Kuyini Ukuhlukaniswa Kwemithambo Yemiphunga? Inhloso, Inqubo & Nemiphumela

Ukuhlukaniswa kwemithambo yemiphunga kuyinqubo yenhliziyo engahlaseli kakhulu ephatha i-atrial fibrillation ngokudala izibazi ezilawulwayo ezizungeze imithambo yemiphunga. Lezi zibazi zivimba amasignali kagesi angajwayelekile abangela ukuthi inhliziyo yakho ishaye ngokungajwayelekile, okusiza ukubuyisela isigqi senhliziyo esijwayelekile.

Cabanga ngakho njengokushintsha kabusha uhlelo lukagesi lwenhliziyo yakho. Le nqubo isebenzisa amandla okushisa noma abandayo ukudala izithiyo ezincane, ezinembile ezivimbela ukushaywa kukagesi okungahlelekile ekuphazameni isigqi semvelo senhliziyo yakho.

Kuyini ukuhlukaniswa kwemithambo yemiphunga?

Ukuhlukaniswa kwemithambo yemiphunga (PVI) kuyinqubo esekelwe kukhatheta ephatha i-atrial fibrillation ngokuhlukanisa imithambo yemiphunga e-atrium yesobunxele. Imithambo yemiphunga iyimithambo yegazi emine ethwala igazi elinothile nge-oksijini lisuka emaphashini akho libuyele enhliziyweni yakho.

Ngesikhathi senqubo, udokotela wakho udala iphethini eyindilinga yezicubu ezilimele ezizungeze ngasinye isivulekile semithambo yemiphunga. Lezi zicubu ezilimele zisebenza njengocingo lukagesi, zivimbela amasignali kagesi angajwayelekile emithanjeni ukuthi angafinyeleli emagumbini aphezulu enhliziyo yakho.

Le nqubo ibizwa nangokuthi ukushiswa kwemithambo yemiphunga noma ukushiswa nge-catheter. Yenziwa egumbini elikhethekile lokufaka ikhatheta lenhliziyo nguchwepheshe we-electrophysiologist, udokotela wenhliziyo onguchwepheshe ekuphazamisekeni kwesigqi senhliziyo.

Kungani kwenziwa ukuhlukaniswa kwemithambo yemiphunga?

Ukuhlukaniswa kwemithambo yemiphunga kwenziwa ikakhulukazi ukwelapha i-atrial fibrillation (AFib), ukuphazamiseka kwesigqi senhliziyo okuvamile okubangela ukushaya kwenhliziyo okungajwayelekile futhi okuvame ukushesha. I-AFib yenzeka lapho amasignali kagesi enhliziyweni yakho eba nezinxushunxushu, okubangela ukuthi amagumbi aphezulu athuthume esikhundleni sokushaya ngempumelelo.

Udktela wakho angase ancome i-PVI uma une-AFib enezimpawu ezingasabeli kahle emithini. Lokhu kuhlanganisa amacala lapho uhlangabezana khona nezikhathi eziningi zokushaya kwenhliziyo okusheshayo, ukuphefumula kanzima, ubuhlungu besifuba, ukukhathala, noma isiyezi okuthinta kakhulu impilo yakho yansuku zonke.

Le nqubo ilusizo ikakhulukazi kubantu abane-paroxysmal AFib, lapho izigameko ziza futhi zihambe ngokungaqondakali. Kungasiza futhi labo abane-persistent AFib abafuna ukunciphisa ukuncika kwabo emithini yesikhathi eside noma labo abangakwazi ukubekezelela imithi ye-AFib ngenxa yemiphumela emibi.

Kwezinye izimo, i-PVI ingase inconywe ukunciphisa ingozi yakho yokushaywa unhlangothi. I-AFib ikhuphula ingozi yokushaywa unhlangothi ngoba ukushaya kwenhliziyo okungajwayelekile kungabangela ukuthi amahlule egazi akheke enhliziyweni yakho, okungase kuthi ekugcineni kuhambe ebuchosheni bakho.

Iyini inqubo yokuhlukaniswa kwemithambo ye-pulmonary?

