Arritmia maligna en prolapso de la válvula mitral: ¿es suficiente el tratamiento quirúrgico? / Malignant arrhythmia in mitral valve prolapse: is surgical management enough?

Resumen El prolapso de la válvula mitral es una enfermedad ampliamente conocida, la cual es benigna en la mayoría de casos; sin embargo, puede estar en asociación con alteraciones del ritmo cardiaco, específicamente arritmias ventriculares malignas y muerte cardiaca súbita. Pese a que esta asociación y su desenlace están descritos en la literatura médica, su baja incidencia conduce a la falta de evidencia en cuanto a su manejo y estratificación. Se presenta el caso de una mujer joven, cuya manifestación inicial fue síncope, con posterior desarrollo de insuficiencia mitral grave, con hallazgo de extrasístoles ventriculares frecuentes, en quien se realizó tratamiento quirúrgico con plastia mitral y crioablación del músculo papilar anterolateral. La evolución clínica fue satisfactoria, ya que se evidenció mejoría de la sintomatología y control de la carga arrítmica.

Abstract Mitral valve prolapse is a well-known condition that is generally benign, but it can be associated with cardiac arrhythmias, particularly malignant ventricular arrhythmias and sudden cardiac death. This association and its outcome have been described in medical literature, but the low incidence leads to a lack of evidence regarding its management and stratification.The case of a young woman is presented, whose initial manifestation was syncope, with subsequent development of severe mitral insufficiency, followed by severe mitral regurgitation and the discovery of frequent ventricular extrasystoles. She underwent surgical repair with mitral valve plasty and cryoablation of the anterior papillary muscle. The clinical outcome was favorable, as evidenced by an improvement in symptoms and control of arrhythmia burden.

Research advances in thermal ablation for lung cancer / 中国胸心血管外科临床杂志

@#Although surgical resection remains to be the best treatment strategy for stageⅠnon-small cell lung cancer (NSCLC), percutaneous thermal ablation offers an important option for patients who are unable to undergo surgical resection. Currently, there are three main thermal ablation methods used in the treatment of lung cancer, including radiofrequency ablation (RFA), microwave ablation (MWA) and argon-helium cryoablation (AHC). With the improvement of technique and the accumulation of experience in the treatment of lung cancer, some limitations are disclosed in the initial application of RFA, such as heat sink effect, skin burns and rapid carbonization. These shortcomings have been overcome in the development of MWA and AHC. The feasibility and safety of thermal ablation for the treatment of lung cancer has been demonstrated and its efficacy has been significantly improved (especially for the tumour diameter≤3 cm). This article will focus on the application and recent research developments of these ablation techniques in the treatment of lung cancer.

Research progress in nanoparticle-mediated cryoablation therapy for tumors / 介入放射学杂志

Cryoablation is a local ablation treatment based on the hypothermia effect,which has been widely used in the treatment of various solid tumors throughout the body.However,low freezing efficiency and insufficient accuracy are the problems in clinical cryoablation therapy which need to be solved urgently.With the continuous progress of nanoscience,various types of nanoparticles have been developed and applied in clinical practice.After being loaded into the target area,the nanoparticles can exert functions such as targeted drug delivery as well as image enhancement,which provides the possibility to break through the current clinical application bottleneck of cryoablation therapy.This paper aims to make a comprehensive review about several currently commonly-used nanoparticles for cryoablation therapy,focusing on their main functions and mechanisms,with the hope that the physicians concerned can get a further detailed understanding of the nanoparticles and lay a solid foundation for conducting in-depth researches and achieving clinical transformation.

Expert consensus on cryoablation therapy of oral mucosal melanoma / 实用口腔医学杂志

Cryoablation therapy with explicit anti-tumor mechanisms and histopathological manifestations has a long history.A large number of clinical practice has shown that cryoablation therapy is safe and effective,making it an ideal tumor treatment method in theory.Previously,its efficacy and clinical application were constrained by the limitations of refrigerants and refrigeration equipment.With the development of the new generation of cryoablation equipment represented by argon helium knives,significant progress has been made in refrigeration efficien-cy,ablation range,and precise temperature measurement,greatly promoting the progression of tumor cryoablation technology.This consensus systematically summarizes the mechanism of cryoablation technology,indications for oral mucosal melanoma(OMM)cryotherapy,clinical treatment process,adverse reactions and management,cryotherapy combination therapy,etc.,aiming to provide reference for carrying out the standardized cryoablation therapy of OMM.

