I-fibrillation ye-Atrial enye yezona zinto ziqhelekileyo zentliziyo, zichaphazela izigidi zabantu base-US kuphela. Ingqungquthela engxamisekileyo, engavumelekiyo yentliziyo evela kumagumbi angaphantsi (aphezulu) entliziyweni, ngokuqhelekileyo kubangele ukuphazamiseka nokukhathala. Yandisa kakhulu umngcipheko wesifo . Ngelishwa, unyango lwalo luhlala luyingxaki yangempela kubo boogqirha kunye nezigulane.
Sibanzi
I-Grail engcwele ekufuneni ukupheka i-fibrillation ye-atrial iye yenzelwa ukuphucula indlela yokuphilisa i-arrhythmia ne-ablation. I-Ablation yinkqubo eyenziwa ngethuba lokufundwa kwe- electrophysiology okanye kwi-suite yokugulisa, apho umthombo wesigulane senhliziyo isigulane, ibalazwe, kwaye yatshatyalaliswa.
Ngokuqhelekileyo, ukuchithwa kwamanzi kufezekiswa ngokusetyenziswa kwamandla ombane (i-cauterization) okanye i-cryoenergy (iqhwa) nge-catheter, ukutshabalalisa indawo encinci yesifo senhliziyo ukuze kuphazamise i-arrhythmia. Nangona iindidi zeemeyimu zomzimba ziye zanyanzeliswa ngokusetyenziswa kwamasu okubhubha, i-fibrillation ye-atrial iye yahlala ingumngeni.
Kutheni Kunzima Kangako?
Uninzi lwama-arrhythmias entliziyo lubangelwa yincinci, indawo esendaweni ethile ngaphakathi kwintliziyo eyenza ukuphazamiseka kombane kwintetho yesiqhelo. Kuba ezininzi i-arrhythmias, ngoko ke, ukuphuma kwezinto kukufuna indawo leyo encinci kwaye iphazamise indawo.
Ngokwahlukileyo, ukuphazamiseka kombane okuhambelana nefayilifayili yonyango kuninzi kakhulu-ngokukodwa kubandakanya ininzi ye-atria.
Imizamo yokuqala yokuphelisa i-fibrillation ye-atrial yayijoliswe ekudaleni "i-maze" yezixhobo eziyinkimbinkimbi, eziqhelekileyo kulo lonke i-atria, ukuphazamisa lo msebenzi ophezulu ongaqhelekanga kagesi.
Le ndlela (ebizwa ngokuba yinkqubo ye - maze ) isebenza ngokufanelekileyo xa iqhutywe ngabagqirha abanamava kakhulu kwigumbi lokusebenza-kodwa kufuna ukuhlinzwa okukhulu kwentliziyo, kunye nemingcipheko echaphazelekayo. Ukudala izixhobo ezifunekayo ukuphazamisa i-fibrillation ye-acill kunzima kakhulu kwinkqubo yokucoca.
Ukuhamba Emva kwezinto eziPhambili
I-Electrophysiologists baye bafunda ukuba banokuphucula i-fibrillation ye-agriyo ngokugqithisa "iziphumo" ze-arrhythmia, ezibizwa nge- PACs (iimbaphu ezingaphambi kwexesha elivela kwi-atria). Uphando lubonisa ukuba kuma-90 eepesenti zezigulane ezine-frilling atrial, ii-PAC ezibangela ukuba i-arrhythmia ivela kwiindawo ezithile kwi-atrium ekhohlo, oko kukuthi, kufuphi nevulo lweemvumba ezine zamapulmoni. ( Iimvumba zamapulmonari yimithambo yegazi ehambisa i-oxygen igazi kwiimiphunga ukuya entliziyweni.)
Ukuba ukuvulwa kweemvini kungabonakaliswa ngombane kwi-atrium yekhohlo, kusetyenziswa i-catheter ekhethekileyo eyenzelwe le njongo, i-fibrillation ye-agriyo inokuthi iyancitshiswa ngamaxesha amaninzi okanye ichithwe.
Ukongezelela, iindlela ezintsha kunye neziphambili kakhulu (kwaye zibiza kakhulu) iinkqubo ezintathu zokubala imephu ziye zaphuhliswa ukuze zisetyenziswe kwinkqubo yokuqhelisa i-lab.
Ezi nkqubo zemibala emitsha zivumela oogqirha ukuba benze izibazi zokuqhekeza ngezinga lokuchaneka engaziwayo kwiminyaka embalwa edlulileyo. Le iteknoloji entsha yenza ukuba i-fibrillation ye-atrial ifikeleleke ngakumbi kunokuba yayisetyenziswa.
Impumelelo
Nangona uphuhliso lwangoku, ukugqithiswa kwe-fibrillation ye-atrial kuseyona inkqubo eninzi kwaye inzima, kwaye iziphumo zayo zingaphantsi. I-Ablation isebenza ngcono kwizigulane ezinemifanekiso emfutshane yefayili ye-atrial - okuthiwa "i-paroxysmal" i-fibrillation ye-atrial . I-Ablation isebenza kangangoko kwizigulane ezinokuphefumula okungapheliyo okanye ezingapheliyo, okanye ezinezifo eziphambili zesifo senhliziyo , ezifana nesifo senhliziyo okanye isifo senhliziyo.
Ngaphandle kwezigulane ezibonakala zizilungele ukuchithwa kwe-fibrillation ye-arrivals, i-long-term (iminyaka emithathu) impumelelo emva kokuba inkqubo enye yokuphulukisa i-50% kuphela. Ngokuphindaphindiweyo kweenkqubo zokuphumelela, izinga lokuphumelela libikwe liphezulu njengama-80 ekhulwini. Inkqubo nganye yokuphulukisa, nangona kunjalo, iveza isigulane kwakhona kwengozi yeengxaki. Kwaye amazinga okuphumelela aphantsi kakhulu kunye nezigulane ezingaphantsi kootitshala abafanelekileyo.
