I can see health

Chapter 869 Opening the first live broadcast rescue? (first update)
Surgery Live.

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 dyspnea".

The previous diagnosis was "dilated cardiomyopathy, heart failure, and ventricular tachycardia". After implantation of ICD, long-term oral anti-heart failure drug treatment.

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

Every electric shock, the patient will suffer great pain.

But this is the only effective way to prevent sudden death from malignant arrhythmia!

After that, the patient still has repeated palpitations, which are often induced when the environment is noisy or the mood is irritable.

Each time lasts about 5-15 minutes, heart rate is 170-200 beats/min, blood pressure is low during attack, and amaurosis appears.

The ICD has been discharged more than 60 times!
Every time an attack occurs, the patient will have a strong sense of fear.

For a long time, his quality of life is very poor!

……

After careful analysis of the patient's medical history, the expert team of the Cardiology Department of the First Affiliated Hospital of Kyoto considered trying radiofrequency ablation for the patient.

The patient's ventricular tachycardia was ablated so that he no longer had malignant arrhythmias and no longer received ICD shocks.

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

And right now, he naturally became Lu Chen's surgery patient.

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

This patient's condition is indeed extremely complicated!
First, the patient's heart function was poor, the left ventricular end-diastolic diameter was 66mm, EF was 27%, blood pressure was low (80+/60+mmHg), and the surgery tolerance was poor!

Ventricular fibrillation is very likely to occur during the operation, leading to cardiogenic shock!
Secondly, the patient's onset of ventricular tachycardia has various forms, which are not completely consistent with the form of ventricular premature beats, making it extremely difficult to map.

Finally, the patient is dilated cardiomyopathy with obvious myocardial remodeling, there may be a large scar area, the ablation area is large, and the ablation catheter is difficult to reach the target.

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

Each of these points is difficult to break through in the Cardiology Department of the First Affiliated Hospital of Kyoto.

However, Lu Chen has done a lot of this type of ablation surgery.

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

Therefore, after a short period of thinking, Lu Chen quickly formulated the best surgical plan.

……

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

The most difficult point of electrophysiological ablation surgery is the mapping and ablation of arrhythmia.

In simple terms, mapping is to find out the origin of arrhythmia.

Ablation is to dissolve the origin point.

"Lu Chen, how are you going to do the mapping?"

Mapping is divided into excitation mapping, pacing mapping and substrate mapping.

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

P point, that is, look for the high-frequency low-amplitude point ahead of QRS in the left ventricular septal area.

Xiao Shikang was very familiar with the patient's electrocardiogram, so he said, "Take the P potential as the target first?"

Lu Chen nodded and began to operate.

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

Two groups of high-frequency potentials can be recorded when ventricular tachycardia occurs.

They are the P1 potential (located in front of the P2 potential, showing a sharp, high-frequency shape, excited from the proximal end to the distal end), and the P2 potential (located behind the P1, in front of the local V wave, showing a high-frequency shape, moving from the earliest excited part to the two excited).

Xiao Shikang stared closely at Lu Chen's operations.

At this time, it is time to steal the teacher!
The gap between electrophysiological surgeons is not in vascular puncture, but in mapping and ablation!

The movements in Lu Chen's hands were neither too fast nor too slow.

The hearts of the audience in the live broadcast room of the surgery have already raised their throats nervously.

……

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

He couldn't find the P1, P2 sites!

The shape of P1 is perpendicular to the left posterior branch, which makes it impossible for the machine to record the P1 site at all.

Everyone in the live broadcast room saw that Lu Chen's operation was stagnant, and they also discovered that there was a problem with the operation.

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

"I didn't find the P1 locus, how to map it?"

"The level of this surgeon is not very good, is it? He didn't even find out the P site!"

"Stop talking sarcastic here, this patient is a special type of ventricular tachycardia, no one can find it all at once!"

Everyone was a little nervous.

But Lu Chen was calm and unafraid. He glanced at Xiao Shikang beside him and said, "Mr. Xiao, help me measure the HV interval."

Xiao Shikang was taken aback for a moment, but the movements of his hands were not slow, "Okay."

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

For the left posterior fascicle VT, the HV interval has a certain correlation with whether the P1 potential can be recorded and the position of the connection point between the distal end of the P1 potential and the left posterior fascicle.

The HV interval is mostly negative, and the greater the absolute value of the negative value of the HV interval, the easier it is to record the P1 potential.

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

The measurement is over.

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

Lu Chen nodded slightly, and said seriously: "The P potential should be near the apex of the heart, Mr. Xiao, help me find it at the apex of the heart."

"Okay." Xiao Shikang immediately began to operate.

Sure enough, after 5 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 piercing alarm!
"Not good, the patient has ventricular fibrillation!"

Lu Chen's face sank like water, and he immediately put down the operating tools in his hand and began to perform cardiopulmonary resuscitation on the patient.

If this kind of stimulus causes ventricular tachycardia, it is likely to cause ventricular fibrillation!
For successful mapping, the risk of ventricular fibrillation cannot be avoided.

"Get the ambulance and the defibrillator!"

Xiao Shikang also reacted immediately, and quickly called the follow-up nurse.

The nurse moved quickly and immediately pushed the ambulance and defibrillator over.

Lu Chen was performing cardiopulmonary resuscitation, while Xiao Shikang picked up the defibrillator.

"I'm defibrillating!"

Xiao Shikang let out a low drink, and Lu Chen immediately stepped aside.

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

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

In the live surgery room.

When the audience saw this sudden scene, they were a little confused for a while.

Is this the beginning of live rescue?
(End of this chapter)