I Can See Health

   Chapter 404 Waterproof

  In the catheter room, the atmosphere became a little subtle.

  Lu Chen paused, his brows wrinkled slightly, he would remember the few electrocardiograms he had seen before, and his heart settled down again, and said, "Teacher, I'm sure."

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

   For each patient, there is no fixed ablation method.

  Individual differences are different, and the origin of arrhythmia is also different.

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

   This step is not very risky, but it is very difficult to do it perfectly.

  If there are few areas for mapping and few ablation parts, it is likely to induce arrhythmia.

   In clinical practice, the probability of such recurrence is not low, most of which are because there are too few ablation sites!

   However, if there are too many places for mapping and ablation, the damage to the heart will also increase!

  Ablation, after all, is an interventional procedure.

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

   The bigger the ablated part, the bigger the damage!

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

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

  Lu Chen took a deep breath and exhaled slowly.

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

   However, this electrophysiology training class and the central hospital are also relieved that they can actually allow the assistant to do such a difficult operation.

   Actually, what Lu Chen didn't know was that every operation had a certain procedure.

   The chief surgeon, the examiner, will conduct assessments at any time according to 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 passing the puncture level, other risks are small and controllable.

   Moreover, if Lu Chen did not pass the first few operations, he would not be qualified to conduct the final assessment at all.

  …

  Lu Chen concentrated his mind, prepared all the equipment, and started the calibration and positioning.

The    electrode is placed on the back of the patient, slightly to the left of the spine at the level of the seventh thoracic vertebra, as an anatomical reference.

  The electrode head is located in the center of the heart shadow under X-ray fluoroscopy.

  Lu Chen chose the bipolar electrogram of the coronary sinus electrode as the reference electrogram, and the electrode entered through the left subclavian vein. Recorded in leads IC1-IC2, the amplitude of the A wave is significantly larger than that of the V wave, and the maximum amplitude is taken as the base point.

   During the operation, it is still necessary to maintain a stable intracardiac recording 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 was not easy to praise a person.

   At this time, Lu Chen was still focused on the patient's ECG changes.

   "The mapping catheter 7FNavi-Star (Cordis Webster) entered the right atrium through the right femoral vein under the guidance of X-ray. IC3-IC4 were bipolar intracardiac recording electrograms."

   He has previously trained many times in the simulated surgery room, guide wire entry, arrhythmia induction and positioning.

   But this is done under perfect conditions, and real clinical cases are different.

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

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

   Don't look at this shift is not big, but the impact is not small!

  Lu Chen measured the location at the entrance of the superior and inferior vena cava, the ostium of the coronary sinus and the His bundle in the right atrium under fluoroscopy, and mapped 3 to 5 points on the tricuspid valve annulus.

   The mapping catheter is then moved non-fluoroscopy and the point is sampled when it is in stable contact with the endocardium.

   aside, Ding Chaobing also stared at Lu Chen without blinking. The final goal is the stability of the mapping.

   Mapping is done, it 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 the points and the mapping.

  Otherwise, the mapped location is invalid 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 box above the relevant window of the screen, and it 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 green!

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

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

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

   He continued to concentrate and began the last other part of the mapping.

  …

   Thousands of miles away in Jinghua Second Hospital, Li Yao also received the news that today is the weekly test of the training class.

   Don't look at this training class with less than 40 people, but there are many people all over the country watching.

   However, the assessment process is not broadcast live, and will only be announced one hour after the assessment is over.

  Li Yao was sitting in the office, holding a bid from the country, but her mind had already flown away.

   On the other side of the Kyoto training class, 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 were 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 final round.

   Now, with the "miracles" created by Lu Chen, Li Yao also values ​​her student more and more.

   In the past six months, Lu Chen served as her assistant several times.

  Although Lu Chen's performance was very good, most of the time he was sterilized and punctured, and occasionally he was asked to perform operations inside the catheter.

   "The training class is a leader in the field of electrophysiology in China!" Li Yao sighed inwardly, "Hey, do you know what happened to Lu Chen?"

   Contrary to Li Yao's worries, Vice President Chen Tairan smiled happily.

   "It's better now if you don't give up your quota." Chen Tairan was half lying on the chair, with his hands crossed, leaning on the back of his head, "I can't pass the weekly exam this time!"

   Chen Tairan learned from a friend in Kyoto that today's weekly test is actually a clinical test!

   He knew some of Lu Chen's achievements so far, and he was considered a good little genius.

   But Lu Chen's specific electrophysiological intervention strength, he did not know.

  In Chen Tairan's view, no matter how smart Lu Chen is, it is unlikely that he will break out of the group of attending physicians and deputy chief physicians, right?

   "Hehe, go to Kyoto for a week, and then come back disheartened." Chen Tairan smiled in his heart, "I don't need to do it myself at all."

  …

  Kyoto Central Hospital.

   Cardiac catheterization laboratory.

Lu Chen has completed all the mapping, and then said to Ding Chaobing: "The mapping is over. According to the three stability criteria, we can eliminate the points of disagreement, and move the boundary in the relevant window to correct the excitation time and cancel the premature beat. Recording point. Mark where there is a bipotential A wave, and the position where the bipotential A wave appears is the boundary crest or Euclidean crest."

  Ding Chaobing nodded with satisfaction, Lu Chen's mapping was done flawlessly.

   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)