Ukuhlukaniswa kwemithambo ye-pulmonary kwenziwa e-cardiac catheterization lab ngenkathi ungaphansi kwe-conscious sedation noma i-general anesthesia. Le nqubo ngokuvamile ithatha amahora angu-2 kuya kwangu-4, kuye ngobunzima becala lakho.

Udktela wakho uqala ngokufaka amashubhu amancane, aguquguqukayo abizwa ngokuthi ama-catheter ngemithambo yegazi emgodini wakho noma entanyeni. Lawa ma-catheter aqondiswa enhliziyweni yakho kusetshenziswa izithombe ze-X-ray kanye nezinhlelo zokwenza imephu ezithuthukisiwe ezakha isithombe se-3D somsebenzi kagesi wenhliziyo yakho.

Nakhu okwenzekayo ngesikhathi sezinyathelo eziyinhloko zenqubo:

1. Ukwenza imephu yesistimu kagesi yenhliziyo yakho ukukhomba izindawo eziqondile lapho imiqondiso engajwayelekile iqala khona
2. Ukubeka i-ablation catheter emgodini womthambo ngamunye we-pulmonary
3. Ukuletha amandla e-radiofrequency (ukushisa) noma i-cryoenergy (ukubanda) ukudala izicubu ezinamanxeba ezilawulwayo
4. Ukuvivinya ukuhlukaniswa ngokuhlola ukuthi imiqondiso kagesi evela emithanjeni ye-pulmonary ivaliwe ngokuphelele
5. Ukuqapha ukushaya kwenhliziyo yakho ukuze kuqinisekiswe ukuthi inqubo iphumelele

Izicubu ezilimele zakheka ngokushesha kodwa ziqhubeka nokuvuthwa emasontweni amaningana. Le nqubo yokwelapha isiza ekuqinisekiseni ukuthi ukwahlukaniswa kukagesi kuhlala unomphela futhi kusebenza isikhathi eside.

Ungalungiselela kanjani ukuhlukaniswa kwemithambo yamaphaphu?

Ukulungiselela ukuhlukaniswa kwemithambo yamaphaphu kuvame ukuqala emasontweni amaningana ngaphambi kwenqubo yakho. Udokotela wakho uzohlinzeka ngemiyalelo ethile eyenzelwe izidingo zakho ngazinye nomlando wezokwelapha.

Kungenzeka udinga ukuyeka imithi ethile ngaphambi kwenqubo, ikakhulukazi ama-blood thinners. Kodwa-ke, ungalokothi uyeke noma iyiphi imithi ngaphandle kwemiyalelo ecacile evela eqenjini lakho lezempilo, njengoba lesi sikhathi sibalulekile ekuphepheni kwakho.

Ukulungiselela kwakho kungabandakanya lezi zinyathelo ezibalulekile:

• Ukwenza izivivinyo zangaphambi kwenqubo njengomsebenzi wegazi, i-X-ray yesifuba, ne-echocardiogram
• Ukuphuza ama-antibiotics anqunyiwe uma unezimo ezithile zenhliziyo
• Ukuzila ukudla amahora angu-8-12 ngaphambi kwenqubo (akukho ukudla noma isiphuzo ngaphandle kokuthatha amanzi amancane nemithi)
• Ukuhlela umuntu ozokuqhuba ekhaya ngemuva kwenqubo
• Ukususa ubucwebe, i-nail polish, kanye nama-contact lenses ngaphambi kokufika

Udokotela wakho angase futhi ancome i-transesophageal echocardiogram (TEE) ukuze ahlolisise amahlule egazi enhliziyweni yakho ngaphambi kwenqubo. Lesi yisinyathelo sokuphepha sokuqinisekisa ukuthi inqubo ingenziwa ngokuphepha.

Ungawafunda kanjani imiphumela yakho yokuhlukaniswa kwemithambo yamaphaphu?

Impumelelo yokuhlukaniswa kwemithambo yamaphaphu ilinganiswa ngokuthi ilawula kahle kangakanani izimpawu zakho ze-atrial fibrillation futhi ivimbele izigameko zesikhathi esizayo. Udokotela wakho uzoqapha inqubekela phambili yakho ngokuqokwa okulandelayo nokuqapha isigqi senhliziyo.

