Update 2011 Fuengirola, Málaga ARRITMIAS Ignacio Fernández Lozano. Javier Alzueta.
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Transcript of Update 2011 Fuengirola, Málaga ARRITMIAS Ignacio Fernández Lozano. Javier Alzueta.
![Page 1: Update 2011 Fuengirola, Málaga ARRITMIAS Ignacio Fernández Lozano. Javier Alzueta.](https://reader035.fdocuments.co/reader035/viewer/2022081414/54b090634979591c328b4ab1/html5/thumbnails/1.jpg)
Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
ARRITMIAS ARRITMIAS Ignacio Fernández Lozano.Ignacio Fernández Lozano.
Javier Alzueta.Javier Alzueta.
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
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Update 2011Update 2011Fuengirola, MálagaFuengirola, MálagaEn el año 2009…..
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
• Clase funcional II-III NYHAClase funcional II-III NYHA• FE FE ≤ 30%≤ 30%• QRS ≥ 120 msec o QRS estimulado ≥ 200 msec.QRS ≥ 120 msec o QRS estimulado ≥ 200 msec.
• DAI convencional o DAI ResincronizadorDAI convencional o DAI Resincronizador• Objetivo principal: Hospitalización o muerte de Objetivo principal: Hospitalización o muerte de
cualquier causa.cualquier causa.
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
Clase II NYHA 80%FA 12,7% QRS medio 157 msec.BRI 72%MP 7,5%
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
QRS > 150 msecFE < 20%BRI
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
ICDICD ICD-TRCICD-TRC
TOTALTOTAL 6161 118118 P < 0.0001P < 0.0001
Hemo/neumotoraxHemo/neumotorax 0.9%0.9% 1.2%1.2%
Hematoma en Hematoma en bolsabolsa
1.2%1.2% 1.6%1.6%
Infección bolsaInfección bolsa 1.8%1.8% 2.4%2.4%
Desplazamiento Desplazamiento electrodoelectrodo 2.2%2.2% 6.9%6.9%
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
Criterios de inclusión del MADIT-IICriterios de inclusión del MADIT-II
• IM con onda Q IM con onda Q >> 4 semanas 4 semanas
• FEVI FEVI << 0.30 0.30
• >> 21 años de edad; sin límite superior de 21 años de edad; sin límite superior de edadedad
• No se requiere TVNS ni EEFNo se requiere TVNS ni EEF
Moss AJ. N Engl J Med. 2002;346:877-83.
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
N.° en riesgoN.° en riesgo
DesfibriladorDesfibrilador 742742 502 (0,91)502 (0,91) 274 (0,94)274 (0,94) 110 (0,78)110 (0,78) 99
ConvencionalConvencional 490490 329 (0,90)329 (0,90) 170 (0,78)170 (0,78) 65 (0,69) 65 (0,69) 33
Moss AJ. N Engl J Med. 2002;346:877-83.
DesfibriladorDesfibrilador
ConvencionalConvencional
P = 0,007P = 0,007
1.01.0
0.90.9
0.80.8
0.70.7
0.60.6
0.00.0
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00 11 22 33 44
AñoAño
MADIT-II: Resultados de supervivenciaMADIT-II: Resultados de supervivencia
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
Mortalidad totalNo DAI 62%DAI: 49%P < 0.001
Mortalidad totalNo DAI 62%DAI: 49%P < 0.001
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
Circulation 2010 122: 1144-52
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
Circulation 2010 121: 635-643
1029 pacientes en 4 paises europeos
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Update 2011Update 2011Fuengirola, MálagaFuengirola, Málaga
Y ademas
• Biventricular verus right ventricular antitachycardia pacing to terminate ventricular tachyarrhythmias in patients receiving cardiac resynchronization therapy: The Advance CRT-D trial. Gasparini M, Anselme F. Clementy J et al. Am Heart J 2010: 16, 1113-23.
• A randomized double-blind comparison of biventricular versus left ventriclar stimulation for cardiac resynchonization therapy: The Biventricular versus Left Univentricular Pacing with ICD Back-up in Heart Failurre (B-LEFT HF) trial. Boriani G, Kraning W, Donal E y cols Am Heart J 2010: 159: 1052-58
• Identification and charasterization of super-responders afther cardiac resynchronitazation therapy. Raen P, Zaroui A, Mignot A y cols. Am J Cardiol 2010: 105; 1327-35
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Update 2011Update 2011Fuengirola, MálagaFuengirola, MálagaUpdate 2010Update 2010Fuengirola, MálagaFuengirola, Málaga