Chapter 400 Ding Chaobing's Choice

Remember [New] in one second! Is this the strength of the trainees in the training class?

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

Even young people like Lu Chen have such terrifying interventional skills, what about those slightly older colleges?

"No wonder everyone is trying their best to get into the training class." Ding Chaobing shook his head secretly, "If everyone is at this level, it's really terrifying."

"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 hurriedly said: "Okay, you continue with the next ablation."

Lu Chen was slightly stunned. He was also asked to do the ablation himself?

Then in this whole operation, only the guide wire link was done by Ding Chaobing, and all other operations were done by Lu Chen!

Lu Chen hurriedly nodded and said: "Okay!"

As an assistant, this is a good opportunity!

On the side, there are also director-level doctors to help watch, and if there is any mistake, they can point it out immediately.

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

In addition, according to the degree of participation of the assistant, it can also be divided into primary, intermediate and senior levels.

Generally, the most junior assistant is to pass things and run errands.

The intermediate assistant assists the surgeon to complete some operations, which is also the work of most assistants at present.

The senior assistant is different. He can complete most of the operations under the guidance of the senior physician. In other words, the main surgeon is on the side, and all operations are completed by the assistant.

Although all operations are completed by the assistant, the premise is under the guidance of the senior doctor.

When the senior physician is gone, it can be said that the operation is performed alone.

As long as there is any senior physician standing by, it is not considered a single operation, but only an assistant.

Now Lu Chen is not qualified to be a main surgeon, but he has grown into a senior assistant!

...

"Start ablation!" Lu Chen encouraged himself in his heart.

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

The mapping catheter is ablated point by point along the road mark from the tricuspid valve ring end to the small a wave and large v wave to the inferior vena cava end. Each point is ablated for about 30 seconds. When the a wave amplitude drops by more than 50% or a double potential appears, ablate one point further down, with a point spacing of about 3 to 5 mm.

The temperature during ablation is set to 60c.

The end point of ablation is complete linear damage and complete bidirectional conduction block.

After ablation, pace on both sides of the ablation line to make an electroanatomical map. According to the conduction sequence on the excitement or conduction map, the amplitude is less than 0.5mv during bipolar recording, and the appearance of a wide atrial bipotential, it is judged whether the linear damage is completely blocked.

Ding Chaobing looked at Lu Chen's operation and was a little puzzled.

The most basic ablation method now is to perform linear ablation on the isthmus between the tricuspid valve ring and the entrance of the inferior vena cava, the narrowest part of the atrial flutter reentry ring.

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

This method made Ding Chaobing a little confused.

"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 anything unexpected happen. "Why not perform linear ablation around the coronary sinus ostium or in the narrowest part of the atrial flutter reentrant loop?"

After hearing Ding Chaobing's voice, Lu Chen followed the movements in his hands.

He thought for a while, looked up at the puzzled Ding Chaobing, and said: "Through the previous electrocardiogram and the mapping of arrhythmias, I think this typical atrial flutter reentrant loop surrounds the right atrium tricuspid valve, the excitation sequence is counterclockwise, the excitation of the middle septum of the right atrium is conducted from bottom to top, and the free wall is conducted from top to bottom."

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

Lu Chen paused, then smiled and said: "For this kind of patient, look for the lower wall ii, ii around the coronary sinus ostium. I, avf lead f wave advance local potential, and use the hidden entrainment method to establish the exit of the slow conduction area as the target, the ablation success rate is about 80%, and the recurrence rate is high. "

"Linear ablation is performed in the isthmus between the tricuspid valve ring 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 for atrial flutter ablation. Although it has a high short-term success rate, the follow-up recurrence rate is high, at 10% to 40%. "

The previous two methods have a high success rate, but the recent recurrence rate is also very high!

Patients are generally very reluctant to undergo a second operation.

If the first operation is not completely cured, many patients will give up the second time.

This is very unfavorable for the entire treatment.

Lu Chen's eyes were sharp, and he continued: "However, my method uses complete bidirectional conduction block in the isthmus after ablation as the treatment endpoint, and the recurrence rate of atrial flutter can be reduced to 5%! "

Ding Chaobing was stunned at first, and then frowned.

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

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

In Ding Chaobing's memory, he has never seen such documents or these data.

Doctor is an extremely rigorous subject!

Any treatment measure requires strict evidence-based medical demonstration.

Lu Chen paused, and he also felt a little shushed in his heart.

Where does this data come from?

It's not just what he read in some papers or documents, it's all what he learned through countless trainings in the system's virtual space.

He can arrange patients with various arrhythmias in the system's virtual space, then perform different mapping methods, different ablation precautions, and finally compare the effects.

This kind of training efficiency cannot be compared with the simulated operating room in reality!

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

However, now facing Ding Chaobing's inquiry, Lu Chen could only give a perfunctory sentence and said: "I once read through documents and reports at UU Kanshu www.uukanshu.net. The data I am talking about comes from this."

In an ambiguous sentence, as for which journal and which author, Lu Chentang hesitated.

Ding Chaobing frowned and continued to ask: "Not to mention where you come from these data. According to what you said, the halo electrode placement requires certain skills. The distal end cannot cross both sides of the ablation line, and the tricuspid valve annulus There are individual differences in the size of the right atrium, so there are limitations in judging whether there is complete bidirectional block in both directions.”

Lu Chen responded: "There are advantages, but there are limitations. In addition, my method avoids unnecessary multiple discharges by marking the original ablation point. And it can be marked along the ablation line, without the need for x-rays , find the leakage point accurately.”

…

As the chief surgeon, Ding Chaobing decides the patient’s ablation method.

Currently, there are two roads before him.

First, use the conventional method to perform linear ablation in the narrowest part of the atrial flutter reentry circle!

Second, choose what Lu Chen said, using complete bidirectional conduction block in the isthmus after ablation as the treatment endpoint!

Which method should be used?