I can see health

Chapter 405 Ding Chaobing's Choice
Is this the strength of the training class students?

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 students?
"No wonder everyone has sharpened their heads and drilled into the training class." Ding Chaobing shook his head secretly, "If everyone is at this level, it will be really terrifying."

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

"what happened?"

"Teacher, my mapping is over."

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

Lu Chen was taken aback for a moment, did Rong Rong let him do it himself?
Then the entire operation, only the step of entering the guide wire, was done by Ding Chaobing, and Lu Chen took care of all the other operations!
Lu Chen nodded quickly and said, "Okay!"

As an assistant, this is a good opportunity!
Not only can you try your hands, but there are director-level doctors on the side to help you watch, and if you make mistakes, you will point them out immediately.

In fact, there are many levels of assistants, such as I assistant, II assistant and so on.

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

Generally, the most junior assistant is to pass things.

Intermediate-level assistants assist the surgeon in completing some operations, not very important operations, such as disinfection, draping, and occasional puncture. This is what most assistants do at present.

The senior assistant is different, he can complete most of the operations under the guidance of the superior physician.In other words, the chief surgeon is on the sidelines, and all operations are done by assistants.

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

The current Lu Chen is not yet qualified to be the chief surgeon, but he has grown into a senior assistant!
……

"Start melting!" Lu Chen cheered himself up in his heart.

Opportunities like this don't come around very often, so grab them!

The annulus of the tricuspid valve and the isthmus of the entrance of the inferior vena cava are facing Lu Chen, which is clearly exposed, and ablation road signs are set.

The mapping catheter was used to ablate the inferior vena cava point by point from the end of the tricuspid valve ring to the small A wave and the large V wave. Each point was ablated for about 30 s, and the A wave amplitude was observed to decrease by more than 50% or bipotentials appeared. , and then ablate a little further down, with a point spacing of about 3-5 mm.

The temperature for ablation was set at 60 °C.

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, and electroanatomical maps were taken. According to the conduction sequence on the excitation or conduction map, the amplitude of bipolar recording was lower than 0.5 mV, and the presence of wide atrial bipotentials was used to judge whether the linear injury was completely blocked.

Ding Chaobing looked at Lu Chen's operation and was a little puzzled.

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

However, Lu Chen took a different approach, taking complete bidirectional conduction block in the isthmus after ablation as the treatment endpoint.

This method made Ding Chaobing a little confused.

"Wait a minute." Ding Chaobing stopped Lu Chen. He is not only the examiner this time, but also the chief surgeon. He can't see what he didn't expect. "Why not around the coronary sinus or in the room?" Linear ablation of the narrowest part of the reentry loop?"

After hearing Ding Chaobing's voice, Lu Chen stopped what he was doing.

He thought for a while, looked up at Ding Chaobing who was puzzled, and then said: "Through the previous electrocardiogram and arrhythmia mapping, I think that the reentrant ring of a typical atrial flutter surrounds the tricuspid valve in the right atrium, and the sequence of activation is In a counter-clockwise direction, activation of the septum in the right atrial septum conducts from inferior to superior, while in the free wall it conducts from superior to inferior."

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 patients, look for local potentials around the coronary sinus ostium that are earlier than the F waves in leads II, III, and aVF of the inferior wall, and use the concealed entrainment method to establish the slow potential." The outlet of the conduction zone is used as the target, and the ablation success rate is about 80%, and the recurrence rate is high."

"In the narrowest part of the atrial flutter reentry ring, that is, the isthmus between the tricuspid annulus and the entrance of the inferior vena cava, linear ablation is performed with a success rate of 80% to 90%. This method has become the basic method for atrial flutter ablation. Although there are many The short-term success rate is high, but the follow-up recurrence rate is high, ranging from 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 is not completely cured, and many patients will give up the second operation.

This is very detrimental to the whole treatment.

Lu Chen stared brightly, and continued: "However, with my method, complete bidirectional conduction block in the isthmus after ablation is used as the treatment endpoint, and the recurrence rate of atrial flutter can be reduced to 5%!"

Ding Chaobing was taken aback for a moment, then frowned.

He is a senior electrophysiological interventional doctor, and he will not be fooled by a student's few words.

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

In Ding Chaobing's memory, he has never read such documents, let alone these data.

Doctor is an extremely rigorous discipline!

Any treatment measures need to be strictly demonstrated by evidence-based medicine.

Lu Chen paused for a moment, and he also felt a little booed.

Where do these data come from?

He didn't read any papers and documents, but he learned from countless trainings in the virtual space of the system.

He can arrange patients with various arrhythmias in the virtual space of the system, and then perform different mapping methods, different ablation prevention methods, and finally compare the effects.

This kind of training efficiency is incomparable in the simulated operating room in reality!
Therefore, Lu Chen also slowly figured out that different ablation methods have different prognosis for patients.

However, facing Ding Chaobing's question now, Lu Chen could only say a word in a perfunctory manner, "I once read a document and read the report. The data I said came from this."

An ambiguous sentence, as for which journal and which author, Lu Chentang blocked it.

Ding Chaobing frowned, and continued to ask: "Let's not talk about where your data come from. Do as you said, Halo electrode placement requires certain skills, the distal end cannot cross the sides of the ablation line, and the tricuspid annulus There are individual differences in the right atrium and the size of the right atrium, so there are limitations in judging whether there is complete bidirectional block in both directions."

However, Lu Chen responded: "If there are advantages, then there will be limitations. In addition, my method avoids unnecessary multiple discharges by marking the original ablation point. It can also mark along the ablation line without X-rays." , to find the leak point exactly.”

……

As the chief surgeon, Ding Chaobing decided on the ablation method for the patient.

Currently, there are two roads ahead of him.

First, choose the conventional one, and perform linear ablation in the narrowest part of the atrial flutter reentry loop!
Second, use what Lu Chen said, taking complete bidirectional conduction block in the isthmus after ablation as the treatment endpoint!
Which method should I use?

Ding Chaobing hesitated, but after careful consideration, he made a decision.

Choose the regular first one!
In the field of medicine, winning in stability is the way.

The second method is not mature yet.

If they fail, they may face questions and complaints from patients.

(End of this chapter)