<br /> <br /> MADIT I<br /> <br /> 1996<br /> <br /> 196<br /> <br /> < 35%<br /> <br /> NSVT and EP+<br /> <br /> 0.46<br /> <br /> (0.26-0.82)<br /> <br /> p=0.009<br /> <br /> MADIT II<br /> <br /> 2002<br /> <br /> 1232<br /> <br /> < 30%<br /> <br /> Prior MI<br /> <br /> 0.69<br /> <br /> (0.51-0.93)<br /> <br /> p=0.016<br /> <br /> CABG-Patch<br /> <br /> 1997<br /> <br /> 900<br /> <br /> < 36%<br /> <br /> +SAECG and CABG<br /> <br /> 1.07<br /> <br /> (0.81-1.42)<br /> <br /> p=0.63<br /> <br /> DEFINITE<br /> <br /> 2004<br /> <br /> 485<br /> <br /> < 35%<br /> <br /> NICM, PVCs or NSVT<br /> <br /> 0.65<br /> <br /> (0.40-1.06)<br /> <br /> p=0.08<br /> <br /> DINAMIT<br /> <br /> 2004<br /> <br /> 674<br /> <br /> < 35%<br /> <br /> 6-40 days post-MI<br /> and Impaired HRV<br /> <br /> 1.08<br /> <br /> (0.76-1.55)<br /> <br /> p=0.66<br /> <br /> SCD-HeFT<br /> <br /> 2006<br /> <br /> 1676<br /> <br /> < 35%<br /> <br /> Prior MI of NICM<br /> <br /> 0.77<br /> <br /> (0.62-0.96)<br /> <br /> p=0.007<br /> <br /> AVID<br /> <br /> 1997<br /> <br /> 1016<br /> <br /> Prior cardiac<br /> arrest<br /> <br /> NA<br /> <br /> 0.62<br /> <br /> (0.43-0.82)<br /> <br /> NS<br /> <br /> CASH†<br /> <br /> 2000<br /> <br /> 191<br /> <br /> Prior cardiac<br /> <br /> NA<br /> <br /> 0.766<br /> <br /> ‡<br /> <br /> 1-sided<br /> <br /> * Hazard ratios for death from any cause in the ICD group compared with the non-ICD group. Includes only ICD and amiodarone patients from CASH.<br /> arrest<br /> p=0.081<br /> ‡CI Upper Bound 1.112 CI indicates Confidence Interval, NS = Not statistically significant, NSVT = nonsustained ventricular tachycardia, SAECG = signal-averaged<br /> electrocardiogram.<br /> <br /> CIDS<br /> 2000<br /> 659<br /> Prior cardiac<br /> NA<br /> 0.82<br /> (0.60-1.1)<br /> Epstein A, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities. J Am Coll Cardiol 2008; 51:e1–62. Table 5.<br /> arrest, syncope<br /> <br /> NS<br /> <br />