He aha ka Pulmonary Vein Isolation? Ke Kumu, ke Kaʻina Hana & nā Hōʻike

ʻO ka pulmonary vein isolation he hana naʻau liʻiliʻi e mālama ai i ka atrial fibrillation ma ka hana ʻana i nā ʻeha i mālama ʻia a puni nā pulmonary veins. Hoʻopaʻa kēia mau ʻeha i nā hōʻailona uila ʻokoʻa e hoʻokumu ana i ka puʻuwai e paʻi ʻole, e kōkua ana i ka hoʻihoʻi ʻana i ka puʻuwai maʻamau.

E noʻonoʻo e like me ka hoʻoponopono hou ʻana i ka ʻōnaehana uila o kou puʻuwai. Hoʻohana ke kaʻina hana i ka wela a i ʻole ka ikehu anuanu e hana i nā pale liʻiliʻi a pololei e pale ai i nā impulses uila chaotic mai ka hoʻopilikia ʻana i ka puʻuwai maoli o kou puʻuwai.

He aha ka pulmonary vein isolation?

ʻO ka pulmonary vein isolation (PVI) he hana i hoʻokumu ʻia i ka catheter e mālama ai i ka atrial fibrillation ma ka hoʻokaʻawale ʻana i nā pulmonary veins mai ka atrium hema. ʻO nā pulmonary veins he ʻehā mau kīʻaha koko e lawe ana i ke koko waiwai oxygen mai kou mau māmā i kou puʻuwai.

I ka wā o ke kaʻina hana, hana kāu kauka i kahi ʻano pōʻai o ka ʻiʻo ʻeha a puni kēlā me kēia puka pulmonary vein. Hana kēia ʻiʻo ʻeha e like me ka pā uila, e pale ana i nā hōʻailona uila ʻokoʻa mai nā veins mai ka hiki ʻana i nā keʻena luna o kou puʻuwai.

Ua kapa ʻia ke kaʻina hana ʻo pulmonary vein ablation a i ʻole catheter ablation. Hana ʻia ia i loko o kahi keʻena catheterization cardiac kūikawā e ka electrophysiologist, he cardiologist i loea i nā maʻi puʻuwai.

No ke aha e hana ʻia ai ka pulmonary vein isolation?

Hana nui ʻia ka pulmonary vein isolation e mālama i ka atrial fibrillation (AFib), kahi maʻi puʻuwai maʻamau e hoʻokumu ana i nā puʻuwai ʻole a pinepine wikiwiki. Hiki mai ʻo AFib i ka wā e lilo ai nā hōʻailona uila i kou puʻuwai i chaotic, e hoʻokumu ana i nā keʻena luna e haʻalulu ma kahi o ka paʻi pono.

Hiki i kāu kauka ke ʻōlelo aku i ka PVI inā loaʻa iā ʻoe ka AFib hōʻailona ʻaʻole e pane maikaʻi i nā lāʻau lapaʻau. Aia kēia i nā hihia kahi e loaʻa ai iā ʻoe nā manawa pinepine o ka puʻuwai wikiwiki, ka hanu ʻana, ka ʻeha o ka umauma, ka luhi, a i ʻole ka ʻūlū e hoʻopilikia nui i kou ola i kēlā me kēia lā.

He mea maikaʻi loa ke kaʻina hana no ka poʻe me ka paroxysmal AFib, kahi e hele mai ai nā manawa a hele ʻole i ke ʻano. Hiki nō hoʻi ke kōkua i ka poʻe me ka AFib mau e makemake e hōʻemi i ko lākou hilinaʻi ʻana i nā lāʻau lapaʻau lōʻihi a i ʻole ka poʻe hiki ʻole ke ʻae i nā lāʻau lapaʻau AFib ma muli o nā hopena ʻaoʻao.

I kekahi mau hihia, hiki ke ʻōlelo ʻia ka PVI e hōʻemi i kou pilikia o ka hahau ʻana. Hoʻonui ka AFib i ka pilikia o ka hahau ʻana no ka mea hiki i nā puʻuwai puʻuwai ʻole ke hana i nā koko koko i loko o kou puʻuwai, a laila hiki ke hele i kou lolo.

He aha ke kaʻina hana no ka hoʻokaʻawale ʻana i ka vein pulmonary?

