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