Matenda a atrial ndi amodzi omwe amachititsa mtima kwambiri, omwe amakhudza mamiliyoni a anthu ku US okha. Ndiwowoneka mofulumira, wosasinthasintha mtima wamtima womwe umachokera mu zipinda zam'mwamba (zam'mwamba) za mtima, zomwe zimawombetsa komanso kutopa. Zimachulukitsa kwambiri chiopsezo chotenga sitiroko . Tsoka ilo, mankhwala ake amakhalabe vuto lalikulu kwa madokotala ndi odwala.
Mwachidule
Grayera Woyera poyesera kuchiza matenda opatsirana pogwiritsa ntchito mankhwala akutha kukhazikitsa njira yothetsera arrhythmia ndi kubweretsa. Ablation ndi ndondomeko yomwe imachitika panthawi yophunzira opaleshoni kapena pa opaleshoni ya opaleshoni, yomwe imayambitsa mapulitsimidwe a mtima wa wodwalayo, kumalo amodzi, ndiyeno kuwonongedwa (mwachitsanzo, kutsekedwa.)
Kawirikawiri, kupuma kwapadera kumagwiritsidwa ntchito pogwiritsira ntchito mphamvu ya radiofrequency (cauterization) kapena cryoenergy (kuzizira) kupyolera mu catheter, kuwononga malo ochepa a minofu ya mtima kuti asokoneze arrhythmia. Ngakhale kuti mitundu yambiri ya mtima yambiri imatha kuchiritsidwa pogwiritsira ntchito njira zothandizira anthu, njira zowonjezera mazira zakhalabe zovuta.
N'chifukwa Chiyani Zili Zovuta Kwambiri?
Magulu ambiri a mtima amayamba chifukwa cha malo ang'onoang'ono omwe amapezeka mkati mwa mtima omwe amachititsa kuti magetsi asokonezeke. Kwa ambiri arrhythmias, ablation amangofuna kupeza malo ang'onoang'ono malo osokoneza.
Mosiyana ndi zimenezi, kusemphana kwa magetsi komwe kumagwirizanitsidwa ndi matenda a atrial fibrillation kumakhala kwakukulu kwambiri-makamaka kumbali yambiri yamanzere ndi ya atria yolondola.
Kuyesa koyambirira kwa kuthetsa mafinya a atrial kunayambitsa kupanga "maze" ya zida zovuta, zowonongeka pakati pa atria, kuti zisokoneze ntchito zamagetsi zovuta kwambiri.
Njira imeneyi (yomwe imatchedwa njira ya maze ) imagwira bwino ntchito yomwe imachitika ndi opaleshoni odziwa bwino kwambiri m'chipinda chochita opaleshoni-koma imafuna opaleshoni yayikulu yotseguka, ndi zoopsa zonse. Kupanga zida zowonongeka zomwe zimafunikira kuti zisokoneze mafinyria akumwa ndi zovuta kwambiri ndi ndondomeko yothandizira.
Kuyenda Pambuyo Poyambitsa
Electrophysiologists aphunzira kuti nthawi zambiri amatha kupangika mafinyria ochotsera matendawa mwa kuthetsa "zovuta" za arrhythmia, zomwe ndi PACs (kupweteka msanga kuchokera ku atria). Kafukufuku amasonyeza kuti pafupifupi 90 peresenti ya odwala omwe ali ndi matenda opha tizilombo toyambitsa matenda, ma PAC omwe amachititsa kuti chiwerengerochi chichoke kumadera ena kumbali ya kumanzere, yomwe ili pafupi ndi mitsempha ya mitsempha inayi. (Mitsempha ya pulmona ndi mitsempha ya magazi imene imapereka magazi okosijeni m'mapapo mpaka pamtima.)
Ngati kutsegula kwa mitsempha kungathe kukhala motalikirana ndi magetsi kumbali yonse ya kumanzere, pogwiritsa ntchito catheter yapadera yokonzera cholinga ichi, kutsekemera kwa magazi kungathe kuchepetsedwa kawirikawiri kapenanso kuthetsedwa.
Kuwonjezera apo, machitidwe atsopano ndi apamwamba kwambiri (komanso okwera mtengo) ma mapulaneti atatu apangidwe apangidwa kuti agwiritsidwe ntchito popereka njira zogwirira ntchito mu labata yothandizira.
Mapulogalamu atsopano a mapu amalola madokotala kuti apange zipsera zoperewera ndi mlingo wachindunji wosadziwika zaka zingapo zapitazo. Teknolojiyi yatsopano yathandiza kuti matenda opatsirana pogwiritsa ntchito mankhwalawa asapangidwe kwambiri kuposa kale.
Mphamvu
Ngakhale kupitako kwapita kwanthaŵi, kubwezeretsedwa kwa mankhwala opatsirana pogwiritsira ntchito mankhwala akugwiritsabe ntchitobe kumakhala kovuta komanso kovuta, ndipo zotsatira zake sizingwiro. Ablation amagwira bwino ntchito kwa odwala omwe ali ndi mafupipafupi ochepa omwe amawagwiritsa ntchito poyambitsa matenda a atrial - omwe amatchedwa "paroxysmal" . Ablation amathandiza kwambiri odwala omwe ali ndi matenda osokoneza bongo, kapena omwe ali ndi matenda aakulu a mtima , monga matenda a mtima kapena matenda a mtima.