Hana ʻia ka hoʻokaʻawale ʻana i ka vein pulmonary i loko o kahi keʻena catheterization cardiac ʻoiai ʻoe e noho ana ma lalo o ka sedation ʻike a i ʻole ka anesthesia maʻamau. ʻO ka maʻamau, e lawe ana ke kaʻina hana i 2 a 4 mau hola, ma muli o ke paʻakikī o kāu hihia.

Hoʻomaka kāu kauka ma ka hoʻokomo ʻana i nā paipu lahilahi a maʻalahi i kapa ʻia he catheters ma nā kīʻaha koko i loko o kou ʻūhā a i ʻole ka ʻāʻī. Hoʻokele ʻia kēia mau catheters i kou puʻuwai me ka hoʻohana ʻana i nā kiʻi X-ray a me nā ʻōnaehana palapala kiʻekiʻe e hana i kahi kiʻi 3D o ka hana uila o kou puʻuwai.

Eia ka mea e hana ʻia i nā ʻanuʻu nui o ke kaʻina hana:

1. Ke kālai ʻana i ka ʻōnaehana uila o kou puʻuwai e ʻike i nā wahi kikoʻī kahi e puka mai ai nā hōʻailona ʻino
2. Ke kau ʻana i ka catheter ablation ma ka puka o kēlā me kēia vein pulmonary
3. Ke hāʻawi ʻana i ka ikehu radiofrequency (wela) a i ʻole cryoenergy (anu) e hana i ka ʻiʻo ʻeha i kāohi ʻia
4. Ke hoʻāʻo ʻana i ka hoʻokaʻawale ʻana ma ka nānā ʻana ua ālaina loa ʻia nā hōʻailona uila mai nā veins pulmonary
5. Ke nānā ʻana i ka puʻuwai o kou puʻuwai e hōʻoia i ka holomua o ke kaʻina hana

Hoʻokumu koke ʻia ka ʻiʻo ʻeha, akā e hoʻomau ana i ka ulu ʻana i nā pule he nui. Kōkua kēia hana hoʻōla i ka hōʻoia ʻana e mau ana ka hoʻokaʻawale uila a he mea mau a maikaʻi i ka wā lōʻihi.

Pehea e hoʻomākaukau ai no kāu hoʻokaʻawale ʻana i ka vein pulmonary?

Hoʻomaka ka hoʻomākaukau ʻana no ka hoʻokaʻawale ʻana i ka vein pulmonary i kekahi mau pule ma mua o kāu kaʻina hana. E hāʻawi kāu kauka i nā ʻōlelo kikoʻī i kūpono i kāu mau pono pilikino a me ka mōʻaukala olakino.

Pono paha ʻoe e hooki i kekahi mau lāʻau lapaʻau ma mua o ke kaʻina hana, ʻo ia hoʻi nā mea lahilahi koko. Eia naʻe, mai hooki i kekahi lāʻau lapaʻau me ka ʻole o nā ʻōlelo kikoʻī mai kāu hui mālama ola, no ka mea, he mea nui kēia manawa no kou palekana.

Hiki i kāu hoʻomākaukau ke komo i kēia mau ʻanuʻu nui:

• Ke hele nei i nā hoʻokolohua ma mua o ke kaʻina hana e like me ka hana koko, ka X-ray umauma, a me ka echocardiogram
• Ke lawe nei i nā antibiotics i kuhikuhi ʻia inā loaʻa iā ʻoe kekahi mau maʻi puʻuwai
• Hoʻokē ʻai no 8-12 mau hola ma mua o ke kaʻina hana (ʻaʻohe meaʻai a i ʻole inu koe wale nō nā ʻōpala wai liʻiliʻi me nā lāʻau lapaʻau)
• Hoʻonohonoho ʻana i kekahi e hoʻokele iā ʻoe i ka home ma hope o ke kaʻina hana
• Wehe i nā mea nani, ka pena kui, a me nā aniani pili ma mua o ka hōʻea ʻana

Hiki i kāu kauka ke ʻōlelo aku i kahi transesophageal echocardiogram (TEE) e nānā i nā koko koko i loko o kou puʻuwai ma mua o ke kaʻina hana. He ana palekana kēia e hōʻoia ai e hiki ke hana palekana ʻia ke kaʻina hana.

Pehea e heluhelu ai i kāu mau hopena hoʻokaʻawale ʻana i ka vein pulmonary?

Hoʻoholo ʻia ka holomua o ka hoʻokaʻawale ʻana i ka vein pulmonary e ka maikaʻi o ka mālama ʻana i kāu mau hōʻailona fibrillation atrial a pale i nā hanana e hiki mai ana. E nānā kāu kauka i kāu holomua ma o nā manawa huli a me ka nānā ʻana i ka puʻuwai.

