Pacing Rhythm NO - me-times.co.jp

1 NO2 3:23 PM 1.. AED .. ICD .. 1 CAD 1 . CAD ICD 1 . 1 2 MADIT I MUSTT MADIT II SCD . ICD HeFT 4 . ICD . 1 MADIT 1 . ICD MADIT I ICD 1 .. evidence based medicine 196 . EBM VT . Q 35 % . SCD EPS . ICD 1 VT/VF . ICD 95 . 101 ICD . 54 1A .. 1. NO2 3:23 PM 2. 2 MADIT 2 3 80 %. MADIT ICD . EF < 30% 3 . MADIT I 50% . VT EPS VT/VF MADIT II 70 % ICD. 3 2 ICD . n=742 MADIT I VT EPS. n=490 1B VT VF . 20 ICD . 31 % EPS . MUSTT 3 2 MUSTT . MADIT EPS VT/VF . ICD VT/VF . MI EPS . MADIT II 2 3 .. 2 6 % 3 10 % . P VT VF n=353 . 3 EPS MADIT I MADIT II VT VF n=1397 . MADIT I MADIT II ICD ICD. 0 1 2 3 4 5 . 54 % 31 %. 2 MUSTT EPS . EPS VT/VF . EPS . 1A B ICD . ICD ICD . 100 100. MADIT II. MADIT II . 80 80 n=490 . MADIT I. 60 60.. 40 40 MADIT I.. n=101 . 20 20. 0 0. 1 2 3 4 5 1 2 3 4 5 . A ICD 1 B ICD MADIT . MADIT ICD . ICD 31% ICD 1 . 54% ICD MADIT .. 1 MADIT MADIT . 2. NO2 3:23 PM 3. 4 ICD II ICD . EPS VT/VF . NSVT QRS . ICD . ICD . DINAMITE .. 6 40 LVEF 35 % . ICD ICD . 2 1 . n = 315 n = 318 DCM ICD 1.

2 4 ICD DEFINITE SCD HeFT .. ICD . 6 . 1 8 DEFINITE. MADIT II 3 . LVEF 35 % . VT/VF ICD 3 15 . NSVT PVC 10 / . ICD 458 DCM . 229 . ICD 229 . ACE. 3A .. Tanno MADIT II ICD 34 %. 90 30 NYHA . 2 MADIT II 5 . NYHA III . MADIT ICD 3B .. A B NYHA class . STD=16/49. 33% . Probability of Survival Probability of Survival ICD=6/47. ICD. 13% . 2 Year ICD. Mortality ICD. = Standard Standard = Standard p= ; RR= p= ; RR= 0 1 2 3 4 5 0 1 2 3 4 5. Survival time in Years Survival time in Years B NYHA class . A ICD 34 % . ICD .. SCD HeFT .. 3 ICD 1 DEFINITE . 3. NO2 3:23 PM 4. SCD HeFT 7 DCM . LVEF 40 % DCM 151 . 1 151 DEFINITE . 3 NSVT PVC 240/ . ACE 91 60 . LVEF 35 % NYHA 5 DFINITE . II III 4 NSVT PVC 91 . 1676 26 12 . ICD 3 . 4A 3 DCM NSVT PVC. ICD VT/VF . SCD . 23 % HeFT MI . 1 QRS 120 ms . hazard ratio NYHA class II ICD . ICD DEFINITE EPS VT/VF . MI .. ICD 4B C . A B C .. 50 50 50. Placebo Placebo Placebo Amiodarone Amiodarone Amiodarone ICD ICD ICD. 40 40 40. 30 30 30. 20 20 20. 10 10 10. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5.

