I Can See Health

Remember [new] in one second! Is this the strength of the students in the training class?

Ding Chaobing began to re-examine this training class...

Even young people like Lu Chen have such terrifying intervention skills. What about those slightly older colleges?

"No wonder everyone is sharpening their heads and getting into the training class." Ding Chaobing shook his head secretly, "If everyone is at this level, it would be really scary."

"Teacher...Teacher? Teacher!" Lu Chen called three times in a row before Ding Chaobing came back to his senses.

"What's wrong?"

"Teacher, my mapping test is over."

Ding Chaobing quickly said: "Okay, you continue to do the next dissolution."

Lu Chen was slightly startled. Was he allowed to do the ablation himself?

In the entire operation, only the guidewire part was performed by Ding Chaobing. All other operations were done by Lu Chen!

Lu Chen nodded quickly and said: "Okay!"

As an assistant, this is a great opportunity!

There are also director-level doctors on the side to help watch. If there are any mistakes, they can point them out immediately.

In fact, there are many levels of assistants, such as i assistant, ii assistant, etc.

In addition, according to the level of participation of the assistant, it can also be divided into beginner, intermediate and advanced levels.

Generally, the most junior assistants are delivering things and running errands.

Intermediate assistants assist the surgeon in completing some operations, which is what most assistants currently do.

The senior assistant is different. He can complete most operations under the guidance of a superior physician. In other words, the main surgeon is on the sidelines and all operations are completed by the assistant.

Although all operations are performed by assistants, they must be under the guidance of a superior doctor.

When the superior doctor is no longer available, it can be said that the operation is performed alone.

As long as there is any senior doctor standing by, it is not considered a solo operation, but can only be regarded as an assistant.

Now Lu Chen is not qualified to be a surgeon, but he has grown into a senior assistant!

…

"Start to melt!" Lu Chen encouraged himself in his heart.

The tricuspid valve annulus and the isthmus of the inferior vena cava entrance were facing Lu Chen, clearly exposed, and ablation landmarks were set up.

The mapping catheter is marked from the end of the tricuspid valve annulus to the small A wave and large V wave and is ablated point by point along the landmarks at the end of the inferior vena cava. Each point is ablated for about 30 seconds. It is observed that the amplitude of the A wave decreases by more than 50% or double potential occurs. Ablate a little further downward, with a point spacing of about 3 to 5 mm.

The temperature during ablation was set to 60c.

The end point of ablation is complete linear damage and complete bidirectional conduction block.

After ablation, pacing was performed on both sides of the ablation line to make electroanatomical diagrams. Based on the conduction sequence on the activation or conduction diagram, the amplitude lower than 0.5mv during bipolar recording, and the presence of wide atrial bipotentials, it was judged whether the linear injury was completely blocked.

Ding Chaobing was a little puzzled when he saw Lu Chen's operation.

The most basic ablation method at present is to perform linear ablation on the narrowest part of the atrial flutter reentrant ring, that is, the isthmus between the tricuspid valve annulus and the entrance of the inferior vena cava.

However, Lu Chen took a different approach and used complete bidirectional conduction block in the isthmus after ablation as the end point of treatment.

This method made Ding Chaobing a little confused.

"Wait a minute." Ding Chaobing stopped Lu Chen. He was not only the examiner this time, but also the chief surgeon. He couldn't see something unexpected happening. "Why not around the coronary sinus ostium, or in the room?" Linear ablation of the narrowest part of the reentrant loop?”

After hearing Ding Chaobing's voice, Lu Chen listened to the movements in his hands.

He thought for a long time, looked up at the confused Ding Chaobing, and said: "Through the previous electrocardiogram and arrhythmia mapping, I think this typical atrial flutter reentry ring surrounds the tricuspid valve in the right atrium, and the activation sequence is Counterclockwise, activation is conducted from bottom to top in the septal part of the right atrium, while in the free wall it is conducted from top to bottom.”

Ding Chaobing nodded slightly, then frowned and said, "You are right, but what does this have to do with your choice of this method?"

Lu Chen paused, then smiled and said: "For this kind of patient, look for the local potential around the coronary sinus ostium that is earlier than the F wave in leads ii, iii, and avf of the inferior wall, and use the concealed entrainment method to establish it as slow Using the exit of the conductive area as the target, the ablation success rate is about 80%, and the recurrence rate is high.”

"Linear ablation is performed in the narrowest part of the atrial flutter reentry ring, that is, the isthmus between the tricuspid valve annulus and the entrance of the inferior vena cava, with a success rate of 80% to 90%. This method has become the basic method for atrial flutter ablation. Although there are many High short-term success rate, but high follow-up recurrence rate, 10% to 40%.”

Although the success rate of the first two methods is high, the recent recurrence rate is also very high!

Patients are generally very reluctant to undergo secondary surgery.

The first operation does not completely cure the disease, and many patients give up on the second operation.

This is very detrimental to the entire treatment.

Lu Chen's eyes were bright and he continued: "However, with my method, which uses complete bidirectional conduction block in the isthmus after ablation as the end point of treatment, the recurrence rate of atrial flutter can be reduced to 5%!"

Ding Chaobing was stunned for a moment, then frowned.

He is a senior interventional electrophysiologist, and he will not be intimidated by a few words from a student.

"Where did you get these data? Which document? Who is the author?"

In Ding Chaobing's memory, he had never seen such documents or data.

Doctoring is an extremely rigorous discipline!

Any treatment measure requires strict evidence-based medical demonstration.

Lu Chen paused, and he also felt a little shushed in his heart.

Where does this data come from?

It's not just what he read in some papers or documents, it's all what he learned through countless trainings in the system's virtual space.

He can arrange patients with various arrhythmias in the system's virtual space, then conduct different mapping methods, different ablation precautions, and finally compare the effects.

This kind of training efficiency cannot be compared with the simulated operating room in reality!

Therefore, Lu Chen slowly figured out that different ablation methods have different prognosis for patients.

However, now facing Ding Chaobing's inquiry, Lu Chen could only give a perfunctory answer and said: "I once read through documents and reports at UU Kanshu www.uukanshu.net. The data I am talking about comes from this."

In an ambiguous sentence, as for which journal and which author, Lu Chentang hesitated.

Ding Chaobing frowned and continued to ask: "Not to mention where you come from these data. According to what you said, the halo electrode placement requires certain skills. The distal end cannot cross both sides of the ablation line, and the tricuspid valve annulus There are individual differences in the size of the right atrium, so there are limitations in judging whether there is complete bidirectional block in both directions.”

Lu Chen responded: "There are advantages, but there are limitations. In addition, my method avoids unnecessary multiple discharges by marking the original ablation point. And it can be marked along the ablation line, without the need for x-rays , find the leakage point accurately.”

…

As the chief surgeon, Ding Chaobing decides the patient’s ablation method.

Currently, there are two roads before him.

First, use the conventional method to perform linear ablation in the narrowest part of the atrial flutter reentry circle!

Second, choose what Lu Chen said, using complete bidirectional conduction block in the isthmus after ablation as the treatment endpoint!

Which method should be used?