Hoʻoholo ʻia ka holomua koke i ke kaʻina hana ponoʻī. Hoʻāʻo kāu kauka inā ua hoʻokaʻawale ʻia nā veins pulmonary ma ka nānā ʻana ʻaʻole hiki i nā hōʻailona uila ke hele ma waena o nā veins a me ka atrium hema o kou puʻuwai.

Ua loiloi ʻia ka holomua lōʻihi ma luna o nā mahina a me nā makahiki ma o kēia mau ʻano:

• Nā hoʻokolohua EKG maʻamau e nānā i kāu puʻuwai i ka wā o nā kipa keʻena
• Nā mea nānā Holter a i ʻole nā mea nānā hanana e hoʻopaʻa i kāu puʻuwai no 24-48 mau hola a ʻoi aku paha
• Ke nānā ʻana i nā hōʻailona e ʻike ai inā ʻoe e ʻike i nā hanana liʻiliʻi o ka puʻuwai wikiwiki, ka hanu ʻana, a i ʻole ka ʻoluʻolu o ka umauma
• Nā hoʻokolohua hoʻoikaika kino e hōʻoia i ka paʻa ʻana o kāu puʻuwai i ka wā o ka hana kino

He ʻokoʻa nā helu holomua, akā hōʻike nā haʻawina he 70-80% o ka poʻe me ka paroxysmal AFib e noho ana me ka ʻole o nā hanana AFib i hoʻokahi makahiki ma hope o ke kaʻina hana. Pono paha kekahi poʻe i kahi kaʻina hana hou inā hoʻi mai ka AFib, he mea maʻamau loa ia a ʻaʻole ia he manaʻo ua hāʻule ke kaʻina hana mua.

He aha ka hopena maikaʻi loa no ka hoʻokaʻawale ʻana i ka vein pulmonary?

ʻO ka hopena maikaʻi loa no ka hoʻokaʻawale ʻana i ka vein pulmonary ka manuahi piha mai nā hanana fibrillation atrial i ka wā e mālama ana i ka hana puʻuwai maʻamau. ʻO ia hoʻi, ʻaʻole ʻoe e ʻike i nā puʻuwai puʻuwai ʻole, nā palpitations, a i ʻole nā hōʻailona pili AFib i kou ola i kēlā me kēia lā.

ʻO ka hopena maikaʻi loa e pili ana i ka maikaʻi o ke ola. Nui ka poʻe e hōʻike i ka hoʻomanawanui ʻana i ka hoʻoikaika kino, ka luhi liʻiliʻi, a me ka hopohopo liʻiliʻi e pili ana i ko lākou maʻi puʻuwai ma hope o ka PVI kūleʻa.

ʻO ka hopena lōʻihi loa e pili ana i kēia mau mea nui:

• ʻO ka puʻuwai maʻamau mau me ka ʻole o nā hanana AFib
• Hoʻemi ʻia ka pono no nā lāʻau lapaʻau puʻuwai
• ʻO ka haʻahaʻa haʻahaʻa haʻahaʻa ma muli o ka mālama ʻana i ka puʻuwai maʻamau
• Hoʻomaikaʻi i ka hiki ke hoʻoikaika kino a me nā pae ikehu
• Hoʻonui i ka maikaʻi o ke ola a me ka hilinaʻi i nā hana i kēlā me kēia lā

ʻOiai inā pono ʻoe e hoʻomau i kekahi mau lāʻau lapaʻau ma hope o ka PVI, ʻo ke kaʻina hana kūleʻa e ʻae pinepine ai i nā mea liʻiliʻi a i ʻole nā lāʻau lapaʻau liʻiliʻi ma mua. E hana kāu kauka me ʻoe e ʻimi i ke kaulike kūpono no kou kūlana pilikino.

He aha nā mea pilikia no ka pono o ka hoʻokaʻawale ʻana i ka vein pulmonary?

Nui nā mea e hiki ke hoʻonui i kou hiki ke loaʻa i ka atrial fibrillation i lawa ka paʻakikī e koi ai i ka hoʻokaʻawale ʻana i ka vein pulmonary. ʻO ka hoʻomaopopo ʻana i kēia mau mea pilikia e kōkua iā ʻoe a me kāu kauka e hana i nā hoʻoholo kūpono e pili ana i ka mālama ʻana.