3 A ICD B ICD C ICD .. ICD . 23% . ICD ICD .. 4 ICD SCD HeFT . 4. NO2 3:23 PM 5.. n=60 1 Moss AJ, Hall WJ, et. al. Improved survival with an implanted defibrillator in patients with . coronary disease at high risk for ventricular n=91. arrhythmia. N Engl J Med. 1996 ; 335 : 1933 1940.. P= Wilcoxon 2 Moss AJ. Zareba W. et al. The Multicenter Automatic Defibrillator Implantation Trial II. 0 Investigators. Prophylactic implantation of a 0 2 4 6 8 10 defibrillator in patients with myocardial 5 . NCVC infarction and reduced ejection fraction. N Engl Med. 346 : 877 83, 2002. LVEF 40 % DCM DEFINITE NSVT . 3 Buxton AE. Lee KL. et al. Electrophysiologic PVC 240 91 . 60 testing to identify patients with coronary artery DFINITE disease who are at risk for sudden death. Multicenter Unsustained Tachycardia Trial Brugada ICD Investigators. N Engl J Med. 342 : 1937 45, 2000. Brugada ICD 4 Hohnloser SH. Kuck HK. et al. DINAMIT. 3 50 Investigators . Prophylactic use of an implan- VF ICD table cardioverter-defibrillator after acute ICD myocardial infarction.

4 N Engl J Med. 351 : 2481 8, 2004. ICD 5 Tanno K, Miyoshi F. et al. Are the MADIT II. VF criteria for ICD implantation appropriate for Brugada Japanese patients ? Circ J. 69 : 19 22, 2005. ICD 6 Kadish A. Dyer A. et al. Defibrillators in Brugada Non-Ischemic Cardiomyopathy Treatment Coved ST 2mm Evaluation DEFINITE Investigators. Prophylactic % defibrillator implantation in patients with non- EPS VF ICD ischemic dilated cardiomyopathy. New Engl J. 8 . Med. 350 : 2151 8, 2004. 2001 13 7 Bardy GH Lee KL Mark DB, et al. The Sudden Brugada Cardiac Death in Heart Failure Trial SCD HeFT . investigators. Amiodarone or an implantable % cardioverter - defibrillator for congestive heart EPS failure. N Engl J Med. 352 : 225 37, 2005.. 9 . 8 Brugada J, Brugada R, Brugada P: Determinants of sudden cardiac death in individuals with the electrocardiographic pattern of Brugada Brugada syndrome and no previous cardiac arrest. ICD Circulation 108 : 3092 3096, 2003. spontaneous 9 . Brugada . Coved ST 2 mm Medical Topics 2005.

5 Brugada EPS VF. 3 2 . 5 . ICD . 5. NO2 3:23 PM 6.. 110 37 .. 79 26 . 20 75 110 37% . 77. 2 2 . 62 14 vs69 14 69 10 p< . 7 40 11 1 . 1 2600 . 1 2 . Brugada . 3 4000 56 33 23 . 54 13 . 1/5 1/10 .. 11 10 7 . 1 2001 1 . 7 3 3 . 2003 12 2a . 52 29 7. 528 299 2 2b . 198 101 68 13 . 1 . 6 6 1 3 vs 7 2 1 3 , n=101 ,72 13 . p < 60 70 50 45. 40. 80 70 80 60 35. 30. 50 . 25. 299 20. 15. 10. 5. 0. 0 10 20 30 40 50 60 70 80 90 100. 68 13 . 100. n=198 ,66 13 . 80 70. 60. 60. 50. 40 40.. 30. 20 20. 10. 0. 0 10 20 30 40 50 60 70 80 90 100 0. 0 10 20 30 40 50 60 70 80 90 100.. 1 . 6. NO2 3:23 PM 7. 222 74 . a 21 7 56 19 . N= 110 70 15 M/F: 75/35 1 .. !! MI. 2 . AP %. CHF % !! .. VHD. Rhythm . DCM.. ! . HCM. ! Congenital Others SOS KANTO . pulselessVT . Pulseless Electrical Activity PEA . % . b . PEA . N=79 70 10 M/F: 50/29 .. 52 . 11 . 29.. 7 HT. DM 3 . 2 CRF HD . HL 192 . 68 35 Pulseless 0 20 40 60. Electrical Activity PEA 44 23 . Asystole 8 0 42 . 2 107 7 7 . PEA 10 9% .. Asystole 90 84 . Asystole . 1.

