I-fibrillation ye-atrial ingenye ye- arrhythmias yenhliziyo evamile, ethinta izigidi zabantu e-US kuphela. Kuyinto esheshayo, engavamile isigqi senhliziyo esivela emagumbini ase-atrial (engenhla) enhliziyweni, evame ukubangela ukuphazamiseka nokukhathala. Ukwandisa kakhulu ingozi yokushaya isifo . Ngeshwa, ukwelashwa kwayo ngokuvamile kuyisimo sangempela kokubili odokotela neziguli.
Sibutsetelo
I-Grail Engcwele ekufuneni ukwelapha i-atrial fibrillation bekulokhu ukuthuthukisa indlela yokwelapha i-arrhythmia nge-ablation. I-Ablation yinkqubo eyenziwa noma ngesikhathi sokutadisha kwe-electrophysiology noma ku-suite yokuhlinzeka, lapho umthombo wesiguli se-heart arrhythmia ihlelwe khona ibalazwe, isendaweni, futhi ibhujiswe (okungukuthi, ichithwe.)
Ngokuvamile, ukuphumula okufezwayo kufezwa ngokusebenzisa amandla omsakazo (cauterization) noma i-cryoenergy (iqhwa) nge-catheter, ukubhubhisa indawo encane ye-muscle we-cardiac ukuze kuphazamise isimiso somzimba. Yize izinhlobo eziningi ze-arrhythmias zenhliziyo seziye zanciphisa kalula ukusebenzisa amasu okubhuka, ukufucula kwe-atrial kuye kwaba yinselele.
Kungani Kunzima Kakhulu?
Iningi lama-arrhythmiya enhliziyo libangelwa indawo encane, indawo yakhona endaweni ethile enhliziyweni eyenza ukuphazanyiswa kagesi komsindo wenhliziyo evamile. Ngakho-ke ama-arrhythmias amaningi, ke, ukuphumula okudinga nje ukuthola indawo encane engavamile nokuyiphazamisa.
Ngokuphambene nalokho, ukuphazamiseka kagesi okuhlobene ne-fibrillation ye-atrial kuningi kakhulu-ngokuyinhloko kuhlanganisa iningi le-atria elingakwesokunxele nelungile.
Imizamo yokuqala ekuqedeni i-fibrillation ye-atrial yayihlose ukwakha "maze" yezibazi eziyinkimbinkimbi, ezilinganayo kulo lonke i-atria, ukuphazamisa lo msebenzi omkhulu ongajwayelekile kagesi.
Le ndlela (ebizwa ngokuthi inqubo ye-Maze ) isebenza ngendlela efanele uma yenza odokotela abahlinzeka kakhulu egumbini lokusebenza-kodwa kudinga ukuhlinzwa okukhulu kwenhliziyo evulekile, nazo zonke izingozi ezihlobene. Ukudala izibazi ezinomsoco ezidingekayo ukuphazamisa ukufucula kwama-atrial kunzima nakakhulu ngenqubo yokucwaninga.
Ukuhamba Ngemva Kokuqeda
Ama-Electrophysiologists afundile ukuthi angakwazi ukuthuthukisa ama-fibrillation e-atrial ngokuqeda "izimbangela" ze-arrhythmia, okungukuthi i- PACs (izinsimbi ezingaphambi kwesikhathi ezivela e-atria). Ucwaningo lubonisa ukuthi ezingamaphesenti angama-90 iziguli ezine-fibrillation e-atrial, ama-PAC aqala ukuhlelwa kwe-arrhythmia ezindaweni ezithile ngaphakathi kwe-atrium engakwesokunxele, okungukuthi, eduze nokuvuleka kwezivunguvungu ezine zamapulmoni. (I -veins yamapayipi yimizila yegazi ehambisa igazi okwenziwe nge-oksijeni kusukela emaphashini kuya enhliziyweni.)