ʻO ka makahiki ka mea pilikia nui loa, no ka mea, ʻoi aku ka maʻamau o ka AFib i kou wā ʻelemakule. Eia naʻe, hiki i nā poʻe ʻōpio ke loaʻa i ka AFib, ʻoiai inā he mau maʻi ʻē aʻe ko lākou.

ʻO nā mea pilikia maʻamau e hiki ke alakaʻi i ka pono o ka PVI, ʻo ia:

• Ke koko kiʻekiʻe i mālama ʻole ʻia i ka manawa
• Maʻi puʻuwai me ka maʻi artery coronary, nā pilikia o ka valve puʻuwai, a i ʻole ka puʻuwai
• Diabetes, ʻoiai ke kiʻekiʻe pinepine nā pae kōpaʻa koko
• Ka momona, e hoʻokau ana i ke kaumaha hou i kou puʻuwai
• Sleep apnea, hiki ke hoʻoulu i nā puʻuwai puʻuwai ʻole
• Nā maʻi thyroid, ʻoi aku ka thyroid overactive
• ʻO ka inu ʻana i ka waiʻona nui a i ʻole ka inu ʻana
• ʻO ka mōʻaukala ʻohana o ka atrial fibrillation a i ʻole nā maʻi puʻuwai puʻuwai ʻē aʻe

Loaʻa i kekahi poʻe ka AFib me ka ʻole o nā mea pilikia maopopo, a he mea maʻamau loa ia. ʻO ka mea nui ka loaʻa ʻana o ka mālama kūpono ke hoʻopilikia nui nā hōʻailona i kou maikaʻi o ke ola.

He aha nā pilikia hiki ke loaʻa i ka hoʻokaʻawale ʻana i ka vein pulmonary?

ʻOiai palekana ka hoʻokaʻawale ʻana i ka vein pulmonary, e like me nā kaʻina hana lapaʻau, he mau pilikia kekahi. He kakaikahi ka hapa nui o nā pilikia a hiki ke mālama pono ʻia i ka wā e hana ai.

ʻO nā pilikia maʻamau ka mea maʻamau a hoʻoponopono koke. Hiki i kēia ke komo i ka ʻeha a i ʻole ka ʻeha ma ka pūnaewele hoʻokomo catheter, e hoʻōla maʻamau i loko o kekahi mau lā.

ʻO nā pilikia koʻikoʻi akā ʻaʻole maʻamau hiki ke komo:

• Ke koko e kahe ana ma kahi i hoʻokomo ʻia ai ke catheter, pono paha ke kaomi a i ʻole ka mālama hou aʻe
• Nā koko koko e hiki ke hele i nā wahi ʻē aʻe o kou kino
• Poino i nā kīʻaha koko i ka wā e hoʻokomo ʻia ai ke catheter
• ʻO ka hōʻeha ʻana i ka esophagus, aia kokoke i ka puʻuwai
• Pulmonary vein stenosis, kahi e ʻuʻuku ai nā veins i mālama ʻia
• Pericarditis, ʻo ia ka mumū o ka ʻeke e puni ana i kou puʻuwai
• Nā pilikia o ka puʻuwai hou, akā he mea manawa wale nō kēia

He mea maʻamau ʻole akā he mau pilikia koʻikoʻi e komo pū ana me ka hahau ʻana, ka puʻuwai, a i ʻole ka pōʻino i nā mea kokoke. E kūkākūkā kāu electrophysiologist i kēia mau pilikia me ʻoe a wehewehe pehea lākou e hōʻemi ai iā lākou i ka wā o kāu kaʻina hana.

I ka manawa hea wau e ʻike ai i ke kauka ma hope o ka hoʻokaʻawale ʻana i ka pulmonary vein?

Pono ʻoe e hoʻokaʻaʻike koke i kāu kauka inā loaʻa iā ʻoe kekahi mau hōʻailona e pili ana ma hope o ka hoʻokaʻawale ʻana i ka pulmonary vein. ʻOiai he mea maʻamau kekahi ʻoluʻolu ʻole, pono kekahi mau hōʻailona i ka lāʻau lapaʻau wikiwiki.

E kelepona koke i kāu kauka inā ʻike ʻoe i ke koko nui, ka pehu ʻana, a i ʻole ka ʻeha e piʻi ana ma kahi i hoʻokomo ʻia ai ke catheter. E ʻimi pū i ka mālama koke inā loaʻa iā ʻoe ka ʻeha o ka umauma, ka pōkole o ka hanu, a i ʻole nā hōʻailona o ka maʻi e like me ke kuni a i ʻole nā anu.

