The busiest and most strenuous organ in our body is the heart! When we are still in our mother’s womb, she is constantly busy. Day and night, minute by minute, she works tirelessly to deliver all kinds of nutrients to us, and help us expel the waste from our bodies, so that we can work, study, play, rest, reproduce …… It can be said that the heart is the “engine” of life, just like the engines of cars, airplanes and ships, carrying each of us from the beginning of life to the end. It is like the engine of a car, an airplane, or a ship that carries each of us from the beginning of our lives to the distance! If we are evaluated as a model worker, our heart deserves the first place!
Perfectly fine, intense and orderly, tireless life engine DD heart
The heart is the “engine” of life. The heartbeat of “dong dah, dong dah, dong dah” is known to all of us, it is the roar of the “engine” of life and the sound of our footsteps on the journey of life! But this engine is very different from the structure of cars, airplanes, ships engines. The heart is composed of heart muscle cells, connective tissue, nerve fibers, etc. She includes the left and right atria and left and right ventricles.
Gasoline engines need battery ignition, and diesel engines need external force to start. Our heart is different in that the myocardial cells that make it up are self-regulating, which in layman’s terms means that they are obedient and do their “homework” without being beaten by their father or scolded by their mother. This property is caused by the transmembrane movement of potassium, calcium, sodium and chloride plasma in and out of the cardiomyocyte membrane through specific channels. Of course, this electrical activity also requires energy consumption, otherwise the law of conservation of energy would be overturned. But not gasoline and diesel, but biological energy such as ATP. Cardiomyocytes are all autonomic and easily excited (in professional terms, easily excitable), all think they can, all want to be leaders! If we let them go their own way, it would be a mess! But don’t be afraid! Since our mother gave us life, she will not forget to give us the tools to manage it.
The heart has its own administrative structure, which is the conduction system of the heart, consisting of the sinus node, the inter-nodal tract, the atrioventricular node, and the Schiff’s tract, etc. The sinus node is the commander-in-chief, responsible for directing the activities of the whole heart, and the atrioventricular node is the political commissar of the administrative structure. The sinoatrial node and the sinoatrial fasciculus are the most important members of the heart. As for the inter-knot bundle and the Hitchcock bundle, they belong to the “middle-level cadres”, whose task is to convey instructions from the superiors and organize the masses to accomplish the tasks given by the superiors. A complete and sophisticated management structure allows the heart to operate efficiently and in an orderly manner.
Fast, slow and irregular heartbeats…the meaning of DD arrhythmia
The heart is naturally active and brings us energy and troubles. A normal heartbeat, initiated by the sinus node, with a frequency of 60-100 beats per minute and a neat rhythm, is our normal heartbeat, and because it originates from the sinus node it is medically called sinus rhythm. The heartbeat is not constant and it is in its nature to change. It can fluctuate according to our activities and emotions. It can increase when we are active, happy or angry, and slow down when we are resting or sleeping. For beats above 100/min, we call it sinus tachycardia; below 60/min, sinus bradycardia; and irregular rhythm, sinus arrhythmia.
Heart rhythms that originate outside the sinus node, including sinus tachycardia, bradycardia, arrest, and arrhythmia, are all abnormal heart rhythms, or arrhythmias, as doctors often call them. There are many different types of arrhythmias, and the mechanisms of their occurrence are complex, so we will not expand on them.
In their daily work, doctors generally classify arrhythmias into 2 main categories: fast and slow arrhythmias. It goes without saying that a slow heartbeat is a slow arrhythmia, including bradycardia, arrest, conduction block, etc.; on the contrary, it is a fast arrhythmia, including premature beats, tachycardia, flutter, fibrillation, etc. Tachycardia, bradycardia, and arrhythmias need no explanation. Premature beats are beats caused by other parts of the heart overstepping their authority and advancing ahead of the sinus node. Flutter and fibrillation are atria and ventricles that do not listen to the command of the sinus node and do things on their own, but flutter can still keep the whole atria or ventricles beating in a more consistent pace, which means that they are making a Taiwan independence and do not listen to the instructions of the central government, but the words of the governor still work. Fibrillation is the atrium or ventricle of each small collective can not keep in sync, is the Somali pirates, in addition to their own, who do not listen to, each act, have to the sea you grab me! Arrest is the heart wants to “lazy”, do not want to beat. Conduction block is the heart conduction system of a part of the failure, biological current can not be transmitted down!
