I Can See Health

   Chapter 869 Start the first live broadcast rescue? (first update)

   Surgery live room.

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

   The patient is a 37-year-old male.

   was admitted to the hospital due to "repeated heart palpitations and dyspnea".

   He was previously diagnosed with "dilated cardiomyopathy, heart failure, and ventricular tachycardia", and was implanted with an ICD 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 each shock, the patient suffers great pain.

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

  After this, the patient continued to experience palpitations repeatedly, which were often induced when the environment was noisy or irritable.

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

  ICD has been discharged more than 60 times!

   Each attack will cause the patient to 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 cardiology expert team of the First Affiliated Hospital of Kyoto considered that radiofrequency ablation could be attempted for the patient.

   Ablation of the patient's ventricular tachycardia, so that he no longer suffers from malignant arrhythmias and no longer suffers from ICD shocks.

   However, the operation of this patient was very difficult and risky. It happened that Mayo's cardiologist came and gave them a teaching demonstration.

   And right now, he has become 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 cardiac function is poor, the left ventricular end-diastolic diameter is 66mm, EF is 27%, the blood pressure is low (80+/60+mmHg), and the surgery tolerance is poor!

   It is very likely that ventricular fibrillation will occur during the operation, leading to cardiogenic shock!

  Secondly, the patient's ventricular tachycardia has various forms, and it is not completely consistent with the form of ventricular premature beats, making it extremely difficult to map.

  Finally, the patient has 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.

   These three points of difficulty in surgery seriously affect the success rate of the overall surgery.

   Each of these points, placed in the Cardiology Department of the First Affiliated Hospital of Kyoto, is a level that is difficult to break.

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

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

   Therefore, after short-term thinking, Lu Chen quickly worked out the best surgical plan.

  …

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

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

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

  Ablation is to ablate the origin point.

   "Lu Chen, how to prepare for mapping?"

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

   "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 electrocardiogram. The origin of the VT is rather special, it should be the left posterior fascicular ventricular tachycardia."

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

  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 started the operation.

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

  Two sets of high-frequency potentials can be recorded during ventricular tachycardia attack.

They are P1 potential (located in front of P2 potential, sharp, high frequency, excited from proximal to distal), and P2 potential (located after P1, local V wave front, high frequency, from the earliest activation site to the two excited).

  Xiao Shikang stared at Lu Chen's operations.

   At times like this, it’s time to steal a teacher!

  The gap between electrophysiological surgeons is not in vascular puncture, but in mapping and ablation!

   Lu Chen's movements in his hands were not hurried or 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 and P2 sites!

  P1 runs 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?"

   "The P1 site has not been found, how to map?"

   "Isn't this surgeon's level very good? He didn't even find the P site!"

   "Don't make rude words here, this patient is a special type of ventricular tachycardia, and no one can find it all at once!"

   Everyone was a little nervous.

   But Lu Chen was not afraid. He glanced at Xiao Shikang next to him and said, "Mr. Xiao, help me measure the HV interval."

  Xiao Shikang was stunned for a moment, but his hands were not slow, "Okay."

   During the onset of VT, the HV interval and the HV interval in sinus rhythm are important electrophysiological indicators.

   For left posterior fascicular ventricular tachycardia, 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 branch.

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 greater 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 HV interval is approximately positive (the greater the positive value), indicating that the distal connection point of P1 and P2 closer to the bottom of the heart.

   Measurement ends.

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

  Lu Chen nodded slightly and said in a serious tone, "The P potential should be close to the apex of the heart, Mr. Xiao, help me find it in the apex of the heart."

   "Okay." Xiao Shikang immediately started the operation.

   Sure enough, after five minutes, the two managed to find the P1 and P2 potentials in the heart.

   But before the two were happy, the ECG monitor next to the operating room sounded a harsh alarm!

   "No, the patient has ventricular fibrillation!"

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

   If this kind of stimulation occurs in patients with ventricular tachycardia, it is likely to have ventricular fibrillation!

   For successful mapping, this risk of ventricular fibrillation is impossible to avoid.

   "Bring the ambulance and defibrillator!"

  Xiao Shikang also reacted immediately and hurriedly called the nurse on the counter.

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

  Lu Chen was performing CPR, and Xiao Shikang next to him picked up the defibrillator.

   "I started defibrillation!"

  Xiao Shikang gave a low voice, and Lu Chen immediately stepped aside.

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

  Charge, Discharge!

  After a defibrillation, the patient immediately turned into ventricular fibrillation within two seconds after restoring sinus rhythm!

   In the surgery live room.

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

   This is the beginning of a live rescue rescue?

   (end of this chapter)