I Can See Health

Live surgery room.

The medical records of the patients undergoing this operation were also displayed in front of the audience of doctors.

The patient is a 37-year-old male.

He was admitted to the hospital because of "repeated palpitations and breathlessness".

Previously diagnosed as "dilated cardiomyopathy, heart failure, ventricular tachycardia", ICD was implanted and treated with long-term oral anti-heart failure drugs.

ICD is an automatic defibrillator implanted in the human heart. When a malignant arrhythmia is detected, it will automatically discharge and defibrillate.

With every electric shock, the patient suffers great pain.

However, this is a malignant arrhythmia and the only effective way to prevent sudden death!

After this, the patient still had recurring palpitations, which were often triggered by noisy environments or irritable moods.

Each episode lasts about 5-15 minutes, with a heart rate of 170-200 beats/min. During the attack, the blood pressure is low and amaurosis appears.

The icd has been discharged more than 60 times!

Each attack will cause the patient to have a strong sense of fear.

If this happens for a long time, his quality of life will be very poor!

…

After carefully analyzing the patient's medical history, the cardiology expert team at Kyoto First Affiliated Hospital considered trying radiofrequency ablation for the patient.

The patient's ventricular tachycardia was ablated so that he would no longer have malignant arrhythmias and no longer receive ICD shocks.

However, the patient's operation was very difficult and risky. Mayo's cardiology experts happened to come and handed it over to them for teaching and demonstration.

But now, he naturally became Lu Chen's surgical patient.

Before the operation, Lu Chen had already seen the patient and carefully analyzed the patient's medical records.

This patient's condition is indeed extremely complex!

First, the patient's heart function is poor, with left ventricular end-diastolic diameter 66mm, EF 27%, low blood pressure (80+/60+mmhg), and poor surgical tolerance!

Ventricular fibrillation is very likely to occur during the operation, leading to cardiogenic shock!

Secondly, the patterns of ventricular tachycardia in patients are diverse and not completely consistent with the patterns of premature ventricular contractions, making mapping extremely difficult.

Finally, the patient has dilated cardiomyopathy, with obvious myocardial remodeling. There may be a large range of scar areas, and the ablation area is large, making it difficult for the ablation catheter to reach the target.

The difficulty of these three operations seriously affects the success rate of the overall operation.

Each of these points is a difficult hurdle to overcome in the Department of Cardiology, Kyoto First Affiliated Hospital.

However, Lu Chen has performed many ablation surgeries of this type.

Whether in reality or in the virtual space of the system, the ablation of special ventricular tachycardia is the main project of his practice.

Therefore, after some short thinking, Lu Chen quickly formulated the best surgical plan.

…

After the puncture, Lu Chen took over Xiao Shikang's position.

The most difficult point of electrophysiological ablation surgery has emerged, which is the mapping and ablation of arrhythmia.

Simply put, mapping is to find the origin of the arrhythmia.

Ablation is to dissolve the origin point.

"Lu Chen, how to prepare for the mapping?"

Mapping is divided into excitement mapping, pacing mapping and matrix mapping.

"Let's find the p site first." Lu Chen fiddled with the instrument in his hand and glanced at Xiao Shikang. "I looked at the patient's electrocardiogram and found that the origin of ventricular tachycardia is quite special. It should be left posterior branch ventricular tachycardia."

The p point is to find a high-frequency, low-amplitude point in the left ventricular septal area that is earlier than qrs.

Xiao Shikang was very familiar with the patient's electrocardiogram and asked: "First use p potential as the target?"

Lu Chen nodded and started to operate.

He placed a grade 20 high-density mapping catheter in the left ventricular septum.

When ventricular tachycardia occurs, two sets of high-frequency potentials can be recorded.

They are p1 potential (located in front of p2 potential, sharp and high-frequency, excited from the proximal end to the distal end), and p2 potential (located behind p1, in front of the local v wave, high-frequency, from the earliest excited site to both sides). Extremely excited).

Xiao Shikang watched Lu Chen's operations closely.

At this time, it’s time to steal the teacher!

The difference between electrophysiology surgeons does not lie in vascular puncture, but in mapping and ablation!

The movements in Lu Chen's hands were slow and unhurried.

The hearts of all the viewers in the live surgery room were nervously raised to their throats.

…

As the operation progressed, Lu Chen began to encounter problems.

He couldn't find the p1 and p2 sites!

The shape of p1 is perpendicular to the left posterior branch, resulting in the machine being unable to record the p1 position at all.

Everyone in the live broadcast room saw the stagnation of Lu Chen's operation and discovered that there was something wrong with the operation.

"Hey, why didn't the mapping come out?"

"The p1 site has not been found, how to map it?"

"This surgeon is not very good, is he? He didn't even find the p-site!"

"Don't make sarcastic remarks here. This patient has a special type of ventricular tachycardia, and no one can find it at once!"

Everyone was a little nervous.

But Lu Chen was calm and unfazed. He glanced at Xiao Shikang beside him and said, "Teacher Xiao, help me measure the hv interval."

Xiao Shikang was stunned, but his hand movements were not slow, "Okay."

During the onset of ventricular tachycardia, the HV interval and the HV interval during sinus rhythm are electrophysiological indicators of great significance.

For left posterior branch ventricular tachycardia, the hv interval has a certain correlation with whether the p1 potential can be recorded and the location of the connection point between the distal end of the p1 potential and the left posterior branch.

The hv interval is mostly negative. The greater the absolute value of the negative hv interval, the easier it is to record the p1 potential.

In addition, the more negative the HV interval is (the greater the absolute value of the negative value), it means that the distal connection point of P1 and P2 is closer to the apex; on the contrary, the HV interval is approximately positive (the greater the positive value), which means that the distal connection point of P1 and P2 is The closer to the bottom of the heart.

The measurement is finished.

Xiao Shikang looked at Lu Chen and read out the values ​​he measured.

Lu Chen nodded slightly and said seriously: "The p potential should be close to the apex of the heart. Teacher Xiao, help me look for it at the apex of the heart."

"Okay." Xiao Shikang immediately started operating.

Sure enough, after five minutes, the two successfully found the p1 and p2 potentials in the heart.

But before the two of them could be happy, the ECG monitor next to the operating room sounded a harsh alarm!

"No, the patient has ventricular fibrillation!"

Lu Chen's face was as dark as water. He immediately put down the operating tools in his hands and began to perform cardiopulmonary resuscitation on the patient.

If a patient suffers from ventricular tachycardia due to this kind of stimulation, ventricular fibrillation is likely to occur!

If mapping is to be successful, it is impossible to avoid the risk of ventricular fibrillation.

"Get the ambulance and defibrillator quickly!"

Xiao Shikang also reacted immediately and quickly called the nurse at the desk.

The nurse acted quickly and immediately pushed over the ambulance and defibrillator. UU Reading www.uukanshu.net

Lu Chen was performing cardiopulmonary resuscitation, and Xiao Shikang on the side picked up the defibrillator.

"I'm defibrillating!"

Xiao Shikang shouted lowly, and Lu Chen immediately moved away.

The two electrode pads of the defibrillator are placed on the patient's chest area.

Charge, discharge!

After a defibrillation, the patient immediately converted to ventricular fibrillation in less than two seconds after returning to sinus rhythm!

In the live surgery room.

Seeing this sudden scene, the audience was a little confused for a while.

Is this the first time for live broadcast rescue?

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