Panic, shortness of breath, chest pain… DD arrhythmia sensations
There are many arrhythmias that are asymptomatic, but many more patients feel uncomfortable. The most common is panic, dangling a little textual term for palpitations. When it comes on, many people feel like their heart won’t stop beating, sometimes their heart is about to jump out of their throat, as if they were a thief. There can also be shortness of breath, chest tightness, and chest pain. Dizziness mostly arises from slow arrhythmias, but tachyarrhythmias with a fast heartbeat can also occur, and in severe cases, syncope and blacklegged excelsior can occur.
If the ventricle is tachycardic, fluttering or fibrillating, it will cause insufficient blood injection to the heart, which will lead to a shortage of blood supply to all organs of the body, including the heart itself, just like a shortage of food, which can lead to heart failure and cellular degeneration and necrosis of important organs over time. The atrium has a relatively small impact on blood circulation, but it should not be paralyzed. Because the blood, this little sister, temperament is very big, not easy to mess with ah! Although the liquid state is her original temperament, but to maintain her watery tenderness is conditional, once not to meet her requirements, unhappy, the little aunt will immediately face up, into a blood clot. If atrial fibrillation and other arrhythmias occur, the direction and nature of blood flow in the heart will change, so that it is easy to form blood clots, or thrombus, as doctors often say, these clots follow the blood vessels, with the blood flow to other parts of the body, stop there and embolism in that, it will cause ischemic necrosis in that area, which is the medical term for infarction. The most common clinical condition is cerebral infarction, which is often referred to as “stroke”.
There are many reasons that can trigger arrhythmia, such as happiness, anger, smoking, drinking, exercise, hypertension, coronary heart disease, hyperthyroidism, etc. Some patients have frequent episodes, others have fewer, but no matter how many, it is a stone in the patient’s heart. I don’t know when and where the disease will start, so the patient is scared all day, sleep and food!
Listen, feel, ECG, CARTO system…DD arrhythmia identification method
In order to lose the arrhythmia trouble, we must first understand the trouble, hoping to destroy the enemy, it is necessary to understand the enemy. Before getting rid of the trouble, it is necessary to find the right path to take.
By listening to the heart sounds and feeling the pulse with a stethoscope, one can initially identify premature beats, arrests, tachycardia, and even atrial fibrillation, but this is not enough, because it is not possible to fully identify the site and nature of the arrhythmia. Therefore, we have to thank Professor Willem Einthoven of the Netherlands, who invented the electrocardiogram more than a hundred years ago, so that we can understand the types and characteristics of arrhythmias more easily and clearly. Modern developments in cardiac electrophysiology have provided us with very precise methods of analysis, which have clarified the mechanisms and characteristics of many arrhythmias and guided clinicians in their work, leading to the eradication of many of them. To use an inappropriate analogy, the ordinary ECG is just a magnifying glass, while modern cardiac electrophysiology technology, including physiological polysomnography, CARTO system, Ensite 3000 system, etc., is an optical microscope and electron microscope.
Drugs, ablation, artificial pacing, electrical resuscitation…DD is a miracle cure for arrhythmia
Not all arrhythmias must be treated. Many benign arrhythmias that have no obvious symptoms and are not life-threatening (e.g., episodic atrial premature, ventricular premature, right bundle branch block, etc.) can be simply observed without any urgency to treat them. It is important to note here that many people who find out they have left or right bundle branch block are very worried and anxious, but this is not necessary. This is because simple bundle branch block, if there are no symptoms, will not affect our heart too much, except for new cases of left bundle branch block and multi-branch block.
Malignant arrhythmias with significant symptoms that can be life-threatening (e.g., paroxysmal supraventricular tachycardia, atrial tachycardia, atrial flutter, atrial fibrillation, frequent premature ventricular events, ventricular tachycardia, etc.) should not be taken lightly as a matter of course.
There are currently 2 major schools of “martial arts” for the treatment of arrhythmias – the “toxic school” and the “non-toxic school”, i.e., drug therapy and non-drug therapy.
1.Drug treatment
Drug treatment is the “poison school”, and its “master” is certainly not the “Western Poison – Ouyang Feng” that we know, but the “master” who has another way. The “master” is not the well-known “Western Poison – Ouyang Feng”, but a “master” of another way.
