I Can See Health

Remember [new] in one second! In the catheterization room, the atmosphere became a little subtle.

Lu Chen paused, frowning slightly, remembering the electrocardiograms he had seen before, and feeling calm again, he said, "Teacher, I'm sure."

"Okay, now you're going to induce positioning." Ding Chaobing's expression was still very calm.

There is no fixed ablation method for each patient.

Individual differences vary, and the origins of arrhythmias vary.

What clinicians need to do is to find as many origin points of arrhythmias as possible, map them, and finally perform radiofrequency ablation.

The risk of this step is not high, but it is very difficult to do it perfectly.

If there are few mapping areas and few ablation parts, it is likely to induce arrhythmia.

Clinically, the probability of recurrence is not low, mostly because the ablation sites are too few!

However, if there are many places marked and ablated, the damage to the heart will also become greater!

Ablation is, after all, an interventional procedure.

As long as it is an invasive operation, it will inevitably cause some damage to the organs.

The larger the ablated part, the greater the damage!

Therefore, knowing the correct ablation site is the most difficult part of ablation surgery!

If you have long-term clinical experience or rich surgical experience, otherwise it is extremely rare to achieve this.

Lu Chen took a deep breath and then slowly exhaled.

This is a real clinical case, not his previous training in simulated surgery!

However, this electrophysiology training class and the central hospital are relieved that they can actually allow assistants to perform such difficult operations.

In fact, what Lu Chen didn't know was that every operation had a certain process.

If the first few operations fail, then he is not qualified to conduct the final review.

…

Lu Chen concentrated, prepared all the equipment, and started mapping and positioning.

The electrodes were placed on the patient's back, slightly to the left of the spine at the level of the seventh thoracic vertebra, as an anatomical reference.

Under X-ray fluoroscopy, the electrode head is located in the center of the heart shadow.

Lu Chen chose bipolar recording electrograms with coronary sinus electrodes as a reference electrogram, and the electrodes entered through the left subclavian vein. Recorded from leads ic1 to ic2, the amplitude of a wave is significantly larger than that of v wave, and the maximum amplitude is taken as the base point.

During the operation, stable intracardiac electrogram recording must still be maintained to ensure that the system recognizes continuous a-wave signals.

"This kid is really good." Ding Chaobing nodded slightly inadvertently. With his high vision, it is not easy to praise someone.

At this time, Lu Chen was still staring at the patient's ECG changes wholeheartedly.

"The mapping catheter 7fnavi-star (cordiswebster) enters the right atrium through the right femoral vein under X-ray guidance. ic3~ic4 are bipolar intracardiac electrogram recordings."

He had trained many times in the simulated operating room before, including the introduction of guide wires and the induction and localization of arrhythmias.

But this is all done under perfect conditions, and actual clinical cases are different.

Lu Chen noticed that the patient was very fat and breathed more than normal people.

Changes in the amplitude of breathing will affect the position of the heart in the chest.

Although this displacement is not big, the impact is not small!

Lu Chen mapped the entrances of the superior and inferior vena cava, coronary sinus ostium and His bundle in the right atrium under fluoroscopy, and mapped 3 to 5 points on the tricuspid annulus.

The mapping catheter is then moved under fluoroscopy and the point is sampled when its contact with the endocardium stabilizes.

On the side, Ding Chaobing was staring at Lu Chen without blinking. The final thing now was the stability of the mapping.

Just because the mapping is done, it doesn’t mean it’s over!

The mapping location must also be stabilized, as its stability directly affects the quality of the points taken and the resulting map.

Otherwise, the mapping location will be useless and cannot be ablated.

The stability of the mapping catheter is determined by the stability of the position, local activation time, and cardiac cycle.

At this time, it is displayed in the three-bar frame above the relevant window on the screen, dynamically expressed in red and green. The more green, the better the stability.

After Lu Chen finished the mapping, green took up most of the screen window!

"Oh my god, this mapping method is so accurate!"

Outside the catheter room, a group of people watching looked at the green on the screen and exclaimed, "This stability is really amazing!"

Lu Chen didn't care about the reactions around him, he couldn't see it in the catheterization room.

He continued to concentrate and began mapping the remaining parts.

…

Thousands of miles away in Jinghua Second Hospital, Li Yao also received the news that today was the weekly exam for the training class.

Even though there are less than forty people in this training class, there are quite a few people watching from all over the country.

However, the assessment process was not broadcast live, and will only be announced one after another one hour after the assessment ends.

Li Yao was sitting in the office, holding the bidding document of Guoziran in her hand, but her mind was already far away.

She still couldn't feel at ease as she didn't know what was going on at the Kyoto training class.

She didn't know when she started to have higher and higher expectations for Lu Chen.

In the past, I just hoped that he could become the champion of the electrophysiology competition.

Later, as Lu Chen created one "miracle" after another, Li Yao valued herself more and more as a student.

During the past half year, Lu Chen worked as her assistant several times.

Although Lu Chen's performance was very good, most of the time he was doing disinfection, puncture, etc., and occasionally he was asked to perform intracatheter operations.

"There is a leader in the field of electrophysiology in China in the training class!" Li Yao sighed inwardly, "Hey, do you know how Lu Chen is doing?"

Contrary to Li Yao's worries, Vice Dean Chen Tairan was smiling.

"It's better that you don't give up your quota now." Chen Tairan was half-lying on the chair, with his hands crossed and leaning on the back of his head, "You won't be able to pass the weekly exam this time!"

Chen Tairan learned from a friend in Kyoto that today's weekly exam at UU Reading www.uukanshu.net is actually a clinical exam!

He knew some of Lu Chen's history and was a pretty good little genius.

But Lu Chen didn't know the specific electrophysiological intervention capabilities.

Looking at Chen Tairan, no matter how smart Lu Chen is, it is unlikely that he can break out from the group of attending doctors and deputy chief doctors, right?

…

Kyoto Central Hospital.

Cardiology cath lab.

Lu Chen had completed all the mapping, and then said to Ding Chaobing: "The mapping is over. According to the three stability standards, we will eliminate the inconsistent points and move the boundaries in the relevant window to correct the excitement time and cancel the premature beat time." Recording point. Mark the location where the bipotential a wave appears. The location of the bipotential a wave is the terminal ridge or Euclidean ridge."

Ding Chaobing nodded with satisfaction. Lu Chen's mapping was impeccable.

He wanted to find some problems, but his eyes were almost swollen and he still couldn't see anything wrong.