Impumelelo esheshayo inqunywa ngesikhathi senqubo uqobo. Udokotela wakho uhlola ukuthi imithambo yamaphaphu ihlukaniswe ngokuphelele yini ngokuhlola ukuthi azikho yini izimpawu zikagesi ezingadlula phakathi kwemithambo kanye ne-atrium yakho yenhliziyo engakwesokunxele.

Impumelelo yesikhathi eside ihlolwa ezinyangeni naseminyakeni ngalezi zindlela:

• Ukuhlolwa kwe-EKG njalo ukuze kuhlolwe ukushaya kwenhliziyo yakho ngesikhathi sokuvakasha ehhovisi
• Ama-Holter monitors noma ama-event monitors aqopha ukushaya kwenhliziyo yakho amahora angu-24-48 noma ngaphezulu
• Ukulandela izimpawu ukuze ubone ukuthi uhlangabezana nezigameko ezimbalwa zokushaya kwenhliziyo okusheshayo, ukuphefumula kanzima, noma ukungakhululeki esifubeni
• Ukuhlolwa kokucindezeleka kokuzivocavoca ukuze kuqinisekiswe ukuthi ukushaya kwenhliziyo yakho kuhlala kuzinzile ngesikhathi sokuzivocavoca

Amanani empumelelo ayahlukahluka, kodwa ucwaningo lubonisa ukuthi ama-70-80% abantu abane-paroxysmal AFib bahlala bekhululekile ezigamekweni ze-AFib ngonyaka owodwa ngemuva kwenqubo. Abanye abantu bangase badinge inqubo ephindwayo uma i-AFib ibuyela, okuyinto evamile ngokuphelele futhi akusho ukuthi inqubo yokuqala yehlulekile.

Yini umphumela ongcono kakhulu wokuhlukaniswa kwemithambo yamaphaphu?

Umphumela ongcono kakhulu wokuhlukaniswa kwemithambo yamaphaphu ukukhululeka okuphelele ezigamekweni ze-atrial fibrillation ngenkathi kugcinwa ukusebenza kwenhliziyo okuvamile. Lokhu kusho ukuthi awutholi ukushaya kwenhliziyo okungajwayelekile, ukushaya kwenhliziyo, noma izimpawu ezihlobene ne-AFib empilweni yakho yansuku zonke.

Umphumela olungile futhi uhlanganisa ngcono izinga lempilo. Abantu abaningi babika ukubekezelelana okungcono kokuzivocavoca, ukuncipha kokukhathala, nokukhathazeka okuncane ngesimo senhliziyo yabo ngemuva kwe-PVI eyimpumelelo.

Umphumela ongcono kakhulu wesikhathi eside uhlanganisa lezi zinto ezibalulekile:

• Ukushaya kwenhliziyo okuvamile okuqhubekayo ngaphandle kwezigameko ze-AFib
• Ukunciphisa isidingo semithi yokushaya kwenhliziyo
• Ukunciphisa ingozi yokushaywa unhlangothi ngenxa yokugcinwa kokushaya kwenhliziyo okuvamile
• Ukuthuthukiswa komthamo wokuzivocavoca namazinga wamandla
• Ukuthuthukiswa kwezinga lempilo yonke nokuzethemba emisebenzini yansuku zonke

Noma ngabe udinga ukuqhubeka neminye imithi ngemuva kwe-PVI, inqubo eyimpumelelo ivame ukuvumela imithamo ephansi noma imithi embalwa kunangaphambili. Udokotela wakho uzosebenza nawe ukuthola ibhalansi efanele yesimo sakho somuntu ngamunye.

Yiziphi izici eziyingozi zokudinga ukuhlukaniswa kwemithambo yamaphaphu?

Izici eziningana zingakhuphula amathuba akho okuba ne-atrial fibrillation eqine ngokwanele ukudinga ukuhlukaniswa kwemithambo ye-pulmonary. Ukuqonda lezi zici eziyingozi kukusiza kanye nodokotela wakho ukuthi nenze izinqumo ezinolwazi mayelana nokwelashwa.