There are four categories of drugs for the treatment of tachyarrhythmias: I, II, III and IV. The “master drugs” of category I are propafenone, lidocaine, mexilol, mirexazine, etc., the “master drugs” of category II are metoprolol, bisoprolol, sotalol, etc. The “master drugs” of class III include amiodarone, and the “master drugs” of class IV include verapamil. They mostly affect the ion channels (such as sodium, potassium, calcium, etc.) or adrenergic nerves in the cardiomyocyte membrane, and alter the bioelectrical activity of cardiomyocytes to combat arrhythmias. Propafenone and amiodarone can have effects on atria and ventricles, etc. They can be used to treat both arrhythmias originating from atria and arrhythmias originating from ventricles, so they are also called broad-spectrum antiarrhythmic drugs, that is, all-purpose champions. Lidocaine and mexilate act mostly in the region below the atrioventricular node and are usually used mostly in the treatment of arrhythmias of ventricular origin.
The “master drugs” for slow arrhythmias are atropine and isoprenaline.
Although these drugs have good therapeutic effects, they cannot eradicate the arrhythmia at its root! As the saying goes, all drugs are toxic, and after a long period of use, they can not only produce many side effects such as hypothyroidism and pulmonary fibrosis, but can also induce arrhythmias themselves. But do not be frustrated, the development of modern technology, and constantly provide us with new tools, so that the eradication of arrhythmia from fantasy gradually become reality!
2. Treatment without drugs
Non-drug treatment techniques for arrhythmias are currently ablation, artificial cardiac pacing, electrical resuscitation, etc. It is impossible to use atropine and isoproterenol for a long time for permanent slow arrhythmias, that will bring a lot of side effects, and it is certainly essential to install a pacemaker and perform artificial cardiac pacing. The function of the pacemaker is that she can feel the heart slowing down, and timely electrical stimulation is given to whip the heart to prevent her from “dozing off”. Anyone can be lazy, but not the heart, because once she falls asleep, it is difficult for us to stay awake, and we will never wake up! Electric resuscitation is to let the heartbeat back to normal, the same as the “nine Yang Shen Gong”, to put it bluntly is through the discharge, so that the chaotic heart electrical activity, all under the unified leadership of the commander-in-chief of the sinus node! That is, to eliminate warlord chaos, so that the local subordination to the central government. This “technique” is mainly used to treat atrial flutter, atrial fibrillation, ventricular tachycardia, ventricular flutter, and ventricular fibrillation.
Paroxysmal tachyarrhythmias are like a stone hanging over the patient’s head, not knowing when it will fall! Medication can only hold this stone up, or hold it up after it has fallen, but it does not completely guarantee that the stone will not fall again. Living in this horrible atmosphere all day long, can it not affect our work and life? The best way is to take away the stone so that the patient is completely free from the shadow of arrhythmia. That is why radiofrequency ablation has become the best method to treat tachyarrhythmia.
The so-called ablation is to use a kind of electric current or other technology called radiofrequency, in the origin of the arrhythmia or abnormal “circuit”, artificially damage, eliminate the primary foci of the arrhythmia, interrupt the folding loop of the arrhythmia, so as to cure the rapid arrhythmia, is “a yang finger It is the same as “one yang finger”. It has been the “master of the martial arts” in the field of drug-free treatment of tachyarrhythmias, and has cured thousands of patients since its inception.
Ablation can be performed in both surgical and medical interventional procedures. The arrhythmias that can be treated are paroxysmal supraventricular tachycardia, atrial tachycardia, atrial flutter, atrial fibrillation, frequent ventricular premature, and ventricular tachycardia. Among them, paroxysmal supraventricular tachycardia, atrial flutter, and frequent ventricular premature have the most mature technology and the highest success rate. Paroxysmal atrial fibrillation has a high success rate and a low recurrence rate; chronic atrial fibrillation currently has a low success rate and a high recurrence rate, but the success rate is rapidly increasing and the recurrence rate is gradually decreasing as technology continues to advance.
Compared with other treatment methods, ablation, especially internal interventional radiofrequency ablation, has the advantages of high safety, few complications and precise efficacy. It is a minimally invasive technique without opening the chest, and the wound is only 1-2 grains of rice in size. It only requires puncturing the blood vessels in the root of the thigh or head and neck, placing electrodes into specific parts of the heart through the blood vessels, detecting the site of arrhythmia with a universal meter to detect the wiring of electrical appliances, and using the electrodes to cauterize the key parts of the arrhythmia with radiofrequency current, ablating and blocking the abnormal circuit or eliminating the lesion, thus curing the arrhythmia and withdrawing the electrodes after surgery without placing interventional materials or machines.