6 Bystander CPR . n=222 70 13* 137 85* 123 55% * 36 16% 7 . n=21 59 10 18 3 17 81% 4 19% 1 . n=56 64 14 43 13 52 93% 16 29% 5 . P . *. n=192 n=107 . 7. 68 7% 10. 80 35% 9% . 42% . 90 PEA Pulseless Electrical Activity . 44 84% . 23% . 3 7. NO2 3:23 PM 8. 2 .. 3 . 9 . 245 46 . 2 .. PEA . n=68 n=40 n=80 . 30 .. 61 14* 72 69 13. Nagao . 56 10* 29 15 49 31. 78 10 . 12 0 0. 3 . P . * 299 54 18 % . 19 7 . 4 11 17 . 68 . 14 PEA 7 2 54 36 . 4 Asystole 66 . 43 . 9 PEA 3 .. 37 . 25 11 64 . 68 12 .. PEA .. 43 4 7 3 14 9 . Myerburg .. 4 . 13 . 3 .. 9 3 2 8 6 0 90. 6 0 0 10 63.. 4 2 4 3 3 7 92.. 19 2 7 2 11 9 17 245.. 49 . 8. NO2 3:23 PM 9. 5 Myerburg .. Myerburg . 1 1 . 10 . 10 0 .. 7 .. 2004 7 AED .. AED . 14 15 .. ICD .. 37 . 26 .. 30 78 .. or or . 35% 35% .. 100,000 200,000 300,000 0 50 100 150.. 5 Myerburg 13 . 9. NO2 3:23 PM 10.. ICD AED . ICD ICD . AED 85 .. T Wave Alternans .. 16 .. ICD 2 . 1 6 . AVID CASH CIDS VF VT . Cardiac Arrest ICD . ICD p233 245 1995. 17 Meta-analysis 2 . ICD LVEF 20 34 2003.

7 LVEF 35 ICD 508 512. 18 . 3 Huikuri VH, Castellanos A, Myerburg RJ: Sudden Death Due to Cardiac Arrhythmias. N Engl J Med. 2001 ; 345 : 1473 1482. ICD 1 4 De Vreede-Swagemakers JJM, Gorgels AP, Dubois-Arbouw WJ, et al. Out-of-hospital cardiac arrest in the 1990'. s : a population based study in ICD the Maastricht area on incidence, characteristics and survival. J Am Coll Cardiol. 1997 ; 30 : 1500 . 1505. ICD 5 Zheng ZJ, Croft JB, Giles WH, et al: Sudden 1 Cardiac Death in the United States, 1989 to 1998. ICD Circulation. 2001 ; 104 : 2158 2163. 1 6 . MADIT II SCD HeFT 37, suppl 3 , 5 10, 2005. 19 20 . ICD 7 SOS KANTO Committee : Incidence of Ventricular Fibrillation in Patients with Out-of-Hospital 21 Cardiac Arrest in Japan Survey of Survivors After Out-of-Hospital Cardiac Arrest in Kanto 1 / 6 Area SOS KANTO . Circ J 2005 ; 69 : 1157 . 1162. 8 Cobb LA, Fahrenbruch CE, Olsufka M et al : Changing Incidence of Out-of-Hospital Ventricular Fibrillation, 1 9 8 0 2 0 0 0 . JAMA. 2002 ; 288: 3008 3 0 1 3.