Ubudala buyisici esiyingozi esibaluleke kakhulu, njengoba i-AFib iba yinto ejwayelekile njengoba ukhula. Kodwa-ke, abantu abasebancane nabo bangathuthukisa i-AFib, ikakhulukazi uma benezinye izimo ezingaphansi.

Izici eziyingozi ezivamile ezingaholela ekudingeni i-PVI zihlanganisa:

• Umfutho wegazi ophezulu ongaphathwanga kahle ngokuhamba kwesikhathi
• Isifo senhliziyo okuhlanganisa isifo semithambo yenhliziyo, izinkinga ze-valve yenhliziyo, noma ukuhluleka kwenhliziyo
• Isifo sikashukela, ikakhulukazi lapho amazinga kashukela egazini ephakeme njalo
• Ukukhuluphala ngokweqile, okubeka ingcindezi eyengeziwe enhliziyweni yakho
• I-Sleep apnea, engabangela ukushaya kwenhliziyo okungajwayelekile
• Izifo ze-thyroid, ikakhulukazi i-thyroid esebenza ngokweqile
• Ukusetshenziswa kotshwala ngokweqile noma ukuphuza ngokweqile
• Umlando womndeni we-atrial fibrillation noma ezinye izifo zokushaya kwenhliziyo

Abanye abantu bathuthukisa i-AFib ngaphandle kwanoma yiziphi izici eziyingozi ezicacile, futhi lokho kuvamile ngokuphelele. Into ebalulekile ukuthola ukwelashwa okufanele lapho izimpawu zithinta kakhulu izinga lakho lempilo.

Ziyini izinkinga ezingaba khona zokuhlukaniswa kwemithambo ye-pulmonary?

Ngenkathi ukuhlukaniswa kwemithambo ye-pulmonary kuvamile ukuthi kuphephile, njenganoma iyiphi inqubo yezokwelapha, kuthwala ezinye izingozi. Izinkinga eziningi azivamile futhi zingalawulwa ngempumelelo uma zenzeka.

Izinkinga ezivamile zivame ukuba zincane futhi zixazululeka ngokushesha. Lokhu kungase kuhlanganise ukulimala kwesikhashana noma ubuhlungu endaweni yokufaka i-catheter, evame ukuphola ezinsukwini ezimbalwa.

Izinkinga ezingathi sína kodwa ezingavamile zingahlanganisa:

• Ukuphuma igazi endaweni okufakwe kuyo i-catheter okungase kudingeke ukucindezela noma ukwelashwa okwengeziwe
• Amaqhubu egazi angase ahambe aye kwezinye izingxenye zomzimba wakho
• Umonakalo emithanjeni yegazi ngesikhathi kufakwa i-catheter
• Ukwenzeka ngengozi ukulimala komphimbo, oseduze nenhliziyo
• I-Pulmonary vein stenosis, lapho imithambo ephathwayo iba mncane
• I-Pericarditis, okuyisifo sokuvuvukala kwesikhwama esizungeze inhliziyo yakho
• Izinkinga ezintsha zesigqi senhliziyo, nakuba lezi zivame ukuba zesikhashana

Izinkinga ezingavamile kodwa ezingathi sína zihlanganisa ukushaywa unhlangothi, ukuhlaselwa yinhliziyo, noma ukulimala kwezakhiwo eziseduze. I-electrophysiologist yakho izoxoxa ngalezi zingozi nawe futhi ichaze ukuthi izinciphisa kanjani ngesikhathi senqubo yakho.

Kufanele ngibone nini udokotela ngemva kokuhlukaniswa komthambo wamaphaphu?

Kufanele uthinte udokotela wakho ngokushesha uma uhlangabezana nanoma yiziphi izimpawu ezikhathazayo ngemva kokuhlukaniswa komthambo wamaphaphu. Nakuba ukungakhululeki okuthile kuvamile, izimpawu ezithile zidinga ukunakekelwa kwezokwelapha ngokushesha.

Shayela udokotela wakho ngokushesha uma uqaphela ukuphuma igazi okukhulu, ukuvuvukala, noma ubuhlungu obanda endaweni okufakwe kuyo i-catheter. Futhi funa ukunakekelwa ngokushesha uma uba nobuhlungu besifuba, ukuphefumula kanzima okukhulu, noma izimpawu zokutheleleka njengomkhuhlane noma ama-chills.