Ezi mpu melelo zifana nezo ziphunyezwe ngezidakamizwa ze-antiarrhythm . Ukongezelela, ukuphunyezwa okuphumelelayo kwefayili ye-atrial akuzange kuboniswe ukunciphisa umngcipheko wokubetha. Ngoko kubalulekile ukuqhubela unyango ukukhusela imivimbo ngisho nangemva kokuphuma.
Iingxaki
Umngcipheko weengxaki kunye ne-catheter ablation kwi-fibrillation ye-atrial iphezulu kunezinye iintlobo ze-arrhythmias. Oku kungenxa yokuba ubude benkqubo yokuphulukiswa kwexesha ludla ixesha elide kunye ne-fibrillation ye-atrial, ubukhulu boluqabunga obuya kuveliswa luhlala lukhulu kakhulu, kwaye indawo yendawo ekhutshwe ngayo (okt, kwi-atrium ekhohlo, ngokuqhelekileyo kufuphi nemithambo ye-pulmonary), yandisa ingozi yeengxaki.
Ukufa okuhlobene nenkqubo kwenzeka phakathi kweyodwa kunye nantlanu kwi-1 000 izigulane ezine-ablation kwi-fibrillation ye-atrial. Iingxaki ezinzulu ezingakhokelela ekufeni ziquka i- tamponade ye-cardia , i-stroke, ukuvelisa i- fistula (uxhumano) phakathi kwe-atrium yekhohlo kunye nesondlo , ukugqithiswa kwe-pulmonary vein and infection.
I-stroke iyenzeka kwiphesenti ezimbini. Umonakalo kwimvumba yamapulmonary (leyo ingavelisa iingxaki zemiphunga ekhokelela ekuphefumlweni okufutshane, ukukhwehlela kunye ne-pneumonia). Ukulimala kwenye imithwalo yegazi (iinqanawa apho i-catheters ifakwe khona) iyenzeka kwipesenti enye okanye ezimbini. Zonke ezi ngxaki zibonakala ziqhelekileyo kwizigulane ezingaphezu kweminyaka engama-75 ubudala, nakwabaseTyhini.
Ngokubanzi, impumelelo yenkqubo kunye nomngcipheko weengxaki ziya kuphucula xa i-ablation iqhutywe yi-electrophysiologist enamava amaninzi ekupheliseni i-fibrillation ye-atrial.
ILizwi
Nabani na onobumba be-friller ocelwa ukuba acinge ngonyango lokuphulukana nokunyusa kufuneka agcine izinto ezimbalwa ezibalulekileyo engqondweni. Okokuqala, izinga lokuphumelela le nkqubo, ngelixa lifanelekileyo, lingenakulinganiswa kangcono kunokuba lunokusetyenziswa kweziyobisi ezichanekileyo-ubuncinane, kungekhona emva kokuphunyezwa komsebenzi omnye.
Okwesibini, nangona xa uphumelele, inzuzo yokuphulukiswa kwezinto ezithinteleyo iyancitshiswa kwiimpawu zokunceda. Ayinakuphucula uphila kwaye ayizange iboniswe ukunciphisa umngcipheko wesifo. Okwesithathu, kukho umngcipheko ongekho phantsi kweengxaki ezinzulu.
Naphezu kwezi nciphiso, kunengqiqo ukuqwalasela inkqubo yokuphulukisa xa i-frill fibrillation iveza iimpawu eziphazamisa ubomi bakho, ingakumbi ukuba omnye okanye ezimbini izilingo zamachiza e-antiarrhymic ziye zahluleka.
Qiniseka ukuba ukuba ucinga inkqubo yokuqhelisa i-fibrillation ye-atrial, uyazibona zonke iinketho zakho zokonyango malunga nale nqubo ye-arrhythmia.
Ukuba i-ablation isenokuba yinto ekhangayo kuwe, uya kufuna ukuqinisekisa ukuba ulungelelanisa iimeko zakho zempumelelo. Oku kuthetha ukwazi i-electrophysiologist yakho ngamava kunye neenkqubo zokususa i-fibrillation ye-atrial.
Musa ukulungelelanisa ukuphindaphinda kweenkcukacha ezivela kwiincwadi zonyango ezishicilelweyo (ezichazwe ngokubanzi kuphela ngamaziko angcono kakhulu). Iingxaki zakho zesiphumo esihle ziphuculwe ukuba ugqirha wakho unamava amaninzi kwaye ufumana ukhuseleko olufanelekileyo kunye nerekhodi esebenzayo kunye neenkqubo zokuqhelisa i-fibrillation ye-atrial.
Imithombo:
Ganesan AN, Shipp NJ, Brooks AG, et al. Iziphumo zexesha elide lokuxhoma kwe-catheter ye-fibrillation ye-atrial: ukuhlaziywa okucwangcisiweyo kunye nokuhlaziywa kwemeta. J Am Heart Assoc 2013; 2: e004549.
Cosedis Nielsen J, Johannessen A, uRaatikainen P, et al. Ukuphulukiswa kwee-Radiofrequency asrapy njengonyango lokuqala kwi-paroxysmal fibrillation ye-atrial. N Engl J Med 2012; 367: 1587.
Morillo CA, Verma A, Connolly SJ, et al. Ukusetyenziswa kwezilwanyana ezinomdla wokurhoxiswa kwezidakamizwa njenge-first line treatment of paroxysmal fibrillation ye-atrial (RAAFT-2): ityala elingenangqondo. JAMA 2014; 311: 692.