8 10. NO2 3:23 PM 11. 9 16 Circ J. 15 10 2005 ; 69 : suppl IV 1209 1252. 10 Nagao K, Hayashi N, Kammatsuse K, et al : 17 The Antiarrhythmics Versus Implantable Defi- Cardiopulmonary cerebral resuscitation using brillators AVID Investigators. A comparison of emergency cardiopulmonary bypass, coronary antiarrhythmic-drug therapy with implantable repurfusion therapy and mild hypothermia in defibrillators in patients resuscitated from near- patients with cardiac arrest outside the hospital. fatal ventricular arrhythmias. N Engl J Med J Am Coll Cardiol 2000 ; 36 : 776 783. 1997 ;337 : 1576 1584. 11 III. 18 S. J. Connolly, A. P. Hallstrom, R. Cappato, et al;. 1 Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials Eur 1998 ; 87 : 98 104. Heart J 2000; 21: 2071 2078. 12 6 19 Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, et al: Prophylactic implantation of a defibrillator in patients with myocardial p218 224 infarction and reduced ejection fraction. N Engl 1995 J Med 2002 ; 346 : 877 883.

9 13 Myerburg RJ, Kessler KM, Castellanos A. 20 Bardy GH, Lee KL, Mark DB et al : Amiodarone Sudden cardiac death: epidemiology, transient or an Implantable Cardioverter Defibrillator for risk, and intervention assessment. Ann Intern Congestive Heart Failure. N Engl J Med 2005 ;. Med 1993 ; 119 : 1187 97. 352 : 225 237. 14 Valenzuela TD, Roe DJ, Nichol G, et al : Outcome 21 Tanno K, Miyoshi F, Watanabe N, et al: Are the of Rapid Defibrillation by Security Officers After MADIT II Criteria for ICD Implantation Cardiac Arrest in Casinos. N Engl J Med Appropriate for Japanese Patients? Circ J 2005;. 2000 ; 343 : 1206 1209. 69 : 19 22. 15 Page RL, Joglar JA, Kowal RC, et al : Use of Automated External Defibrillator by a Airline. N Engl J Med 2000 ; 343 : 1210 1216.. + DR. 21700 BZG00032000. + DR. 21700 BZG00033000. / 3-39-4. 11. NO2 3:23 PM 12.. ICD .. ICD .. Implantable Cardioverter 1 . Defibrillator = ICD .. Dr. Mirowski . 1980 . ICD . ICD .. 1 ICD. ICD ICD .. 2000. ICDs with 1997/8 Cardiac 2002.

10 Dual- Resynch MADIT-II. Chamber 1989 ICDs 90,000 1980 Transvenous Size First Leads Reduction 80,000 Human Biphasic AVID. 1985. 70,000 Implant Waveform CASH. FDA CIDS. 1993. 60,000 Approval of Smaller 1999. ICDs 50,000 Devices AT Therapies 1988 MUSTT. 40,000. Tiered 1996. 30,000 Therapy MADIT. 20,000 Steroid-eluting Leads Increased Diagnostic 10,000 and Memory Capacity . 0. 1980 1985 1990 1995 2000 2002. Number of Worldwide ICD Implants Per Year (Ref: Corporate Market Share Database). 2 ICD . 12. NO2 3:23 PM 13. ICD . 30 35 J . 4 . ICD . ICD . ICD .. ICD .. ICD .. 2 . St Jude Medical . ICD 3 . 1996 ICD .. 2000 ICD . Atlas 4 . EpicTM. ICD . 3 St Jude Medical ICD 8 shock on T . ICD . ICD .. ICD ICD . ICD .. ICD 2 5 .. ICD ICD .. QRS . P .. cardioversion . J 10 J . ICD T . 13. NO2 3:23 PM 14. shock on T . QRS ICD .. 45 1 . ICD AIDS .. 3 5.. ICD . 2 3 . ICD . 2 .. ICD . 5 .. ICD 4- 6 .. Log rank test Probability of Survival P = Defibrillator Conventional 0 1 2 3 4. RISK. Year Defibrillator 742 503 274 110 9.