Eia nā kūlana e pono ai ka lāʻau lapaʻau wikiwiki:

• Ke koko nui mai kahi i hoʻokomo ʻia ai ʻaʻole e pau me ke kaomi mālie
• Nā hōʻailona o ka maʻi e komo pū ana me ke kuni, ka ʻulaʻula, ka mehana, a i ʻole ka wai mai kahi i hoʻokomo ʻia ai
• ʻEha nui o ka umauma a i ʻole ke kaomi e ʻokoʻa ana mai kāu mau hōʻailona AFib maʻamau
• Hoʻomaka koke o ka pōkole o ka hanu nui a i ʻole ka pilikia o ka hanu
• Nā hōʻailona o ka hahau ʻana e like me ka nāwaliwali koke, nā pilikia o ka ʻōlelo, a i ʻole nā loli o ka ʻike
• ʻO ka nausea mau, ka luaʻi ʻana, a i ʻole ka hiki ʻole ke mālama i nā wai

No ka nānā maʻamau, e ʻike ʻoe i kāu kauka ma waena o 1-2 pule ma hope o ke kaʻina hana. Hāʻawi kēia manawa i kāu hui mālama ola e nānā i kāu holomua hoʻōla a pane i nā nīnau a i ʻole nā hopohopo āu e loaʻa ai.

Nā nīnau i nīnau pinepine ʻia e pili ana i ka hoʻokaʻawale ʻana i nā veins pulmonary

He maikaʻi anei ka hoʻokaʻawale ʻana i nā veins pulmonary no nā ʻano fibrillation atrial a pau?

ʻOi aku ka maikaʻi o ka hoʻokaʻawale ʻana i nā veins pulmonary no ka fibrillation atrial paroxysmal, kahi e hele mai a hele wale nā hanana. ʻO ka maʻamau ka kiʻekiʻe o nā helu holomua i kēia hui, me 70-80% o nā kānaka e noho ana me ka ʻole o nā hanana AFib ma hope o hoʻokahi makahiki.

No ka AFib mau, kahi e lōʻihi ai nā hanana ma mua o ʻehiku mau lā, hiki nō ke maikaʻi ʻo PVI akā pono paha i nā ʻenehana ablation hou. Pono paha kāu kauka e hana i nā laina ʻeha hou i loko o kou puʻuwai ma mua o ka hoʻokaʻawale ʻana i nā veins pulmonary.

Hiki i nā kānaka me ka AFib mau lōʻihi ke loaʻa nā helu holomua haʻahaʻa me PVI wale nō. Eia naʻe, hiki i ke kaʻina hana ke hāʻawi i ka hōʻoluʻolu nui i nā hōʻailona a me ka maikaʻi o ke ola, ʻoiai inā ʻaʻole i loaʻa ka lāʻau lapaʻau piha.

Hoʻōla mau anei ka hoʻokaʻawale ʻana i nā veins pulmonary i ka fibrillation atrial?

Hiki i ka hoʻokaʻawale ʻana i nā veins pulmonary ke hāʻawi i ke kūʻokoʻa lōʻihi mai ka fibrillation atrial, akā ʻaʻole ia he lāʻau lapaʻau mau. Nui ka poʻe e noho ana me ka ʻole o AFib no nā makahiki ma hope o ke kaʻina hana, aʻo nā mea ʻē aʻe e ʻike paha i nā hanana manawa.

Aia ka holomua o PVI i nā mea he nui me ke ʻano o ka AFib āu i loaʻa ai, pehea ka lōʻihi o kou loaʻa ʻana, a me kou olakino puʻuwai holoʻokoʻa. Pono paha kekahi poʻe i kahi kaʻina hana hou inā hoʻi mai ka AFib, he ʻāpana maʻamau kēia o ka mālama ʻana.

ʻOiai inā hoʻi mai ka AFib i kekahi manawa, ʻike ka hapa nui o nā kānaka i ka hoʻomaikaʻi nui ʻana i kā lākou mau hōʻailona a me ka maikaʻi o ke ola. ʻO ka pinepine ʻole o nā hanana, ʻoi aku ka pōkole o ka lōʻihi, a maʻalahi hoʻi e mālama me nā lāʻau lapaʻau.

