Atrial fibrillation ndiyo imwe yemwoyo yakawanda yakagadzikana, inokanganisa mamiriyoni evanhu muUnited States chete. Icho chinokurumidza, chisina kuchena mwoyo rhythm inobva mumakamuri ekumusoro (kumusoro) makamuri emwoyo, zvinowanzokonzera kupera uye kuneta. Inowedzera zvikuru njodzi yekurohwa . Zvinosuruvarisa, kurapwa kwayo kunowanzova dambudziko rechokwadi kune vose vanachiremba nevarwere.
Overview
Iyo Girasi Tsvene mukutsvaga kwekurapa inrial fibrillation yave iri kukudziridza nzira yekurapa arrhythmia nekubvisa. Ablation inzira inoshandiswa kana panguva yekudzidzira electrophysiology kana mubhuku rinopurira, iro rinobva mumoyo wemurwere arrhythmia rakarongedzwa, rinowanikwa, uye rinoparadzwa (kureva, rakabviswa.)
Kazhinji, kubheta kunopedzwa nokushandisa mafirofrequency energy (cauterization) kana kuti cryoenergy (kupisa) kuburikidza nekatheta, kuparadza nzvimbo shoma yemutsipa wemukati kuitira kuti zvivhiringidze arrhythmia. Kunyange zvazvo mhando dzakawanda dzomukati dzomwoyo dzakagadziriswa nyore nyore kuburikidza nekugadzirisa nzira dzokugadzirisa, hutachiona hwehutachiona hwakaramba hwakaoma.
Nei Zvakaoma Kwazvo?
Nyaya dzakawanda dzomukati dzomukati dzinokonzerwa nenzvimbo duku, nzvimbo yaunogara pane imwe nzvimbo mukati memwoyo inoita kuti magetsi asakanganiswa nemoyo wose. Kune akawanda arrhythmias, saka, kubvumira kunoda kungoona nzvimbo duku iyo isina kukwana uye kuvhiringidza.
Kusiyana neizvi, kukanganiswa kwemagetsi kunobatanidza nefriday fibrillation kune zvakawanda zvakanyanya-zvikurukuru inosanganisira yakawanda yekuruboshwe uye yakarurama yearia.
Kuedza kwekutanga kwekuvhara kwemafuta ekurapa kwakagadzirirwa kugadzira "maze" yezvinotyisa, zvitsva zvakakomba muAria, kuzovhiringidza basa iri rakawandisa remagetsi.
Iyi nzira (iyo yave ichinzi iyo nzira yekat maze ) inoshanda zvakanaka kana ichiitwa nevanovhiya vane ruzivo muimba yekushandira-asi inoda kuvhiyiwa mwoyo yakavhara, pamwe nezvose zvinowanzokanganisa. Kuumba zvipembenene zvakakosha zvakakosha kuti zvivhiringidze kuurawa kwefridhi inowedzera zvakaoma nemitambo ye catheterization.
Going After Triggers
Electrophysiologists vakadzidza kuti vanowanzogadzirisa hutachiona hwemagetsi kuburikidza nekupedza "izvo zvinokonzera" zverramthmia, iyo inonzi PACs (nguva dzisati dzavapo dzinotanga muAria). Zvidzidzo zvinoratidza kuti kusvika 90 muzana yevarwere vane inrial fibrillation, iyo PACs inoita kuti armemia inomuka kubva kune dzimwe nzvimbo mukati meftri atrium, iyo, pedyo nekuzarurirwa kwemakumbo mana emapemmine. (Mishonga yemapurmoni ndiyo mishonga yeropa iyo inopa ropa rakapoteredzwa kubva mumapapu kusvika pamwoyo.)
Kana kuvhura kwemitsipa kunogona kushandiswa magetsi kubva kune rumwe rutivi rworuboshwe, uchishandisa catheter yakagadzirirwa nokuda kwechinangwa ichi, frill fibrillation inogona kuderedzwa kazhinji kana kunyange kubviswa.
Uyezve, zvitsva uye zvakanyanya kwazvo (uye zvinodhura zvikuru) zvirongwa zvitatu-mapikicha mapikirwo zvakagadzirirwa kuti zvishandiswe mukugadziriswa kwebasa mubazi recatheterization.
Aya mapurogiramu matsva anosvitsa vanachiremba kuti vagadzire zvinopisa zvishoma nehuwandu hwezvakarurama zvisingazivikanwi makore mashomanana akapfuura. Iyi teknolojia itsva yakagadzirisa kubviswa kwepriysi fibrillation yakawanda zvikuru kudarika iyo yaimbova iyo.
Kubudirira
Pasinei nekufambira mberi kwemazuva ano, kubviswa kwehutachiona hwehutachiona kuchiri nguva yakareba uye yakaoma, uye zvigumisiro zvayo zvisingasviki. Ablation inoshanda zvakanyanya kune varwere vane zvikamu zviduku zviduku zvehutachiona hwehutachiona - zvinonzi "paroxysmal" inrial fibrillation . Ablation inoshanda zvishoma zvakanyanya kune varwere vane chisingagumi kana kuti vanoramba vachiita fyria, kana kuti vane vane hutachiona hwehutano hwemwoyo , hwakadai sekushaya mwoyo kana chirwere chemwoyo.