Uma ukuvulwa kwemivuthwandaba kungabhekwa ngogesi kusuka kulo lonke i-atrium kwesokunxele, besebenzisa i-catheter ekhethekile eklanyelwe le njongo, ukufucula kwama-atrial kunganciphisa imvamisa noma kuqedwe.
Ngaphezu kwalokho, izinhlelo ezintsha zokuhamba kwamaphesenti amathathu nezinyanga eziphezulu kakhulu (futhi ezibiza kakhulu) zakhiwe ukuze zisebenzise ezinkambisweni zokukhishwa kwamathambo kulebhu yokucwaninga.
Lezi zindlela ezintsha zokumamephu zivumela odokotela ukuba benze izibazi zokuqeda ngezinga lokucacisa elingaziwa eminyakeni embalwa eyedlule. Lolu buchwepheshe obusha lwenze ukukhishwa kwe-fibrillation ye-atrial kunokwenzeka nakakhulu kunalokho okwakungenzeka.
Ukuphumelela
Naphezu kwentuthuko yamuva, ukukhishwa kwe-fibrification ye-atrial kusengumgomo omude futhi onzima, futhi imiphumela yayo ingaphansi kokuphelela. I-ablation isebenza kangcono ezigulini ezinama-episodes amancane okufibamba kwe-atrial - okuthiwa "i-paroxysmal" i-fibrillation ye-atrial . I-ablation ayisebenzisi kahle kakhulu ezigulini ezinomzimba ongapheli noma ophikisanayo we-atrial fibrillation, noma obani abanesifo esibalulekile esibangelwa yisifo senhliziyo , njengesifo senhliziyo noma isifo senhliziyo.
Ngisho neziguli ezibonakala zilungele ukukhishwa kwe-fibrillation yase-atrial, izinga lokuphumelela (iminyaka emithathu) lokuphumelela emva kokukhipha inqubo eyodwa kuphela ngamaphesenti angaba ngu-50 kuphela. Ngokuphindaphindiwe kwezinqubo zokuphumula, izinga lokuphumelela libikwa ukuthi liphakeme ngamaphesenti angu-80. Inqubo ngayinye yokuphumula, noma kunjalo, iveza isiguli futhi engcupheni yezinkinga. Futhi amazinga okuphumelela aphansi kakhulu neziguli ezingaphansi kwezingxoxo ezifanele.
Lezi zindleko zokuphumelela zifana nalokho okutholakala ngezidakamizwa ezidambisayo . Ngaphezu kwalokho, ukukhishwa okuphumelelayo kwe-friday fibrillation akukaze kuboniswe ukunciphisa ingozi yokushaya. Ngakho kubalulekile ukuqhubeka nokwelashwa ukuvimbela izibhamu ngisho nangemva kokuphumula.
Izinkinga
Ingozi yezinkinga nge-catheter ablation ye-friday fibrillation iphakeme kunezinye izinhlobo ze-arrhythmias. Lokhu kungenxa yokuthi ubude bezinqubo ze-ablation buvame ukuba nesikhathi eside ngokufibhala kwe-atrial, ubukhulu besibalo okumelwe kukhiqizwe ngokuvamile bukhulu kakhulu, futhi indawo yamacembe akhiqizwa (okungukuthi, e-atrium kwesokunxele, ngokuvamile eduze kwemithanga ye-pulmonary), kwandisa ingozi yezinkinga.
Ukufa okuhlobene nenqubo kwenzeka phakathi kweziguli eziyizinkulungwane eziyisihlanu neziyisihlanu ezinezinhlelo zokuphefumula kwe-atrial fibrillation. Izinkinga ezinkulu ezingase ziholele ekufeni zihlanganisa ukukhwabanisa inhliziyo , ukushaya isifo, ukukhiqiza i- fistula (uxhumano) phakathi kwe-atrium kwesokunxele kanye nesifo , i-perforation ye-pulmary vein, nokutheleleka.