Here some of you may ask: Will the inserted electrodes poke our stomach and intestines? Actually, there is no need to worry about this! Because doctors do not play with their conscience and reputation. Medical professionals always try to take the least harmful and most beneficial method to treat you. The electrodes are pushed through our normal blood vessels to the heart, not the fierce Zhang Fei, usually will not poke our blood vessels and other organs!
(1) Ablation of simple cardiac arrhythmias
The devices used to detect cardiac electrical activity in the heart are becoming more and more sophisticated, detailed and complex, and their functions are becoming more and more comprehensive, and they are more and more able to reveal the mysteries of various arrhythmias in depth and thoroughly, making more and more arrhythmias that can be cured. The most effective treatments are paroxysmal supraventricular tachycardia, type I atrial flutter, and premature ventricular contractions of right ventricular outflow tract origin. Paroxysmal supraventricular tachycardia includes atrial folding tachycardia and atrioventricular nodal folding tachycardia. Patients with this type of tachycardia come out of the womb with an extra “circuit” in their heart, which forms a closed loop with other “circuits”. This “circuit” forms a closed loop with other “circuits”, and the heart’s current can move in a circular motion along this loop, similar to our usual running around the playground. If this current keeps going around in circles, it hurts our heart! Our heart has to work along with it, and the patient feels panic, and paroxysmal supraventricular tachycardia occurs. But in the presence of radiofrequency ablation, paroxysmal supraventricular tachycardia is a piece of cake. Using only a “compass” like a polysomnograph, the extra circuit can be found in a two-dimensional plane and burned out using conventional large-headed electrodes. Similarly, for the relatively simple arrhythmias such as type I atrial flutter and right ventricular outflow tract-derived premature ventricular contractions, which have well-known classical and relatively fixed circuits, the polyphysiometer can take care of them without much effort!
(2) Ablation of complex arrhythmias
Complex arrhythmias, such as atrial fibrillation, lack classical and fixed routes, so relying only on a simple “compass” like polysomnography is not enough, so our clever brains came up with a better idea…
The CARTO system and Ensite3000 system have their own advantages, the most important feature of CARTO system is contact, and the prominent feature of Ensite3000 system is non-contact. By contact, we mean that electrodes are used to probe the endocardium directly, measure the associated potential, and construct an electrical structure model of the heart by computer, while non-contact is used to record the electrical activity of one heartbeat with an elliptical-shaped mesh of electrodes. In our country now CARTO system is used a little more widely. In particular, radiofrequency ablation therapy for atrial fibrillation is used.
Atrial fibrillation is one of the most common arrhythmia diseases, the “Somali pirate” mentioned earlier. The incidence increases with age, with a prevalence of up to 5.9% in people over 65 years of age, and it is estimated that we have about 8 million patients with AF in China. As per capita life expectancy increases, there will be more and more patients with atrial fibrillation, and the dangers of atrial fibrillation have been largely described earlier and will not be repeated here. Her principle of occurrence is still not very clear, the French found that she is related to the pulmonary veins, caused by the pulmonary vein potential, so the modern radiofrequency ablation technology of atrial fibrillation was created. Radiofrequency ablation of atrial fibrillation is performed mainly by isolating the electrical conduction between the pulmonary veins and the atria, that is, by sending a warship escort to separate the pirate ship from the merchant ship, which can cure atrial fibrillation. At this time, the polyspectrometer with two-dimensional scalar measurement alone cannot meet the need. It is necessary to navigate with the help of three-dimensional imaging system equivalent to global positioning system such as CARTO in order to determine the site where the doctor needs to perform RF ablation, guide RF ablation and finally judge the effect of RF ablation.
Returning a healthy heartbeat to you
Patients with cardiac arrhythmias are a group that requires a high level of care. They are numerous, have a poor quality of life, some have lost the ability to work, and the vast majority do not receive effective treatment. We should give them support and encouragement, while taking the best possible steps to relieve their suffering and give them a healthy heartbeat. But then again, despite all your thousands of prescriptions and wonders, it is only truthful not to get sick. What there is, never get sick! Prevention is better than cure, change bad habits and maintain a good state of mind tops important!