Detailed data of radiofrequency ablation

Surgical introduction, indications, preoperative precautions, surgical methods, precautions, surgical process, patients' feelings, success rate, postoperative complications and postoperative precautions. Catheter radiofrequency ablation is an interventional technique that sends an electrode catheter into a specific part of the heart cavity through veins or arterial vessels, and releases radiofrequency current to coagulate and necrotize the local endocardium and subendocardial myocardium, thus blocking the abnormal conduction bundle and the origin of tachyarrhythmia. The damage range of RF current introduced into the heart cavity through the catheter is 1-3 mm, which will not cause harm to the body. Radiofrequency ablation has become the most effective method for radical treatment of paroxysmal tachycardia. The basic equipment includes X-ray machine, radiofrequency ablation instrument and intracardiac electrophysiological examination instrument. Surgical indications. Atrioventricular reentrant tachycardia (preexcitation syndrome): there is a congenital "bypass" between atrioventricular cavities, and catheter radio frequency will "cut off" the bypass, and tachycardia or pre-shock wave will no longer exist. 2. Atrioventricular node reentrant tachycardia: Atrioventricular node forms a "double path", and the current runs rapidly in the reentrant loop formed by the two paths under suitable conditions, causing tachycardia; Catheter radiofrequency ablation of slow path, only retaining fast path, tachycardia no longer has the conditions for attack. Third, atrial flutter (atrial flutter): atrial flutter is a big ring in the atrium, and the current keeps turning on the ring. Atrium beats 250-350 beats/min, and ventricles generally beat 150 beats/min; Catheter radio frequency can destroy the ring and cause bidirectional current block, thus radical treatment of atrial flutter. 4. Atrial tachycardia (atrial tachycardia): Atrial tachycardia is an "exciting point" where abnormal rapid current release occurs in a certain part of the left atrium or right atrium or there is a small reentry movement in the atrium; The ectopic "exciting point" or reentrant ring was mapped by electrophysiological examination and completely cured after ablation. V. Ventricular premature beats (premature beats): Mainly used for single-source frequent ventricular premature beats with obvious clinical symptoms; Often caused by ventricular "excited focus"; After ablation of ectopic excitation, the ventricle will disappear as soon as possible. The intransitive verb ventricular tachycardia (VT) includes idiopathic, bundle branch reentrant and cicatricial VT. Idiopathic ventricular tachycardia is common in people with normal heart structure and function. There is no evidence of organic heart disease, but frequent episodes of tachycardia can lead to tachycardia cardiomyopathy. Its occurrence is that the "excited focus" on the outflow tract of the right ventricle or left ventricle and the left ventricular septum quickly releases current, leading to tachycardia. Ventricular tachycardia can be cured by catheter finding "excited focus" and releasing RF current for ablation. Bundle branch reentrant ventricular tachycardia and cicatricial ventricular tachycardia are more common in patients with dilated heart disease, coronary heart disease, congenital heart disease and other organic heart diseases after operation. Patients may have syncope and convulsion when they have an attack, and they often need emergency rescue. Bundle-branch reentrant ventricular tachycardia is a ring ("loop") in which current flows between the left and right conduction bundle branches of the heart and between the left and right ventricles. The catheter electrode finds and sends out a radio frequency current blocking loop. Scarred ventricular tachycardia is caused by the reentrant ring produced by the remaining myocardial cells between cardiac fibrous scar tissues, and can also be cured by blocking the ring by releasing radio frequency current. Radiofrequency catheter ablation can cure ventricular tachycardia, but it cannot cure heart disease. When ablation is unsuccessful or ventricular tachycardia is life-threatening, implantable cardiac defibrillator (ICD) should be implanted to prevent sudden death. Seven, atrial fibrillation (atrial fibrillation): Atrial fibrillation is the most common persistent arrhythmia, the study found that the trigger of atrial fibrillation is because the "myocardial sleeve" on the great vein connected with the atrium sends out rapid electrical pulses, and the persistence of atrial fibrillation is also related to the self-reconstruction of the atrium. Using catheter electrode to ablate around pulmonary vein orifice to form "electrical isolation" between great vein and atrium, or adding some linear ablation in atrium, can achieve the goal of radical treatment of atrial fibrillation. Precautions before operation 1. Electrophysiological examination and radiofrequency ablation generally require hospitalization and routine laboratory examination (including electrocardiogram and blood examination, etc.). ). Second, diet precautions: Do not eat within 6-8 hours before surgery. Third, tell the doctor the name and dosage of the