Chapter 399: Watertight

Remember [New] in one second!     In the catheter room, the atmosphere became a little subtle.

Lu Chen paused, frowned slightly, and thought of the electrocardiograms he had seen before. He felt at ease again and said, "Teacher, I'm sure."

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

There is no fixed ablation method for each patient.

The origin of arrhythmia is different due to individual differences.

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

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

If there are few mapped areas and few ablated areas, it is very likely to induce arrhythmia.

In clinical practice, the probability of such recurrence is not low, and most of them are because there are too few ablated areas!

However, if there are many mapped areas and many ablated areas, the damage to the heart will also increase!

Ablation is an interventional operation after all.

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

The larger the ablation area, the greater the damage!

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

If you have long-term clinical experience or rich surgical experience, it is extremely rare to do this.

Lu Chen took a deep breath and then 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 reassuring, and they can actually let assistants do such difficult operations.

In fact, what Lu Chen didn't know was that every operation has a certain process.

If the first few operations are not passed, then he is not qualified to conduct the final review.

...

Lu Chen concentrated, prepared all the equipment, and began to mark and position.

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

Under X-ray fluoroscopy, the electrode head was located in the center of the heart shadow.

Lu Chen selected the coronary sinus electrode bipolar recording electrogram as the reference electrogram, and the electrode entered through the left subclavian vein. IC1~IC2 lead recording, the a wave amplitude is significantly greater than the v wave, take the maximum amplitude as the base point.

During the operation, it is still necessary to maintain a stable intracardiac electrogram to ensure that the system recognizes continuous a wave signals.

"This child is really good." Ding Chaobing nodded slightly inadvertently. With such a high vision, it is not easy to praise a person.

At this time, Lu Chen was still staring at the patient's ECG changes wholeheartedly.

"The mapping catheter 7fnavi-star (cordiswebster) enters the right atrium through the right femoral vein under the guidance of x-ray. IC3~IC4 is its bipolar intracardiac electrogram."

He had trained many times in the simulated operating room before, including the entry of the guidewire, the induction and positioning of arrhythmias.

But these were all carried out under perfect conditions, and the actual clinical cases were different.

Lu Chen noticed that this patient was very fat and his breathing amplitude was larger than that of normal people.

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

Although the displacement is not big, the impact is not small!

Lu Chen located the superior and inferior vena cava entrances, coronary sinus ostium and HIS bundle in the right atrium under fluoroscopy, and marked 3 to 5 points on the tricuspid ring.

Then move the mapping catheter under non-fluoroscopy, and take samples when it is in stable contact with the endocardium.

On the side, Ding Chaobing stared at Lu Chen without blinking. The final thing now is the stability of the mapping.

Mapping is done, but it does not mean it is over!

The mapping location must be stabilized, and its stability directly affects the quality of point selection and mapping.

Otherwise, the mapping location will be useless and ablation cannot be performed.

The stability of the mapping catheter is determined by the stability of the position, local excitation time, and cardiac cycle.

At this time, it is displayed in the three columns above the relevant window on the screen, and is dynamically expressed in red and green. The more green, the better the stability.

After Lu Chen finished mapping, green occupied most of the screen window!

"Oh my god, this mapping technique is so accurate!"

Outside the catheter room, a group of people watching looked at the green on the screen and exclaimed, "This stability is really awesome!"

Lu Chen didn't care about the reactions of the people around him, he couldn't see it in the catheter room.

He continued to concentrate and started the last part of the mapping.

...

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

Although this training class has less than 40 people, there are many people all over the country watching.

However, the assessment process was not broadcast live, and it would only be announced one hour after the assessment.

Li Yao sat in the office with the bid of the National Natural Science Foundation in her hand, but her mind was already far away.

Over at the Kyoto training class, she didn't know what was going on, and she couldn't feel at ease.

I don't know when she started to expect more and more from Lu Chen.

In the past, she just hoped that he could enter the champion of the electrophysiology competition.

Later, as Lu Chen created one "miracle" after another, Li Yao also valued her student more and more.

During this half year, Lu Chen had served as her assistant several times.

Although Lu Chen's performance was very good, most of the time he was doing disinfection, puncture, etc., and occasionally he was asked to perform intracatheter operations.

"There is a leader in the field of electrophysiology in China in the training class!" Li Yao sighed inwardly, "Hey, do you know how Lu Chen is doing?"

Contrary to Li Yao's worries, Vice Dean Chen Tairan was smiling.

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

Chen Tairan learned from a friend in Kyoto that today's weekly exam at UU Reading www.uukanshu.net is actually a clinical exam!

He knew some of Lu Chen's history and was a pretty good little genius.

But Lu Chen didn't know the specific electrophysiological intervention capabilities.

Looking at Chen Tairan, no matter how smart Lu Chen is, it is unlikely that he can break out from the group of attending doctors and deputy chief doctors, right?

…

Kyoto Central Hospital.

Cardiology cath lab.

Lu Chen had completed all the mapping, and then said to Ding Chaobing: "The mapping is over. According to the three stability standards, we will eliminate the inconsistent points and move the boundaries in the relevant window to correct the excitement time and cancel the premature beat time." Recording point. Mark the place where the bipotential a wave appears. The location of the bipotential a wave is the terminal ridge or Euclidean ridge.”

Ding Chaobing nodded with satisfaction. Lu Chen's mapping was impeccable.

He wanted to find some problems, but his eyes were almost swollen and he still couldn't see anything wrong.