Ngakhalenso odwala omwe amawoneka kuti ndi oyenerera kuti abwerere kuntchito yowonjezereka, nthawi yaitali (zaka zitatu) kupambana pokhapokha pokhapokha pokhapokha pokhapokha peresenti yokwana 50 peresenti. Ndi njira zowonjezera kubwereza, kupambana kwabwino kumawonekera kuti ndikoposa 80 peresenti. Njira iliyonse yowonjezerapo, komabe, imayambitsanso wodwalayo pangozi ya mavuto. Ndipo mitengo yabwino ndi yotsika kwambiri ndi odwala omwe sali oyenera.
Mapulogalamu opambanawa ndi ofanana ndi omwe amapezeka ndi mankhwala osokoneza bongo . Kuwonjezera apo, kuperewera kwabwino kwa mankhwala ophera tizilombo toyambitsa matenda sikukuwonetseratu kuchepetsa chiopsezo cha kugwidwa. Choncho ndikofunikira kupitiliza ndi mankhwala kuti muteteze zikwapu ngakhale mutatha kupuma.
Mavuto
Kuopsa kwa mavuto ndi catheter kublation kwa atrial fibrillation ndi apamwamba koposa mitundu ina ya arrhythmias. Izi zili choncho chifukwa nthawi ya njira yowonjezeramo nthawi zambiri imakhala yayitali kwambiri ndi mafinya oopsa, kuchuluka kwa chilonda chomwe chiyenera kupangidwa nthawi zambiri chimakhala chachikulu kwambiri, komanso malo omwe amabala pafupi ndi mitsempha ya pulmonary), amachititsa kuti pakhale mavuto.
Imfa yokhudzana ndi ndondomeko imakhala pakati pa odwala 1 ndi 5,000 alionse omwe ali ndi ndalama zowonjezereka. Mavuto akuluakulu omwe angapangitse imfa ndiyo kuphwanya matenda a mtima , kupweteka, kupanga fistula (kulumikizana) pakati pa atrium kumanzere ndi mimba , kupweteka kwa mitsempha, ndi matenda.
Mliriwu umapezeka mpaka 2 peresenti. Kuwonongeka kwa mitsempha ya pulmonary (yomwe ikhoza kutulutsa mavuto a mapapu omwe amatsogolera ku mpweya wochepa kwambiri, chifuwa, ndi chibayo chobwerezabwereza) amapezeka mpaka atatu peresenti. Kuwonongeka kwa mitsempha ina ya mitsempha (ziwiya zomwe kathetta zimalowetsedwa) zimapezeka chimodzi kapena ziwiri peresenti. Zovuta zonsezi zimaoneka ngati zofala kwambiri kwa odwala opitirira zaka 75, ndi akazi.
Kawirikawiri, kupambana kwa njirayi ndi chiopsezo cha mavuto kumapangitsa kuti pulogalamuyi ikwaniritsidwe ndi electrophysiologist ndi zowonjezereka zowonongeka kwa mafinya.
Mawu Ochokera
Aliyense amene ali ndi atrial fibrillation amene akufunsidwa kuti aganizire mankhwala opatsirana nawo ayenera kusunga zinthu zochepa m'maganizo. Choyamba, kupambana kwa njirayi, pamene kulibwino, sikuli bwino kuposa momwe zimakhalira ndi mankhwala osokoneza bongo-osachepera, pokhapokha atatha njira imodzi yobweretsera.
Chachiwiri, ngakhale pokhapokha atapindula, phindu la kupereka ndalama kumangopereka mpumulo wa zizindikiro. Sichikuthandizani kupulumuka ndipo sichinawonetsedwe kuchepetsa chiopsezo cha kupwetekedwa. Chachitatu, pali chiopsezo chosakanikirana ndi mavuto aakulu.
Ngakhale zili zolepheretsa, ndi zomveka kuganizira njira yowonjezerapo mankhwala ngati mankhwala opatsirana pogonana akuwonetsa zizindikiro zomwe zimasokoneza moyo wanu, makamaka ngati mayesero amodzi kapena awiri a mankhwala osokoneza bongo alephera.
Onetsetsani kuti ngati mukuganizira njira yothandizira anthu kuti ayambe kumwa mankhwalawa, mumadzidziwitsa nokha momwe mungasankhire mankhwalawa.
Ngati ablation akadakali chokongola kwa inu, mudzafuna kuonetsetsa kuti mukuchita bwino. Izi zikutanthawuza kudziŵa nokha zomwe umoyo wa electrophysiologist umakumana nacho ndi njira zowonjezerapo zowonjezereka.
Musamangokhalira kufufuza zowerengera za zofalitsa zachipatala zosindikizidwa (zomwe kaŵirikaŵiri zimafotokozedwa ndi malo abwino koposa). Zotsatira zanu zabwino zimakhala bwino ngati dokotala ali ndi zambiri ndipo ali ndi chitetezo chabwino ndi chitetezo chokhala ndi njira zowonjezerapo zowonjezereka.
Zotsatira:
Ganesan AN, Shipp NJ, Brooks AG, et al. Zotsatira za nthawi yayitali ya catheter kuperewera kwa mankhwala opatsirana pogwiritsa ntchito mankhwala: njira yowonongeka ndi kusanthula meta. J Am Heart Assoc 2013; 2: e004549.
Cosedis Nielsen J, Johannessen A, Raatikainen P, et al. Kuperewera kwa mankhwala mofulumira ngati mankhwala oyamba poyambitsa mafinya oopsa. N Engl J Med 2012; 367: 1587.
Morillo CA, Verma A, Connolly SJ, et al. Mankhwala osokoneza bongo omwe amagwiritsira ntchito mankhwala ozunguza bongo monga mankhwala oyamba omwe amachititsa kuti pakhale mankhwala osokoneza bongo (RAAFT-2). JAMA 2014; 311: 692.