!"#$"%&'( #"!)&*#+&),)#-./'( 0"#'1)( 23456 43783923:;< =6>62<? @A32<>6:B3C :6AD6>23C 26D3:;E;3>23:;<
F59<4E683:;G, %
FJK)F'"L+!0M N+OM&J* ! *!& 100 90 80 70 60 50 40 30 20 10 0
80% !"#$%& % 70% #'&(%& ) *+, -./%0123 4 3'$'&%% 8 5'3
M (n = 237) K (n = 230)
0
2
4
6
8
10
FA68? H3:=6 H3:;E234B< D<EI237E *!&, I3DE Framingham Heart Study (1948 – 1988) in Atlas of Heart Diseases. American Heart Association. Heart Disease and Stroke Statistics—2003 Update.
$)!!)&*#+&)( •
sPnchronós — 3D234A686225C (IA6>.)
•
D<::<2@A32<? - 26:34HED62<6 43 4A6862< D4Q@ <=< 26:B3=GB<@ ?4=62<C <=< H6A<3D<>6:B<@ HA3R6::34
•
4EA<E2;5: •
S=6B;A<>6:BE?
•
86@E2<>6:BE?
$)!!)&*#+&)( •
sPnchronós — 3D234A686225C (IA6>.)
•
D<::<2@A32<? - 26:34HED62<6 43 4A6862< D4Q@ <=< 26:B3=GB<@ ?4=62<C <=< H6A<3D<>6:B<@ HA3R6::34
•
4EA<E2;5: •
S=6B;A<>6:BE?
•
86@E2<>6:BE?
&+#L'
$)!!)&*#+&)(
TO"L"&0J !"#$"%&+U $)!!)&*#+&)) - 42Q;A<96=QD3>B345C - 86996=QD3>B345C - HA6D:6AD23-96=QD3>B345C
F!0#"%'"L+!0M !"#$"%&+U $)!!)&*#+&)) 1#) *!& (%) ,EI3=343B
8%
&3A8E=G2E? :<:;3=<>6:BE? VQ2BR<? OK
24 %
!<:;3=<>6:BE? D<:VQ2BR<? OK
38 %
*!& 2-4 V.B. 0
10
20
30
40
Masoudi, et al. JACC 2003;41:217-23; Aaronson, et al. Circ 1997;95:2660-7
&"NO'W+1#)(0&J" TXX"Y0J $)!!)&*#+&)): •
)&%#'&%' 46'!'&% 7%1)3.5%$')8./. &1-.5&'&%9 1
•
.)5105'&%' ).8613%!.)3% 2
•
"75%&'&%' 46'!'&% !%3615:&.; 2 6'/"6/%31<%%
•
-.)3)%)3.5%$')8.' ).861('&%' .37'5:&=> )'/!'&3.4 3
•
1. Grines CL, et al Circulation 1989;79: 845-853
•
2. Xiao HB, et al Br Heart J 1991;66: 443-447
•
3. Søgaard P, et al. J Am Coll Cardiol 2002;40:723–730
$)!!)&*#+&)( ) $O)0"OM&+!0M Y+L1O"Y!' QRS 86996=QD3>B34E?
42Q;A<96=QD3>B34E?
70 %
*!& + QRS > 120 ms
20 %
*!& + QRS < 120 ms
0
41 % 18
35
53
70
Fauchier L. Am J Cardiol 2003, 93: 341-4
FJK)F'"L+!0M N+OM&J* ! *!& ) $O)0"OM&+!0M Y+L1O"Y!' QRS 50
QRS < 120 ms
QRS > 120 ms
38
49 %
25
34 %
13
11 %
16 %
0
I3D<>2E? 459<4E683:;G
3;DE=62256 :A3B< Baldasseroni S, et al. Eur Heart J 2002;23:1692-98; Iuliano et al. AHJ 2002;143:1085-91
«1<AE8<DE» *!& :A6D< 2E:6=62<? !Z', 8=2. (AHA, 2008)
1+Y','&)( Y !"#$"%&+U #"!)&*#+&),)#-./"U 0"#'1)) •
@A32<>6:BE? :6AD6>2E? 26D3:;E;3>23:;G 3-4 V.B.