I-stroke ivele ngamaphesenti amabili. Ukulimala emthonjeni we-pulmonary (okungabangela izinkinga zamaphaphu okuholela ekuphefumuleni okukhulu, ukukhwehlela, kanye ne-pneumonia ephindaphindiwe) kwenzeka kumaphesenti amathathu. Ukulimala kwamanye imithwalo yegazi (izitsha lapho ama-catheters afakwa khona) kwenzeka ngephesenti eyodwa noma amabili. Zonke lezi zinkinga zibonakala zivame kakhulu kwiziguli ezingaphezu kweminyaka engu-75 ubudala, nakwabesifazane.
Ngokuvamile, impumelelo yenqubo kanye nobungozi bezinkinga zithuthukisa lapho ukukhishwa kwe-ablation kuqhutshwa yi-electrophysiologist onokuhlangenwe nakho okukhulu ekuqedeni ukucubungula kwama-atrial.
Izwi elivela
Noma ubani one-fibrillation e-atrial oceliwe ukuba acabange ukwelashwa kwe-ablation kufanele agcine izinto ezimbalwa ezibalulekile engqondweni. Okokuqala, izinga lokuphumelela le nqubo, ngenkathi lihle kakhulu, alihle kangcono kakhulu kunezidakamizwa ezithathelwanayo-okungenani, hhayi ngemuva kwenqubo eyodwa yokuphumula.
Okwesibili, ngisho nangenkathi iphumelele, inzuzo ye-ablation ikhawulelwe ekuhluleni kwesifo. Ayiphuthumisi ukusinda futhi ayizange iboniswe ukunciphisa ingozi yokushaywa yisifo. Okwesithathu, kukhona ingozi engekho emthethweni yezinkinga ezinkulu.
Naphezu kwalokhu kunciphisa, kunengqondo ngokuphelele ukucubungula inqubo ye-ablation uma i-fibrillation yakho ye-atrial iveza izimpawu eziphazamisa impilo yakho, ikakhulukazi uma ukuhlolwa okukodwa noma ezimbili kwezidakamizwa zokulwa nokuhlukunyezwa kwehlulekile.
Qinisekisa ukuthi Uma ucubungula inqubo yokuphumula ye-fibrification ye-atrial, uyaziqaphela zonke izinketho zakho zokwelapha kule-arrhythmia.
Uma i-ablation isengakhetha okukhangayo kuwe, uzofuna ukuqinisekisa ukuthi ukwandisa izinkinga zakho zenqubo ephumelelayo. Lokhu kusho ukwazi okuhlangenwe nakho kwakho komuntu we-electrophysiologist ngezinqubo zokuqeda ukukhishwa kwe-atrial fibrillation.
Ungazilungiseleli ukuphindaphinda kwezibalo ezivela ezincwadini zezokwelapha ezishicilelwe (okuvame ukubikwa kuphela yizikhungo eziphambili kakhulu). Izinga lakho lomphumela omuhle liyathuthukiswa uma udokotela wakho enolwazi oluningi futhi ephethe irekhodi elihle lokuphepha nokusebenza kahle ngezinqubo zokukhishwa kwe-fibrillation ye-atrial.
Imithombo:
IGanesan AN, Shipp NJ, Brooks AG, et al. Imiphumela yesikhathi eside yesikhala se-catheter yokuphefumula kwe-atrial: ukubuyekezwa okuhlelekile nokuhlaziywa kwe-meta. J Am Heart Assoc 2013; 2: e004549.
Cosedis Nielsen J, Johannessen A, uRaatanainen P, et al. Ukunciphisa ama-radiofrequency njengendlela yokwelashwa kokuqala e-fibrographic atrial paroxysmal. N Engl J Med 2012; 367: 1587.
I-Morillo CA, i-Verma A, i-Connolly SJ, et al. Ukusetshenziswa kwezidakamizwa zokuhlukunyezwa kwezidakamizwa njenge-anti-rhythmic drug njengoba ukwelashwa kokuqala kwe-paroxysmal fibrillation ye-atrial (RAAFT-2): ukuhlolwa okungahleliwe. I-JAMA 2014; 311: 692.