I can see health

Chapter 404
In the catheterization room, the atmosphere became somewhat delicate.

Lu Chen paused, his brows were slightly frowned, and he would think of the ECGs he had seen before, and he felt at ease again, and said, "Teacher, I'm sure."

"Okay, next you will induce positioning." Ding Chaobing's expression was still very calm.

There is no fixed method of ablation for each patient.

Individual variability is different, and the origin of arrhythmia is also different.

What clinicians need to do is to find as many origins of arrhythmia as possible, map and process them, and finally perform radiofrequency ablation.

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

If there are few places to map and few ablation parts, it is likely to induce arrhythmia.

Clinically, the probability of this recurrence is not low, most of which are because too few ablated sites!
However, if more places are mapped and more parts are ablated, the damage to the heart will also increase!

Ablation, after all, is an interventional operation.

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

The larger the ablated part, the greater the damage!

Therefore, if you grasp the correct ablation site, it is one of the most difficult points in ablation surgery!

Unless you have rich surgical experience, it is extremely rare to do this.

Lu Chen took a deep breath, and then let it out slowly.

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

However, the electrophysiology training class and the central hospital can be assured that the assistant can do such a difficult operation.

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

The chief surgeon, that is, the examiner, will conduct assessments at any time based on the performance of each student.

At the same time, the examiner is also responsible for the safety of the patient.

After all, the most dangerous part of electrophysiological intervention is puncture. After puncture, other risks are small and controllable.

Moreover, if Lu Chen did not pass the first few operations, then he is not qualified to take the final assessment at all.

……

Lu Chen concentrated his mind, prepared all the equipment, and began to perform calibration and positioning.

Electrodes were placed on the patient's back, slightly to the left of the spine at the level of the seventh thoracic vertebra, for anatomical reference.

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

Lu Chen selected bipolar electrograms recorded by coronary sinus electrodes as reference electrograms, and the electrodes entered through the left subclavian vein. IC1 ~ IC2 lead records, A wave amplitude is significantly greater than the V wave, take the maximum amplitude as the base point.

During the operation, it is still necessary to maintain a stable intracardiac electrogram 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 heart rate changes wholeheartedly.

"The mapping catheter 7F Navi-Star (Cordis Webster) was inserted into the right atrium through the right femoral vein under the guidance of X-ray. IC3-IC4 were bipolar intracardiac electrograms."

He has trained many times in the simulated operating room before, including the entry of guide wires, induction and positioning of arrhythmias.

But this is all carried out under perfect conditions, and the actual clinical cases may be different.

Lu Chen noticed that this patient was very fat, and his breathing was more than normal.

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

Don't look at the displacement is not big, but the impact is not small!
Under fluoroscopy, Lu Chen mapped the entrance of the superior and inferior vena cava, the ostium of the coronary sinus, and the bundle of His in the right atrium, and mapped 3 to 5 points on the tricuspid annulus.

The mapping catheter is then moved non-fluoroscopically and the point is sampled when contact with the endocardium has stabilized.

On the side, Ding Chaobing also stared at Lu Chen without blinking his eyes. The final thing at present is the stability of the mapping.

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

It is also necessary to stabilize the location of the mapping, and its stability directly affects the quality of point selection and mapping.

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

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

At this time, it is displayed in the three column frames above the relevant window on the screen, and is dynamically represented by red and green. The more green, the better the stability.

After Lu Chen finished the mapping, most of the screen window was filled with green!

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

Outside the catheter, a group of onlookers looked at the green color on the screen and sighed, "This stability is really amazing!"

Regardless of the reactions around him, Lu Chen couldn't see him in the catheterization room.

He continued to concentrate and began the final mapping of other parts.

……

In Jinghua No. [-] Hospital, thousands of miles away, Li Yao also received the news that today is the weekly exam for the training class.

Don't look at this training class with less than 40 people, but there are quite a few people staring at it from all over the country.

However, there was no live broadcast of the assessment process, and it would only be announced one hour after the assessment ended.

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

On the other side of the training class in Kyoto, she didn't know what was going on, and she still couldn't feel at ease.

I don't know when it started, but her expectations for Lu Chen have been getting higher and higher.

In the past, I just hoped that he could enter the semi-finals of the electrophysiology competition.

Later, it was the finals.

Up to now, with the "miracles" created by Lu Chen, Li Yao also values ​​herself as a student more and more.

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

Although Lu Chen performed well, most of the time he was disinfected and punctured, and occasionally he was asked to perform catheter operations.

"The training class is the best in the field of electrophysiology in China!" Li Yao sighed inwardly, "Oh, do you know how Lu Chen is doing?"

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

"It's good for you not to give up your quota now." Chen Tairan half-lyed on the chair, crossed his hands, and leaned on the back of his head, "This time, you won't pass the weekly exam!"

Chen Tairan learned from his friends in Kyoto that today's weekly exam is actually a clinical exam!

He has learned about some of Lu Chen's current achievements, and he is considered a pretty good young genius.

But Lu Chen's specific electrophysiological intervention strength, he didn't know.

From Chen Tairan's point of view, no matter how smart Lu Chen is, it's impossible for him to break out from the group of attending doctors and deputy chief physicians, right?

"Hehe, I went to the capital for a week, and then came back in disgrace." Chen Tairan smiled in his heart, "There is no need for me to do it myself."

……

Kyoto Central Hospital.

Cardiology cath lab.

Lu Chen has completed all the mapping, and then said to Ding Chaobing: "The mapping is over. According to the three stability standards, we can eliminate the points that do not match, and move the boundaries in the relevant window to correct the excitation time and cancel premature beats. Recording points. Make a mark at the place where there is a bipotential A wave, and the place where the bipotential A wave appears is the position of the boundary crest or Euclidean crest."

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

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

(End of this chapter)