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 procedure went very smoothly, which was a good start.

   However, Lu Chen performed significantly less operations than others.

   "Mr. Xiao, is there surgery tomorrow?" Lu Chen found Xiao Shikang.

   He can't just 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."

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

   "Tomorrow there will be a discussion of a difficult electrophysiological case, which is jointly organized by several hospitals in Kyoto." Xiao Shikang said, "At that time, all the trainees of your training class must attend."

   "Discussion of difficult cases?" Lu Chen raised his brows.

   "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 put down the idea of ​​surgery.

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

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

   Most of the electrophysiological doctors in the cardiology department came to the meeting.

  Lu Chen also saw Fang Ruzhang who came to attend the conference. He took several of Corey's students 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 Conference on Difficult Cases officially started.

On the big screen of the    conference hall, the pictures of cardiology departments of more than ten hospitals in Kyoto are 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 good reputation participated, and some small hospitals also came to join in the fun.

   The difficult case this time came from the 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 sixty-year-old male."

"Recurrent ventricular tachycardia due to ischemic cardiomyopathy, received radiofrequency ablation, ICD implantation (implantable cardioverter-defibrillator, a pacemaker that can monitor malignant arrhythmias and defibrillate in time) ."

   "ICD can save a patient's life through electrical defibrillation in a critical moment."

   But because of the patient's repeated ventricular tachycardia and ventricular fibrillation, the patient was repeatedly shocked by electric shocks, which made him extremely fearful!

   Even saw the medical staff, the electrocardiograph and the pacemaker programmer saying not to "shock" him.

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

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

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

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 came out, the doctor at Kyoto City People's Hospital immediately spoke up.

   "Hello everyone, I'm a cardiologist studying at Kyoto City People's Hospital."

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

   "Bo Ge is really positive..."

   This is all because this case discussion will be included in the second-stage assessment.

   Therefore, the trainees from the training class are all geared up and ready to express themselves.

   On the screen, Min Xiaobo talked eloquently: "I think, if this patient wants to completely repeat the problem of ventricular tachycardia, he can only do radiofrequency ablation again! Drugs or ICDs are not good."

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

   But problems also follow, frequent ventricular tachycardia episodes can cause "ICD electrical storms", which not only shorten the lifespan of ICDs, but also increase mortality in such patients.

   Although antiarrhythmic drugs can reduce the incidence of ventricular tachycardia, the effect is not ideal.

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

  Min Xiaobo's words were also approved by everyone.

   "Well, I feel pretty good, but I still have to dissolve!"

   "ICD is a good thing, but this patient can't bear it."

   "However, it is very difficult to ablate a patient with ventricular tachycardia alone!"

  ICD can solve the problem of ventricular tachycardia, but patients cannot bear the pain of continuous "discharge".

   Offstage, Lu Chen also agreed with Min Xiaobo's view that only by removing the origin of VT through radiofrequency ablation can it be possible 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 alert sounded.

  I didn't intend to read it, but seeing the message from Min Xiaobo on the screen, Lu Chen turned on his phone anyway.

   "Lu Chen, you have to speak too! Your performance this time will be recorded in the assessment results."

  Lu Chen smiled and replied immediately: "Don't worry, Brother Bo, 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 is waiting for the most opportune moment.

  …

   For the treatment method of the patient, everyone discussed for more than ten minutes, and finally unanimously chose to ablate again!

At this time, the host from Kyoto Central Hospital started to speak again: "The result of our department's discussion at that time, as everyone said, was to do ablation. On the fourth day after the patient was admitted to the hospital, we performed surgery on him. "

"In a sedated state, after the patient underwent routine electrophysiological examination, ventricular tachycardia was easily induced, the heartbeat suddenly "rushed" to 230-240 beats/min, and the blood pressure dropped to 50/40 mmHg, and the termination Continue to check later.”

After   , the host took out an electrophysiological examination report.

   "You 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 electrophysiological report.

The host did not sell off, and continued: "After careful inspection by our professional electrophysiology team in the catheterization laboratory, we considered the source of ventricular tachycardia, carefully searched, mapped, ablated, and re-examined to induce another form of ventricular tachycardia. After the team The analysis considers the epicardial source!"

   Epicardial origin?

   Hearing the host's words, Lu Chen had a weird expression on his face.

   During the examination, the atrial fibrillation he encountered originated from the epicardium.

   It didn't take long before I encountered another ventricular tachycardia of epicardial origin!

   I really met myself!

  …

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

   Ventricular tachycardia of epicardial origin is uncommon!

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

   are also arrhythmias originating from the epicardium!

   On the screen, the host said again: "Do you have any good surgical advice for arrhythmia originating from the epicardium?"

   This is the focus of this case discussion.

   How to perform radiofrequency ablation for ventricular tachycardia originating from the epicardium?

  Except for the First Affiliated Hospital of Kyoto University, all other hospitals started a very lively discussion.

   And the atmosphere of the First Affiliated Hospital of Kyoto University is terrifyingly quiet!

   Everyone seemed to be sitting in their seats with confidence and not having much communication with the people around them.

   (end of this chapter)