Hiki iaʻu ke hoʻoikaika kino maʻamau ma hope o ka hoʻokaʻawale ʻana i nā veins pulmonary?

Hiki i ka hapa nui o nā kānaka ke hoʻi mālie i ka hoʻoikaika kino maʻamau a me nā hana kino ma hope o ka hoʻokaʻawale ʻana i nā veins pulmonary. Eia naʻe, pono ʻoe e hahai i kahi manawa kikoʻī no ka hoʻomaka hou ʻana i nā ʻano hana like ʻole.

No nā lā mua ma hope o ke kaʻina hana, pono ʻoe e pale i ka hāpai ʻana i nā mea kaumaha, ka hoʻoikaika kino ikaika, a me nā hana e hoʻoikaika ai i ka wahi i hoʻokomo ʻia ai ke catheter. Hoʻoikaika pinepine ʻia ka hele wāwae māmā e hāpai i ka hoʻōla a pale i nā koko koko.

E hāʻawi kāu kauka i nā alakaʻi kikoʻī e pili ana i kou kūlana pilikino. Nui ka poʻe i ʻike e hiki iā lākou ke hoʻoikaika kino me ka ʻoluʻolu ma hope o ka PVI kūleʻa no ka mea ʻoi aku ka paʻa o kā lākou puʻuwai a ʻike lākou i ka pōkole o ka hanu i ka wā o ka hana kino.

E pono anei au e lawe i nā mea lahilahi koko ma hope o ka hoʻokaʻawale ʻana i nā veins pulmonary?

ʻO ka hoʻomau ʻana i ka lawe ʻana i nā mea lahilahi koko ma hope o ka hoʻokaʻawale ʻana i nā veins pulmonary e pili ana i kāu mau mea pilikia pilikino. ʻAʻole i hoʻokumu ʻia ka hoʻoholo ʻana ma ke ʻano he kūleʻa ka hana i ka mālama ʻana i kāu AFib.

E hoʻohana kāu kauka i nā ʻōnaehana helu e like me ka helu CHA2DS2-VASc e loiloi i kou pilikia ʻana i ka hahau ʻana e pili ana i nā mea e like me ka makahiki, ke kāne, ka maʻi diabetes, ke koko kiʻekiʻe, a me ka mōʻaukala hahau mua. Inā hōʻike kāu helu i ka pilikia kiʻekiʻe, pono paha ʻoe e hoʻomau i nā mea lahilahi koko no ka wā lōʻihi.

Hiki i kekahi poʻe me nā helu pilikia hahau haʻahaʻa ke hiki ke hooki i nā mea lahilahi koko ma hope o ka PVI kūleʻa, akā pono e hana mau ʻia kēia hoʻoholo ma ke kūkākūkā ʻana me kāu hui mālama ola. E noʻonoʻo lākou i kāu kiʻi olakino piha i ka wā e hana ai i kēia ʻōlelo.

Pehea ka lōʻihi o ka hoʻōla ʻana mai ka hoʻokaʻawale ʻana i nā veins pulmonary?

Hiki i ka hapa nui o nā kānaka ke hoʻi i nā hana i kēlā me kēia lā i loko o kekahi mau lā a i hoʻokahi pule ma hope o ka hoʻokaʻawale ʻana i nā veins pulmonary. Eia naʻe, hiki i ka hoʻōla piha a me nā pōmaikaʻi piha o ke kaʻina hana ke lawe i kekahi mau pule a i ʻole mau mahina.

He maʻamau ka hoʻōla ʻana o nā wahi hoʻokomo catheter i loko o 3-5 mau lā, akā, e loaʻa paha iā ʻoe kekahi ʻeha a i ʻole ke ʻano palupalu no nā pule ʻelua. Pono ʻoe e pale i ka hāpai ʻana i nā mea kaumaha a me ka hoʻoikaika kino ikaika no kahi pule e ʻae ai i ka hoʻōla pono.

Hoʻomau ka ulu ʻana o ka ʻiʻo ʻeha i hana ʻia i ka wā o ke kaʻina hana no 2-3 mau mahina ma hope o ka PVI. I kēia manawa, hiki iā ʻoe ke ʻike i kekahi mau puʻuwai puʻuwai ʻole a i ʻole nā hanana AFib, e hoʻoponopono pinepine ʻia i ka wā e pau ai ke kaʻina hana hoʻōla. E nānā pono kāu kauka i kāu holomua i kēia wā.