Chapter 420: Strange Case

Remember [New] in one second!     In the next few days, under the guidance of Xiao Shikang, Lu Chen completed his first operation - implantation of a dual-chamber pacemaker.

The operation went very smoothly, which was a good start.

However, the number of operations completed by Lu Chen was obviously less than that of others.

"Teacher Xiao, is there an operation tomorrow?" Lu Chen found Xiao Shikang.

He couldn't just sit there and wait for death!

Xiao Shikang was in the office. When he looked up and saw that it was Lu Chen, he smiled, "Tomorrow, there will be an operation, but you may not have time."

"Ah? I don't have time?" Lu Chen asked in confusion.

"Tomorrow there will be a discussion of difficult electrophysiological cases, which is jointly organized by multiple hospitals in Kyoto." Xiao Shikang said, "When the time comes, all the students in your training class will have to participate."

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

"Well, it's a very complicated patient." Xiao Shikang smiled, "Let you participate mainly to improve your knowledge and provide some ideas. This is also one of the important indicators of the assessment!"

Lu Chen nodded and gave up the idea of ​​doing surgery.

The next day, at 3pm.

The conference room next to the catheterization room of the cardiology department.

Most of the electrophysiology doctors in the cardiology department came to attend the meeting.

Lu Chen also saw Fang Ruzhang who came to attend the meeting. He walked into the conference room with several students in the department.

However, the two were far away, so Lu Chen did not say hello.

At 3:15, the difficult case conference officially began.

On the big screen in the conference room, pictures of the cardiology departments of more than ten hospitals in Kyoto were displayed.

Among them were Kyoto Central Hospital, Kyoto University Second Affiliated Hospital, and Kyoto People's Hospital.

In short, all hospitals with good reputations participated, and some small hospitals also came to join in the fun.

This time, the difficult case came from 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 60-year-old male."

"Due to ischemic cardiomyopathy causing repeated ventricular tachycardia, he received radiofrequency ablation treatment and ICD implantation (implantable cardioverter defibrillator, a pacemaker that can monitor malignant arrhythmias and perform internal defibrillation in a timely manner)."

"ICD can save the patient's life through electric defibrillation at critical moments."

But because the patient had repeated ventricular tachycardia and ventricular fibrillation, the patient was shocked many times in succession, which made him extremely fearful!

He even saw medical staff, electrocardiographs and pacemaker programmers saying not to "shock" him.

However, after the staff adjusted the defibrillation parameters, the patient would be in repeated low-frequency ventricular tachycardia, which caused low blood pressure, palpitations and fatigue.

This repetition put the patient and his family on the verge of collapse.

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

On the screen, the host on the stage began to raise questions.

"How to completely solve the problem of repeated ventricular tachycardia in patients?"

As soon as the question came out, the doctor of Kyoto People's Hospital spoke immediately.

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

Lu Chen felt that the voice was familiar. He looked up and saw that it was Min Xiaobo who was speaking!

"Brother Bo is really active..."

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

So the trainees from the training class are all ready to show themselves.

On the screen, Min Xiaobo talked freely: "I think that if this patient wants to completely cure the problem of ventricular tachycardia, he can only do radiofrequency ablation again! Neither drugs nor ICDs are very effective."

With the advent of implantable cardioverter defibrillators (ICDs), the incidence of sudden cardiac death has been greatly reduced.

But problems also come with it. Frequent ventricular tachycardia attacks can cause "ICD electrical storms", which not only shorten the service life of ICDs, but also increase the mortality rate of 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 ventricular tachycardia.

Min Xiaobo's words were also agreed by everyone.

"Well, I feel good too, we still need ablation!"

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

"However, it is also very difficult to ablate this kind of patient with isolated ventricular tachycardia!"

ICD can solve the problem of ventricular tachycardia, but patients can hardly bear the pain of continuous "discharge".

Offstage, Lu Chen also agreed with Min Xiaobo's view that only by clearing the origin of ventricular tachycardia through radiofrequency ablation can it be solved once and for all.

Next, several doctors from other hospitals spoke.

Their conclusions were similar to Lu Chen's, and they all advocated continuing radiofrequency ablation!

"Ding Ding..."

Lu Chen suddenly felt his phone vibrate, and the WeChat notification sound rang.

He didn't intend to read it, but when he saw the message sent by Min Xiaobo on the screen, Lu Chen still opened his phone.

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

Lu Chen smiled and immediately replied: "Don't worry, Brother Bo, there will be another chance, I will speak later."

"That's good!"

This patient can't be that simple, otherwise there would be no need for concentrated discussion.

Lu Chen is waiting for the most appropriate time.

...

For the treatment 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 began to speak again: "The result of our department's discussion at the time was the same as what everyone said, that is, to do ablation. On the fourth day after the patient was admitted to the hospital, we performed surgery on him."

"Under sedation, the patient underwent routine electrophysiological examinations, and ventricular tachycardia was easily induced. The heartbeat suddenly "jumped" to 230-240 beats/minute, and the blood pressure dropped to 50/40 mmHg. After termination, the examination continued."

After speaking, the host took out an electrophysiological examination report.

"Everyone can take a look and analyze the origin of the patient's ventricular tachycardia."

After the examination report came out, everyone also quieted down and watched the electrophysiological report.

The host did not keep the suspense, and continued: "After careful examination by our professional electrophysiological team in the catheter room, the ventricular tachycardia from the left ventricle was considered. Careful search, mapping, and ablation were performed, and another form of ventricular tachycardia was induced again. After the team's analysis, it was considered to be epicardial!"

Epicardial source?

Hearing the host's words, Lu Chen showed a strange expression on his face.

The atrial fibrillation he encountered during the assessment originated from the epicardium.

It wasn't long before he encountered another ventricular tachycardia originating from the epicardium!

It really happened to me!

...

As soon as the host finished speaking, the UU Reading Book wｗw.uukanshu.net conference room was filled with whispers.

Ventricular tachycardia originating from the epicardium is not common!

While everyone was surprised at the rare origin of ventricular tachycardia, some doctors who had watched the electrophysiological assessment recalled Lu Chen's assessment!

They were also arrhythmias originating from the epicardium!

On the screen, the host said again: "For arrhythmias originating from the epicardium, do you have any good surgical suggestions?"

This is the focus of this case discussion.

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

Except for Kyoto University First Hospital, all other hospitals started extremely heated discussions.

And the atmosphere of Kyoto University First Hospital was a little scary!

Everyone seemed to sit in their seats with full confidence and did not communicate much with the people around them.