Nazi izimo ezidinga ukunakekelwa kwezokwelapha ngokushesha:

• Ukuphuma igazi eliningi endaweni yokufaka okungami ngokucindezela okulula
• Izimpawu zokutheleleka ezihlanganisa umkhuhlane, ububomvu, ukufudumala, noma ukukhipha amanzi endaweni yokufaka
• Ubuhlungu obukhulu besifuba noma ukucindezela okuzizwa kuhluke ezimpawini zakho ezivamile ze-AFib
• Ukuqala okungazelelwe kokuphefumula kanzima okukhulu noma ubunzima bokuphefumula
• Izimpawu zokushaywa unhlangothi njengobuthakathaka obungazelelwe, ubunzima bokukhuluma, noma izinguquko embonweni
• Isicanucanu esiqhubekayo, ukuhlanza, noma ukungakwazi ukugcina uketshezi phansi

Ukuze ulandelele njalo, ngokuvamile uzobona udokotela wakho phakathi kwamasonto angu-1-2 ngemva kwenqubo. Lokhu kuqokwa kuvumela ithimba lakho lokunakekelwa kwezempilo ukuthi lihlole ukuqhubeka kwakho kokuphola futhi liphendule noma yimiphi imibuzo noma izinkathazo ongase ube nazo.

Imibuzo evame ukubuzwa mayelana nokuhlukaniswa kwemithambo yamaphaphu

Ingabe ukuhlukaniswa kwemithambo yamaphaphu kulungele zonke izinhlobo ze-atrial fibrillation?

Ukuhlukaniswa kwemithambo yamaphaphu kusebenza kahle kakhulu ku-paroxysmal atrial fibrillation, lapho izigameko ziza futhi zihambe zodwa. Amazinga empumelelo ngokuvamile aphakeme kakhulu kulolu hlu, lapho abantu abangu-70-80% behlala bekhululekile ezigamekweni ze-AFib ngemva konyaka owodwa.

Ku-AFib eqhubekayo, lapho izigameko zihlala isikhathi esingaphezu kwezinsuku eziyisikhombisa, i-PVI ingase isasebenza kodwa ingase idinge ezinye izindlela zokuhlanza. Udokotela wakho angase adinge ukudala eminye imigqa yezibazi enhliziyweni yakho ngaphezu nje kokuhlukanisa imithambo yamaphaphu.

Abantu abane-AFib eqhubeka isikhathi eside bangase babe namazinga aphansi empumelelo nge-PVI kuphela. Noma kunjalo, le nqubo ingase inikeze ukukhululeka okukhulu kwezimpawu kanye nempilo engcono, ngisho noma ukwelashwa okuphelele kungafinyelelwa.

Ingabe ukuhlukaniswa kwemithambo yamaphaphu okuphumelelayo kulapha i-atrial fibrillation unomphela?

Ukuhlukaniswa kwemithambo yamaphaphu kungahlinzeka ngenkululeko ehlala isikhathi eside ku-atrial fibrillation, kodwa akuyona ngaso sonke isikhathi ikhambi elihlala njalo. Abantu abaningi bahlala bekhululekile ku-AFib iminyaka eminingi ngemva kwale nqubo, kanti abanye bangase bahlangabezane nezigameko ngezikhathi ezithile.

Impumelelo ye-PVI incike ezintweni eziningana okuhlanganisa uhlobo lwe-AFib onalo, ukuthi usunesikhathi esingakanani unayo, nempilo yakho yonke yenhliziyo. Abanye abantu bangase badinge inqubo ephindwayo uma i-AFib ibuyela, okuyingxenye evamile yokwelashwa.

Noma ngabe i-AFib ibuyela ngezikhathi ezithile, abantu abaningi basahlangabezana nokuthuthuka okukhulu ezimpawini zabo nasezingeni lempilo. Izigameko zivame ukuba zingavamile, zibe mfushane ngesikhathi, futhi kube lula ukuzilawula ngemithi.

