I Can See Health

   Chapter 405 The choice of Ding Chaobing

   Is this the strength of the trainees?

  Ding Chaobing began to re-examine this training class...

   Even a young man like Lu Chen has such terrifying intervention skills, what about the slightly older students?

   "No wonder everyone sharpened their heads and drilled into the training class." Ding Chaobing shook his head secretly, "If everyone is at this level, it's really scary."

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

"What's wrong?"

   "Teacher, my mapping is over."

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

  Lu Chen was stunned for a moment. He also let him do the ablation himself?

   In this entire operation, only the part of entering the guide wire was performed by Ding Chaobing, and Lu Chen did all the other operations!

  Lu Chen nodded quickly and said, "Okay!"

  As an assistant, this is a great opportunity!

   Not only can you try your hand, but there is also a director-level doctor watching to help you. If there is a fault, you will immediately point it out.

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

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

   The most basic assistant is to pass things.

  A mid-level assistant, assisting the operator to complete some operations, but not very important operations, such as disinfection, spreading towels, and occasional puncture. This is also the work that most assistants do at present.

   The senior assistant is different. He can complete most of the operations under the guidance of the superior physician. That is to say, the main knife is on the side, and all operations are done by the assistant.

   As long as there is any superior doctor standing by, it is not considered an independent 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.

   This kind of opportunity doesn’t come often, but you have to seize it!

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

The mapping catheter was ablated point by point from the tricuspid annulus to the small A wave and the large V wave along the road sign to the inferior vena cava. Each point was ablated for about 30 s. It was observed that the amplitude of the A wave decreased by more than 50% or double potential appeared. And then ablation down a little, the point spacing is about 3 ~ 5mm.

  The temperature was set at 60°C during ablation.

  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 to make an electroanatomical map. According to the conduction sequence on the excitation or conduction map, the amplitude of bipolar recording was less than 0.5mV, and the appearance of a wide atrial bipotential was used to judge whether the linear injury was completely blocked.

  Ding Chaobing was a little puzzled when he saw Lu Chen's operation.

  The most basic ablation method now is to perform linear ablation on 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.

   However, Lu Chen took a different approach and used complete bidirectional conduction block in the isthmus after ablation as the end point of treatment.

   This method made Ding Chaobing a little unclear.

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

   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 said, "Through the previous electrocardiogram and the arrhythmia mapping, I think the reentry ring of this typical atrial flutter surrounds the tricuspid valve in the right atrium, and the sequence of excitation is: Counterclockwise, the right atrial septal activation is conducted from the bottom to the top, and the free wall is conducted from the top to the bottom."

  Ding Chaobing nodded slightly, then frowned: "You are right, but what does this have to do with your choice of this method?"

After a pause, Lu Chen smiled and said, "For this kind of patient, look for the local potentials around the coronary sinus ostium that are ahead of the F waves in leads II, III, and aVF of the inferior wall, and use the concealed entrainment method to establish the potential as slow. The outlet of the conduction area is used as the target, and the ablation success rate is about 80%, and the recurrence rate is high."

"Linear ablation is performed on the isthmus between the tricuspid annulus and the entrance of the inferior vena cava, the narrowest part of the atrial flutter reentry ring, with a success rate of 80% to 90%. This method has become the basic method of atrial flutter ablation at present. Although there are many High short-term success rate, but high follow-up recurrence rate of 10% to 40%."

   The first two methods have a high success rate, but 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 bad for the whole treatment.

  Lu Chen continued, "However, with this method of mine, complete bidirectional conduction block in the isthmus after ablation is used as the end point of treatment, and the recurrence rate of atrial flutter can be reduced to 5%!"

  Ding Chaobing was stunned for a moment, then frowned.

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

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

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

  Doctor is an extremely rigorous discipline!

  Any treatment measure requires strict evidence-based medical demonstration.

  Lu Chen paused, he was also a little booed in his heart.

   Where does this data come from?

   It's not from reading any papers and documents, but he usually learned from countless training sessions 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 precautions, and finally compare the effects.

   This kind of training efficiency is incomparable in a real simulated surgery room!

   Therefore, Lu Chen slowly figured out that different ablation methods have different prognosis for patients.

   However, facing Ding Chaobing's question now, Lu Chen can only perfunctory, saying: "I once read a document and read a report. The data I said came from this."

   An ambiguous sentence, as for which journal and which author, Lu Chen stopped.

Ding Chaobing frowned and continued to ask: "Let's not say where your data came from. Do as you said, Halo electrode placement requires a certain skill, the distal end cannot cross both sides of the ablation line, and the tricuspid valve annulus must be placed. There are individual differences in the size of the right atrium and the right atrium, so there are limitations in judging whether the two-way block is complete or not.”

However, Lu Chen responded: "If there are advantages, then there will be limitations. In addition, this method of mine avoids unnecessary multiple discharges by marking the original ablation point. It can also be marked along the ablation line, without the need for X-rays. , look for leaks exactly.”

  …

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

   At present, there are two paths before him.

   First, use conventional, linear ablation at the narrowest part of the atrial flutter reentry ring!

   Second, choose what Lu Chen said, with complete bidirectional conduction block in the isthmus after ablation as the end point of treatment!

  Which method should I use?

  Ding Chaobing hesitated, but after thinking about it, he made a decision.

  Choose the regular first one!

  In the medical field, winning while maintaining stability is the way to go.

   The second method is not yet mature.

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

   (end of this chapter)