2017.04.17 [心內] 各種 PPM indication

PPM

common indication:
 1.Sinus node disease(SND), or Sick Sinus Syndrome(SSS)
 2.High degree AV block (Mobitz II& 3rd AVB)
 3.Chronotropic incompetence

**補充: AV node dysfunction
First degree AV block
 PR > 200ms
Second degree AV block
 -Mobitz type 1 (PR 漸長)
 -Mobitz type 2 (PR 固定)
 **2:1 AV block難以區分2度1 或2度2
Third Degree AV block= complete AV block

Bifasicular/Trifasicular block

ICD (Implantable cardiac defibrillator)

common indication:
sustained VT w/ hemodynamically unstable
cardiac arrest due to VF

post MI且LVEF<=35%,並有NYHA Fc II-III
post MI且LVEF<=30%,並有NYHA Fc IV

健保給付規定:
1.嚴重VT、Vf導致猝死可能或昏迷
2.反覆發作之持續性VT
3.高危險性心臟血管疾病: post MI且LVEF<=40%, HCM,DCM且合併VT
4.高危險性心臟遺傳疾病 如LQTS,SQTS,Brugada Syndrome、ARVC、CPVT

CRT (cardiac re-synchronized therapy)

common indiciation:
1.Sinus rhythm+ CLBBB(QRS >=0.12sec) 且LVEF<=35%且NYHA III-IV
2.Af+ CLBBB(QRS >=0.12sec) 且LVEF<=35%且NYHA III-IV經藥物無法善者
3.心室節律器依賴之病患,且LVEF<=35%且NYHA III-IV經藥物無法善者