Ngingakwazi yini ukuzivocavoca ngokujwayelekile ngemva kokuhlukaniswa kwemithambo yamaphaphu?

Abantu abaningi bangakwazi ukubuyela kancane kancane ekuzilolongeni okuvamile nasemisebenzini yomzimba ngemva kokuhlukaniswa kwemithambo yegazi yamaphaphu. Nokho, kuzodingeka ukulandela uhlelo oluthile lwesikhathi lokubuyela ezinhlotsheni ezahlukene zemisebenzi.

Ezinsukwini ezimbalwa zokuqala ngemva kwenqubo, kufanele ugweme ukuphakamisa izinto ezisindayo, ukuzivivinya okunzima, nemisebenzi engase igcizelele indawo yokufakwa kwe-catheter. Ukuhamba kancane kuvame ukukhuthazwa ukuze kukhuthazwe ukuphola nokuvimbela amahlule egazi.

Udokotela wakho uzonikeza imihlahlandlela ethile esekelwe esimweni sakho ngasinye. Abantu abaningi bathola ukuthi bangakwazi ukuzivivinya ngokunethezeka ngemva kwe-PVI ephumelelayo ngoba isigqi senhliziyo yabo sizinzile futhi abahlangabezani nokuphefumula okuncane ngesikhathi somsebenzi womzimba.

Ngabe ngizodinga ukuqhubeka ngithatha ama-blood thinners ngemva kokuhlukaniswa kwemithambo yegazi yamaphaphu?

Noma ngabe uqhubeka nokuthatha ama-blood thinners ngemva kokuhlukaniswa kwemithambo yegazi yamaphaphu kuncike ezingozini zakho ngazinye zokushaywa unhlangothi. Isinqumo asisekelwe kuphela ekutheni inqubo iphumelele yini ekulawuleni i-AFib yakho.

Udokotela wakho uzosebenzisa amasistimu okushaya amagoli afana ne-CHA2DS2-VASc score ukuhlola ingozi yakho yokushaywa unhlangothi ngokusekelwe ezintweni ezinjengobudala, ubulili, isifo sikashukela, umfutho wegazi ophezulu, nomlando wokushaywa unhlangothi wangaphambilini. Uma amaphuzu akho ekhombisa ingozi ephakeme, ungase udinge ukuqhubeka nama-blood thinners isikhathi eside.

Abanye abantu abanamaphuzu aphansi ezingozini zokushaywa unhlangothi bangase bakwazi ukuyeka ama-blood thinners ngemva kwe-PVI ephumelelayo, kodwa lesi sinqumo kufanele senziwe ngaso sonke isikhathi ngokubonisana nethimba lakho lezempilo. Bazocabangela isithombe sakho esiphelele sezokwelapha lapho benza le ncomo.

Kuthatha isikhathi esingakanani ukululama ekuhlukanisweni kwemithambo yegazi yamaphaphu?

Abantu abaningi bangakwazi ukubuyela emisebenzini yansuku zonke evamile phakathi nezinsuku ezimbalwa kuya evikini ngemva kokuhlukaniswa kwemithambo yegazi yamaphaphu. Nokho, ukuphola okuphelele kanye nezinzuzo ezigcwele zenqubo kungase kuthathe amasonto amaningana kuya ezinyangeni.

Izindawo zokufaka i-catheter ngokuvamile zithatha izinsuku eziyi-3-5 ukuphola, nakuba ungase ube nokulimala noma ubuhlungu kuze kube amasonto amabili. Kuzodingeka ukuthi ugweme ukuphakamisa izinto ezisindayo nokuzivocavoca okunzima cishe isonto ukuze ukuphola kahle.

Izicubu ezilimele ezenziwe ngesikhathi senqubo ziqhubeka zivuthwa izinyanga ezi-2-3 ngemuva kwe-PVI. Ngesikhathi lesi, ungase uhlangabezane nokushaya kwenhliziyo okungajwayelekile noma iziqephu ze-AFib, ezivame ukuxazululeka njengoba inqubo yokuphola iphela. Udokotela wakho uzoqapha intuthuko yakho eduze ngalesi sikhathi.