Kunyangwe nevarwere vanoita sevakakodzerwa zvakanaka kuti vabatsirwe neutrial fibrillation, nguva yakareba (mitatu-gore) kubudirira kwehutano mushure mekunge imwe nzira yekubvumira inenge inenge 50 muzana chete. Nekudzokorora kwekugadzirisa maitiro, huwandu hwekubudirira hunoonekwa huri hwepamusoro se80 muzana. Nzira imwe neimwe yekugadzirisa, asi, inodzosera murwere zvakare kune njodzi yezvinetso. Uye kubudirira kwehuwandu kune zvakaderera zvikuru nevarwere vasingasviki vakakodzera.
Aya kubudirira mazinga akafanana zvakafanana neaya anowanikwa nemishonga inopesana nemishonga . Uyezve, kubudirira kwekugadzirisa hutachiona hwehutachiona hahugere kuratidzwa kuti kuderedze njodzi yekurohwa. Saka zvakakosha kuti urambe uchirapa kurapa zvirwere kunyange mushure mekupedzisira.
Matambudziko
Ngozi yezvinetso ne catheter ablation ye-atrial fibrillation yakakwirira kudarika mamwe marudzi e arrhythmias. Izvi ndezvokuti nguva yebato rekubvumira inowedzera kuva yakareba kwenguva yakareba nefriday fibrillation, chiyero chevhara iyo inofanira kubudiswa inowanzo yakawanda kwazvo, uye nzvimbo yezviyo zvinokonzerwa (kureva, mucheki wekurima, kazhinji pedyo nemapapiro emapurmonary), inowedzera ngozi yezvinetso.
Kufa kwehutano hunoitika pakati pemumwe nemashanu kune vane chiuru chimwechete varwere vane ruzivo rwehutachiona hwemagetsi. Zvinetso zvakakomba zvinogona kutungamirira kurufu zvinosanganisira tamponade yemwoyo , kushungurudzika, kubudisa fistula (kufambidzana) pakati peatrium yakasara uye inophagus , perforation yemapinmonary vein, uye utachiona.
Kurwadza kunoitika kusvika kuviri kubva muzana. Kukuvadza kwemapurmonary vein (iyo inogona kuunza zvinetso zvemapapu zvinotungamirira kukurumidza kufema, kufema, uye pneumonia). Kukuvadza kune dzimwe mitsipa yeropa (midziyo iyo iyo catheters inowanikwa) inoitika mune imwe kana maviri muzana. Zvose izvi zvinetso zvinoratidzika kuva zvakajairika muvarwere vanopfuura makore makumi manomwe, uye muvakadzi.
Pakati pese, kubudirira kwehutano uye pangozi yezvinetso zvinowedzera apo kubvumira kunoitwa ne electrophysiologist ine ruzivo rwakawanda mukubvisa hutachiona hwehutano.
Shoko Rinobva
Chero ani anine fibrionic atrial uyo ari kubvunzwa kuti afunge nezvekurapwa kwepabonde anofanira kuchengeta zvinhu zvishoma zvinokosha mupfungwa. Chokutanga, kubudirira kwehutano, panguva yakajeka, haisi nani kutaridzika kupfuura iyo ine antiarrhythmic zvinodhaka-zvichida, kwete mushure mekunge imwe nzira yekubvisa.
Chechipiri, kunyange kana ichibudirira, kubatsirwa kwekubhadharisa mari kunongopedzisira kuregererwa kwechiratidzo. Iyo haifaniri kuwedzera kupona uye haina kuratidzirwa kuderedza dambudziko rekurohwa. Chechitatu, pane dambudziko risingaregi rezvinetso zvakakomba.
Pasinei nezvikwereti izvi, zvinonzwisisika kufunga nezvenzira yekugadzirisa kana chirwere chako chekushaya ropa chinokonzera zviratidzo zvinokanganisa hupenyu hwako, kunyanya kana imwe kana miviri yemishonga yekurwisa yakakundikana.
Ingova nechokwadi chokuti Kana uri kufunga nezvekugadzirisa zvirongwa zvehutachiona hwehutachiona, iwe unozvigadzirisa uchiziva zvose zvaunoshandisa kurapwa kwechirongwa ichi.
Kana kublation ichiri chiitiko chakanaka kwauri, iwe unoda kuve nechokwadi kuti iwe unogadzirisa matanho ako ehupenyu hunobudirira. Izvi zvinoreva kuziva nhengo yako ye electrophysiologist pachedu nekugadzirisa zvirongwa zvehutachiona hwemagetsi.
Usagadziridza kudzokorora kwezvinyorwa kubva kune zvakabudiswa zvekurapa mabhuku (izvo zvinowanzoburwa chete chete nepamusoro-soro nzvimbo). Maitiro ako ezvakanaka zvinogadziriswa kana chiremba wako ane ruzivo rwakawanda uye iwe pachako ane hutano hwakanaka uye hunobudirira rehutano nehutano hwekugadzirisa hutachiona hwehutano.
Sources:
Ganesan AN, Shipp NJ, Brooks AG, et al. Zvenguva refu zvinoguma zve catheter kubhadhara kwepriysi fibrillation: kugadziriswa kwekuongorora uye meta-analysis. J Ndimo Mwoyo Assoc 2013; 2: e004549.
Cosedis Nielsen J, Johannessen A, Raatikainen P, et al. Rodofrequency ablation as initially therapy in paroxysmal atrial fibrillation. N Engl J Med 2012; 367: 1587.
Morillo CA, Verma A, Connolly SJ, et al. Kurwiswa kwehuwandu hwemapurisa nehutachiona hwemishonga inotanga kushandiswa kwepakutanga kwepiriniti yepyroysymal atrial fibrillation (RAAFT-2): muedzo unongoramba uripo. JAMA 2014; 311: 692.