I Can See Health

Remember [new] in one second! In the next few days, under the guidance of Xiao Shikang, Lu Chen completed the first operation - the implantation of a dual-chamber pacemaker.

The operation went very smoothly and was a good start.

However, the number of operations performed by Lu Chen was obviously less than that of others.

"Teacher Xiao, are there any surgeries tomorrow?" Lu Chen found Xiao Shikang.

He can't sit still and wait for death!

Xiao Shikang was in the office. When he looked up and saw Lu Chen, he smiled and said, "There is an operation tomorrow, but you may not have time."

"Ah? I don't have time?" Lu Chen asked doubtfully.

"There will be a discussion on difficult electrophysiology cases tomorrow, which is jointly organized by multiple hospitals in Kyoto." Xiao Shikang said, "At that time, all the students in your training class will be required to participate."

"Discussing difficult cases?" Lu Chen raised his eyebrows.

"Well, he is a very complicated patient." Xiao Shikang smiled, "The main reason for letting you participate is to improve your knowledge and provide some ideas. This is also one of the important indicators of the assessment!"

Lu Chen nodded and gave up the idea of ​​surgery.

The next day, three o'clock in the afternoon.

The conference room next to the Cardiology Catheterization Laboratory.

Most doctors from the cardiology department who specialize in electrophysiology came to attend the meeting.

Lu Chen also saw Fang Ruzhang, who came to attend the meeting. He took several students from Corey and walked into the conference hall.

However, the distance between the two was quite far, so Lu Chen did not say hello.

At 3:15, the conference on difficult cases officially begins.

On the big screen in the conference hall, images of cardiology departments from more than a dozen hospitals in Kyoto were displayed.

Among them are Kyoto Central Hospital, Kyoto University Second Affiliated Hospital, and Kyoto People's Hospital.

In short, all hospitals with relatively good reputations participated, and some small hospitals also came to join in the fun.

The difficult case this time came from Kyoto Central Hospital.

On the screen, the host from the Department of Cardiology at Kyoto Central Hospital began to introduce the patient's condition.

"The patient is a 60-year-old male."

"Due to recurrent ventricular tachycardia caused by ischemic cardiomyopathy, I underwent radiofrequency ablation and ICD implantation (implanted cardioverter-defibrillator, a pacemaker that can monitor malignant arrhythmias and perform timely internal defibrillation) "

"ICD can save the patient's life through electric defibrillation in critical moments."

However, because of the patient's repeated ventricular tachycardia and ventricular fibrillation, the patient was shocked multiple times in succession, which caused him to develop extremely serious fear!

Even the medical staff, electrocardiograph and pacemaker programmer told him not to "shock" him.

However, after the staff adjusted the defibrillation parameters, the patient experienced repeated low-frequency ventricular tachycardia, resulting in lowered blood pressure, palpitations and fatigue.

Repeatedly, patients and their families are on the verge of collapse.

This time, in order to completely solve the problem, the patient came to Kyoto Central Hospital.

On the screen, the host on stage began to ask questions.

"How to completely solve the problem of repeated ventricular tachycardia in patients?"

As soon as the question came out, doctors from Kyoto Municipal People's Hospital immediately spoke out.

"Hello everyone, I am a cardiologist studying at Kyoto City People's Hospital."

Lu Chen felt that the voice was familiar. When he looked up, it was Min Xiaobo who spoke!

"Brother Bo is really positive..."

This is all because this case discussion will be included in the second stage of assessment.

Therefore, the students from the training class are gearing up, ready to go, and ready to express themselves.

On the screen, Min Xiaobo talked eloquently: "I think that if this patient wants to completely relapse the ventricular tachycardia problem, the only way is to undergo radiofrequency ablation again! Neither drugs nor ICD will work."

With the advent of the implantable cardioverter defibrillator (icd), the incidence of sudden cardiac death has been greatly reduced.

But problems also arise. Frequent episodes of ventricular tachycardia can cause "icd electrical storm", which not only shortens the service life of icd, but also increases the mortality of such patients.

Although antiarrhythmic drugs can reduce the incidence of ventricular tachycardia, the effect is not ideal.

As catheter ablation continues to evolve, it has become an effective treatment method for controlling ventricular tachycardia.

Min Xiaobo's words also received approval from everyone.

"Well, I feel pretty good too, but I still need to melt!"

"ICD is a good thing, but this patient can't bear it."

"However, it is very difficult to ablate patients with isolated ventricular tachycardia!"

ICD can solve the problem of ventricular tachycardia, but patients cannot bear the pain of continuous "discharge".

In the audience, Lu Chen also agreed with Min Xiaobo's view that only by clearing the origin of ventricular tachycardia through radiofrequency ablation can it be solved once and for all.

Next, doctors from several hospitals spoke.

Their conclusion was similar to Lu Chen’s, both advocating continuing radiofrequency ablation!

"Ding ding..."

Lu Chen suddenly felt his phone vibrate, and the WeChat notification sounded.

He didn't intend to read it, but when he saw the message from Min Xiaobo on the screen, Lu Chen opened his phone anyway.

"Lu Chen, you have to speak too! Your performance this time will be recorded in the assessment results."

Lu Chen smiled and immediately replied: "Don't worry, Brother Bo, there is still a chance. I will speak later."

"That's good!"

This patient cannot be that simple, otherwise there would be no need to focus on the discussion.

Lu Chen was waiting for the most appropriate time.

…

Everyone discussed the patient's treatment method for more than ten minutes, and finally unanimously chose another ablation!

At this time, the host from Kyoto Central Hospital began to speak again: "The result of the discussion in our department was the same as everyone said, which was to perform ablation. On the fourth day after the patient was admitted to the hospital, we performed the surgery on him. "

"Under sedation, after the patient underwent routine cardiac electrophysiological examination, ventricular tachycardia was easily induced, the heartbeat suddenly "jumped" to 230-240 beats/min, and the blood pressure dropped to 50/40 mmHg. Continue checking later.”

After speaking, the host took out an electrophysiological examination report.

"Everyone can take a look and analyze the origin of the patient's ventricular tachycardia."

After the examination report came out, everyone calmed down and watched the electrophysiology report.

The host did not sell out, and continued: "After careful examination by our professional electrophysiology team in the cath lab, the left ventricular source of ventricular tachycardia was carefully searched, mapped, ablated, and another form of ventricular tachycardia was induced through re-examination. After the team Analyze and consider the epicardial source!”

Epicardial origin?

Hearing the host's words, Lu Chen had a strange expression on his face.

During the assessment, the atrial fibrillation he encountered originated from the epicardium.

Not long after this, I encountered another ventricular tachycardia of epicardial origin!

It really happened to me!

…

As soon as the host finished speaking, everyone in the UU Reading www.uukanshu.net conference room began to whisper.

Ventricular tachycardia originating from the epicardium is uncommon!

While everyone was surprised that the origin of ventricular tachycardia was rare, some doctors who had watched the electrophysiological examination all thought of Lu Chen's examination!

They are also arrhythmias originating from the epicardium!

On the screen, the host said again: "Do you have any good surgical advice for arrhythmias originating from the epicardium?"

This is the focus of this case discussion.

How to perform radiofrequency ablation for ventricular tachycardia originating from the epicardium?

Except for Kyoto University First Affiliated Hospital, all other hospitals started extremely heated discussions.

The atmosphere at Kyoto University First Affiliated Hospital is eerily quiet!

Everyone seemed to be sitting confidently in their seats without much interaction with the people around them.