I can see health

Chapter 425 Strange Cases
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, which is a good start.

However, the amount of surgeries completed by Lu Chen was obviously less than that of others.

"Ms. Xiao, is there an operation tomorrow?" Lu Chen found Xiao Shikang.

He can't sit still!
Xiao Shikang was in the office. When he looked up and saw Lu Chen, he smiled, "Tomorrow, there is an operation, but you may not have time."

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

"Tomorrow there will be a discussion on difficult electrophysiological cases, which will be jointly organized by many hospitals in Kyoto." Xiao Shikang said, "At that time, all the students in your training class will have to participate."

"Discussion on difficult cases?" Lu Chen frowned.

"Well, it's a very complicated patient." Xiao Shikang smiled, "The main reason for you to 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 let go of the idea of ​​surgery.

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

The conference hall next to the catheterization room of the Cardiology Department.

Most of the electrophysiological doctors in the Department of Cardiology came to the meeting.

Lu Chen also saw Fang Ruzhang who came to attend the conference. He led several students from Corey into the conference hall.

However, the distance between the two was relatively far, so Lu Chen didn't say hello.

At a quarter past three, the Difficult Cases Conference officially began.

On the large screen in the conference hall, pictures from the cardiology departments of more than ten hospitals in Kyoto were displayed.

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

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

This difficult case comes from Kyoto Central Hospital.

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

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

"Due to repeated ventricular tachycardia caused by ischemic cardiomyopathy, he received radiofrequency ablation and ICD implantation (implantable cardioverter defibrillator, a pacemaker that can monitor malignant arrhythmias and perform internal defibrillation in time) .”

"ICD can save a patient's life through electrical defibrillation at a life-threatening moment."

But because of the patient's repeated ventricular tachycardia and ventricular fibrillation, the patient was shocked many times in succession, which made him have extremely serious fear!

I even saw the medical staff, the EKG machine and the pacemaker programmer telling him not to "shock" him.

However, after the staff adjusted the defibrillation parameters, the patient would experience repeated low-frequency ventricular tachycardia, resulting in lower blood pressure and palpitation and fatigue.

Repeatedly, the patient and his family are on the verge of collapse.

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

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 was asked, the doctors from the Kyoto City People's Hospital immediately spoke up.

"Hi everyone, I am a cardiologist studying at the Kyoto Municipal People's Hospital."

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

"Boge 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 all 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 repeat the problem of ventricular tachycardia, he has to do radiofrequency ablation again! Drugs or ICDs are not good enough."

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

But problems also follow, frequent episodes of ventricular tachycardia will 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 satisfactory.

With the continuous development of catheter ablation, it has become a treatment that can effectively control VT.

Min Xiaobo's words also won the approval of everyone.

"Well, I feel good too, I still have to ablate!"

"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 it is difficult for patients to bear the pain of continuous "discharge".

In the audience, Lu Chen also agreed with Min Xiaobo's opinion that only by radiofrequency ablation to clear up the source of ventricular tachycardia can it be done once and for all.

Next, doctors from several hospitals spoke.

Their conclusions are similar to Lu Chen's, they all advocate continuing to do radiofrequency ablation!

"Ding ding..."

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

I didn't plan to read it, but seeing the message from Min Xiaobo on the screen, Lu Chen turned on the 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, Boge, there is still a chance, I will speak later."

"That's good!"

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

Lu Chen was waiting for the most appropriate moment.

……

For the patient's treatment method, everyone discussed for more than ten minutes, and finally chose unanimously, and ablated again!

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

"Under sedation, after the patient underwent routine cardiac electrophysiological examinations, the ventricular tachycardia was easily induced, the heartbeat suddenly "jumped" to 230-240 beats per minute, and the blood pressure dropped to 50/40 mm Hg, the procedure was terminated. Continue to check 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 quieted down and watched the electrophysiology report.

The host didn’t hold back, and continued: “After careful inspection by our professional electrophysiological team in the cath lab, we considered the source of VT from the left ventricle, carefully searched, mapped, ablated, and re-examined to induce another form of VT. After the team Analyze and consider the source of the epicardium!"

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, I encountered another ventricular tachycardia originating from the epicardium!
I really met myself!

……

As soon as the host's voice fell, everyone whispered in the conference room.

Ventricular tachycardia of epicardial origin, uncommon!

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

Both are arrhythmias originating from the epicardium!
On the screen, the host said again: "For arrhythmias originating from the epicardium, do you have any good surgical advice?"

This is the focus of this case discussion.

How to do radiofrequency ablation for ventricular tachycardia originating in the epicardium?

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

And the atmosphere in the First Affiliated Hospital of Kyoto University was terrifyingly quiet!
Everyone seems to be sitting in their seats with confidence, not having much communication with the people around them.

(End of this chapter)