•
3H;<8E=G2E? =6BEA:;4622E? ;6AEH<? 4 ;6>62<6 HA6D[6:;4Q\]<@ 3-@ 86:?R64
•
VAEBR<? 45^A3:E =643I3 96=QD3>BE 86266 35 % (Simpson)
•
D=<;6=G23:;G <2;6A4E=E QRS ^3=66 120 8:
NO+Y'$' O&1W •
7ED6A9BE :3BAE]62<? 96=QD3>B34
•
86996=QD3>B34E? 7ED6A9BE
•
42Q;A<96=QD3>B34E? 7ED6A9BE
•
HA6:<:;3=<>6:BE? 8<;AE=G2E? A6IQAI<;ER<?
•
B3A3;B36 4A68? D<E:;3=<>6:B3I3 7EH3=262<?
,'$"#KY' !+Y#'/"&)( K"O-$+%Y+F
•
7ED6A9BE :6AD6>23I3 45^A3:E >140 ms
•
86996=QD3>B34E? 7ED6A9BE > 40 ms
F&-0#)K"O-$+%Y+F'( $)!!)&*#+&)(
•
L-A69<8 > 130 8:
F#"L( $)!0+O)%"!Y+W+ &'1+O&"&)(
•
86266 45 % :6AD6>23I3 R<B=E
37 %
0A6@BE86A25C BEAD<346A;6A D6V<^A<==?;3A (CRT-D) InSync III Marquis
+1#"$"O"&)" +10)L'OM&+W+ L"!0+1+O+K"&)( F&-0#)!"#$"%&+W+ TO"Y0#+$' Right Atrial Lead
Left Ventricular Lead
Right Ventricular Lead
)!1+OM,+F'&)" L"0+$)Y) F+ F#"L( +1"#'_))
-L"&MZ"&)" $)!!)&*#+&)) OK F #",-OM0'0" !#0
TXX"Y0J #"!)&*#+&),)#-./"U 0"#'1)): •
?!'&:@'&%' 61A!'6.4 % .0BC!.4 DE
•
F.4=@'&%' "716&./. .0B'!1 % G618<%% 4=06.)1
•
?!'&:@'&%' )3'-'&% !%3615:&.; 6'/"6/%31<%
•
?4'5%$'&%' 3.5'61&3&.)3% 8 G%A%$')8%! &1/6"A81!
•
?5"$@'&%' 81$')341 #%A&% % G"&8<%.&15:&./. )313")1
•
+&%#'&%' $1)3.3= /.)-%315%A1<%; % )!'63&.)3%
+N#'0&+" #"L+$"O)#+F'&)" &' X+&" !#0
+^`68 OK
L<;AE=G2E? A6IQAI<;ER<?
)786262<6 D<E:;3=<>6:B3C VQ2BR<< 4 A67Q=G;E;6 !#0 (Bax JJ et al. J Am Coll Cardiol 2005;46:2168–82)
TXX"Y0J &' 1#+L"K-0+%&J" ) Y+&"%&J" 0+%Y) •
•
>E:;3;E I3:H<;E=<7ER<C :4?7E225@ : Q@QD[62<68 ;6>62<? *!& :2<9E6;:? 2E 29-50 %
:86A;23:;G :2<9E6;:? 2E 27-51 %
•
JAMA meta-analysis (n=1634) Bradley DJ, et al. JAMA 2003;289:730-740;
1+$N+# 'F - ,'$"#KY)
•
2E<^3=66 >E:;3 3H;<8E=G2E? 110 8:
1+$N+# FF - ,'$"#KY)
•
2E<^3=66 >E:;3 3H;<8E=G2E? - 12 8: : 3H6A6962<68 437^Q9D62<? OK
L"!0+1+O+K"&)" C#0 !#"$) $#-W)* L"0+$+F O"%"&)( *!&
Jessup M, Brozena S. Medical Progress--Heart Failure. N Eng J Med 2003; 348: 2007-2018. Copyright 2002 Massachusetts Medical Society.!
Y+O)%"!0F+ )L1O'&0)#-"LJ* CRT - -!0#+U!0F
Implant rates per million CYO7, ECOMED
FL"!0+ ,'YO.%"&)(... •
:6AD6>2E? 26D3:;E;3>23:;G 2E<^3=66 >E:;E? HA<><2E :86A;< < I3:H<;E=<7ER<C 4 "4A3H6
•
CRT - ;6AEH<? H3743=?6; Q862G[<;G >E:;3;Q I3:H<;E=<7ER<< H3 H343DQ Q@QD[62<? ;6>62<? *!& 2E 52 %
•
75 % HER<62;34 "4A3H5, 2Q9DE\]<@:? 4 <8H=E2;ER<< CRT - Q:;A3C:;4, 26 H3=Q>E\; 263^@3D<83C H383]<
CRT
25%
^67 CRT
75%
CRT-devices