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 />
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