The other day
Liu Bo, 81, suddenly fainted at home
Two or three minutes later, he woke up on his own
He was troubled inside
Decided to go to the hospital to find out
The examination found that the proximal middle stenosis of Liu Bo's anterior descending branch was about 80%, and the problem of coronary stenosis could be solved by implanting a stent.
Just when he thought he could "stride through the threshold", Professor Chen Banxin, vice president of Sun Yat-sen Memorial Hospital of Sun Yat-sen University (hereinafter referred to as "Sun Yat-sen Memorial Hospital") and deputy director of the Department of Cardiovascular Medicine, who received the treatment, keenly judged that there was another culprit behind the syncope, and Liu Bo might faint again after being discharged from the hospital, and even sudden cardiac death.
In order to find out the real cause, Professor Chen Banxin installed an implantable ECG monitor for Liu Bo before he was discharged from the hospital, and successfully discovered the real culprit behind it through this "artifact".
Implantable ECG monitor
Pull out the culprit behind the fainting
What is the "implantable ECG monitor" mentioned above?
It turned out that after Liu Bo was admitted to the hospital, Holter electrocardiogram and head CT examinations did not find obvious abnormalities, and the serious coronary stenosis problems found by coronary angiography could also be solved by implanting stents.
Professor Chen Shanxin judged from his years of rich clinical experience that this syncope was not explainable by coronary stenosis. After many considerations, experts decided to install an implantable ECG monitor for Liu Bo to capture or identify whether syncope was caused by intermittent arrhythmia events.
The day before discharge, Liu Bo implanted an ECG monitor next to the bed in the ward, and the picture shows the implantable ECG monitor and post-implantation image.
A month later, Liu Bo went to the hospital for a follow-up consultation. While inquiring about the medical history and physical examination, Professor Chen Zhanxin retrieved the data records stored by the ECG monitor in Liu Bo's body.
Sure enough, in the early hours of the morning, Liu Bo had a ventricular tachycardia that lasted up to 46 seconds, which was a serious and life-threatening malignant arrhythmia.
Due to the clear diagnosis of persistent ventricular tachycardia, Liu Bo was admitted to the hospital again. After excluding other factors, the "culprit" of Liu Bo's fainting was clear, and it was this sinister ventricular tachycardia.
Syncope is clinically common, with about 40% of people having a syncope attack in their lifetime, but because of the occasional and uncertain episodes of syncope, conventional tests often fail to confirm the diagnosis.
"Studies have shown that even after routine noninvasive and invasive examinations, nearly 40% of patients with syncope are unable to identify the cause, with the highest probability of cardiogenic syncope." Professor Chen Further explained that the risk of cardiogenic syncope is the highest and the prognosis is the worst, and implantable ECG monitors play a key role in defining the diagnosis of cardiogenic syncope.
Implantable ECG monitors can automatically record tachyarrhythmias and bradyarrhythmias, and have been recognized by guidelines and experts around the world as a first-line recommendation for unexplained syncope and cryptogenic stroke (unexplained stroke).
Magnetic resonance compatible ICD
The patient's "mobile ambulance"
In order to effectively prevent liu bo syncope recurrence and reduce the risk of sudden cardiac death, the expert team implanted Liu Bo with an ICD compatible with 3.0T magnetic resonance.
Professor Chen's team successfully implanted an ICD compatible with 3.0T magnetic resonance for Liu Bo
Professor Chen Fanxin introduced that ICD is currently the most effective means to prevent sudden cardiac death, which can be identified at the first time when patients have ventricular tachycardia, ventricular fibrillation and cardiac arrest, and automatically discharge and pacing therapy, saving patients' lives in time, which can be called "mobile ambulance".
Patients with traditional ICD implantation cannot undergo magnetic resonance imaging, but Liu Bo is 81 years old and has other chronic diseases, and there is a possibility that magnetic resonance imaging may be needed in the future. Experts admit that encountering such a problem a few years ago would put clinicians in a dilemma - without ICD, patients will be at a very high risk of sudden cardiac death; with ICD, patients will lose their eligibility for magnetic resonance imaging.
Today, the problem has both worlds – ICDs compatible with magnetic resonance imaging. Professor Chen Banxin implanted the latest 3.0T magnetic resonance ICD compatible with Liu Bo, and Sun Yat-sen Memorial Hospital is also the first batch of hospitals in China to use this new technology.
According to reports, as early as more than 10 years ago, the team of Professor Wang Jingfeng of Sun Yat-sen Memorial Hospital took the lead in carrying out implantable ECG monitoring (previously known as implantable ECG recorder) technology in South China, which clarified the cause and gave timely and effective treatment for countless patients in the diagnosis and differential diagnosis of syncope.
The current pocket-sized next-generation implantable ECG monitor can be used for about 3 years, can be compatible with 3.0T magnetic resonance, and can also be implanted at the bedside, which is extremely convenient, especially for patients who have occasional syncope or cryptogenic stroke and have difficulty capturing evidence.
Reporter | Zhou Yanmei
Editor | Wu Qiuqiu is responsible for editing | Zhang Xiuli
Correspondent | Zhang Yang Huang Rui