drugs used, and stop using all antiarrhythmic drugs 3-5 days before electrophysiological examination and radiofrequency ablation. Antiarrhythmic drugs may affect the test results. Fourth, tell the doctor about the drug allergy. Precautions for surgical methods Children have the characteristics of small blood vessels and small heart, and radiofrequency ablation is difficult and risky, so it needs to be carefully selected. For children with tachyarrhythmia under 3 years old, drug treatment should be taken first as far as possible, and children over 3 years old can consider radiofrequency ablation. For arrhythmia such as premature beats, drugs can not shorten the course of disease, but can only relieve symptoms, so drug treatment should be highly alert to its toxic and side effects; Only when tachycardia affects the quality of life and physical development of children can antiarrhythmic drugs be actively used, and radiofrequency ablation should be used when appropriate. Electrophysiological examination and radiofrequency ablation are carried out in an operating room (called catheter room) with special equipment. Catheter room staff usually include electrophysiologists, assistants, nurses and technicians. The patient is lying on the X-ray examination bed. The medical staff will connect all kinds of monitoring equipment with the patient's body and cover your body with sterile sheets. Medical staff will wear sterile surgical gowns and gloves. Firstly, the skin of the catheter insertion site (groin, arm, shoulder or neck) is disinfected and locally anesthetized with local anesthesia; Then puncture the vein/artery with a puncture needle, and insert the electrophysiological examination catheter into the heart cavity through the blood vessel; The electrode catheter used for cardiac electrophysiological examination is a long and flexible catheter, which can transmit electrical signals into and out of the heart. The electrode catheter records the electrical activity of different parts of the heart and sends out weak electricity to the heart, thus inducing arrhythmia and clearly diagnosing tachycardia; Then the doctor finds the exact location of abnormal electrical activity of the heart through the catheter (this process is called "mapping"), and then carries out radiofrequency current ablation treatment through the ablation instrument, thus radically curing the tachycardia. Patients feel generally awake during the whole process, and sometimes doctors will use sedatives to relieve patients' nervousness, and patients will be monitored throughout the process; Electrophysiological examination generally does not cause pain, and patients will not feel when the catheter passes through blood vessels and heart cavities. During the examination, the doctor may use weak current to * * * the heart. Patients will not feel these electrical impulses, but they will often induce tachycardia and feel the same as before (dizziness, dizziness, palpitation, chest pain or shortness of breath, etc.). ), so just notify the doctor; These operations have little risk and are relatively safe. The success rate of radiofrequency ablation of arrhythmia such as atrioventricular nodal reentrant tachycardia and preexcitation syndrome can reach above 98%, and the success rate of ablation of complex arrhythmia such as atrial tachycardia, atrial flutter, premature ventricular beats and idiopathic ventricular tachycardia can reach above 90%. At present, the success rate of atrial fibrillation ablation can reach 80-90% for paroxysmal atrial fibrillation and 60-80% for persistent and chronic atrial fibrillation, and the success rate of re-ablation will be further improved. Surgical complications Vascular puncture complications include local bleeding, hematoma, infection, pneumothorax, thrombosis and embolism, catheter operation complications include aortic regurgitation, myocardial perforation and pericardial tamponade, and discharge ablation complications include atrioventricular block and myocardial infarction. Precautions: After radiofrequency ablation, the patient must stay in bed according to the doctor's advice. The sandbag at the venipuncture site is compressed for 6 hours, and the sandbag at the arterial puncture site is compressed for 8- 12 hours. The affected limb is braked (restricted) to observe whether there is bleeding. Give a digestible diet during bed rest; Observe the heart rate and rhythm closely in the early stage after radiofrequency ablation, report to the doctor in time if you feel unwell, and check ECG, echocardiography and chest X-ray when necessary; If the feeling of tachycardia recurs after operation, but it doesn't really happen, don't be nervous and don't need special treatment; 1 week can resume normal activities; If there is any recurrence after discharge, you should record the electrocardiogram nearby in time and get in touch with the surgeon to decide the next treatment plan. Anticoagulant therapy is needed after radiofrequency ablation. Generally, anticoagulant is needed for 1-3 months, depending on the patient's heart rhythm, age and general condition. Application of other auxiliary drugs: Amiodarone should be used after atrial fibrillation ablation and taken according to the doctor's advice to achieve the expected curative effect.