Effects of salvage therapies for local recurrence of tumor following prostate cryoablation / 现代泌尿外科杂志

【Objective】 To explore the effectiveness and safety of different salvage therapies for local recurrence of tumor following primary prostate cryoablation so as to provide the reference for the treatment of prostate similar cases. 【Methods】 The clinical data of patients with prostate cancer (cT1c-4N0M0) who received salvage therapy for local recurrence of tumor following primary prostate cryoablation in the Sun Yat-Sen University Cancer Center during June 2014 and Dec. 2020 were retrospectively analyzed. Salvage therapies included local therapy (salvage radiotherapy, salvage cryoablation or salvage radical prostatectomy) and androgen deprivation therapy (ADT). 【Results】 Altogether 8 patients were involved. The median age was 71(63-76) years, the median prostate specific antigen (PSA) at the first diagnosis was 17.650(10.380-325.100) ng/mL, the median nadir post-cryoablation PSA was 0.041(0.003-0.541) ng/mL, and the median PSA at local recurrence was 3.030(2.090-19.180) ng/mL. Abnormal digital rectal examination was found in 3 cases, and radiographic evidence of local recurrence was found in 7 cases. Prostate biopsy was performed in 4 cases, 2 of which had positive results. The median follow-up after salvage therapy lasted for 54 (9-75) months. Four cases received salvage radiotherapy, 2 of which developed bloody stool, hematuresis and urinary tract infection, and recovered after conservative treatment; 1 case received salvage cryoablation without side effects; 1 case underwent radical prostatectomy and radiotherapy, developed lymphorrhagia and recovered after conservative treatment; 2 cases received ADT alone, one experienced hot flashes and recovered after conservative treatment, and the other progressed into castration-resistant prostate cancer after 63 months. No other progression or death occurred at the termination of follow-up. 【Conclusion】 Salvase therapy (salvage radiotherapy, salvage cryoablation, salvage radical prostatectomy) and ADT can be used for local recurrence of tumor following primary prostate cryoablation. However, large-scale prospective research is needed to confirm the effectiveness and safety of different therapies.

La crioablación: una alternativa en el tratamiento del cáncer mamario

La crioablación es un tratamiento de crioterapia para tumores localizados en pulmones, mediastino, huesos, hígado, riñón, próstata y mama. Puede ser curativo o paliativo y se desarrolla de manera efectiva en la medicina moderna. Este tratamiento busca mitigar la quinta causa de muerte a nivel mundial, el cáncer de mama. La presente investigación es una revisión bibliográfica acerca de la crioablación percutánea como un método seguro que no involucra a otros órganos cercanos a la parte a intervenir. Es un procedimiento ambulatorio, con imagen guiada, mínima invasión, anestesia local y recuperación inmediata. Los resultados demuestran que es recomendable en pacientes de edad avanzada o que por su enfermedad tengan alto riesgo en cirugías y para cualquier paciente con el padecimiento referido. El objetivo del estudio es fundamentar teóricamente los beneficios de la crioterapia, medir y probar su eficacia, así como su tolerancia a largo y mediano plazo.

Cryoablation is a cryotherapy treatment for tumors located in the lungs, mediastinum, bones, liver, kidney, prostate, and breast. It can be curative or palliative and is effectively developed in modern medicine. It seeks to mitigate the fifth cause of death worldwide, breast cancer. The present investigation is a bibliographic review about percutaneous cryoablation as a safe method that does not involve other organs close to the part to be intervened. It is an outpatient procedure, with guided image, minimal invasion, local anesthesia and immediate recovery. The results show that it is recommended in elderly patients or those who are at high risk for surgery due to their disease and for any patient with the aforementioned condition. The objective of the study is to theoretically support the benefits of cryotherapy, measure and test its efficacy, as well as its tolerance in the long and medium term.

The success rate of radiofrequency catheter ablation in Wolff-Parkinson-White-Syndrome patients: A systematic review and meta-analysis

Introduction: radiofrequency catheter ablation (RFA) is the first-line therapy for symptomatic Wolff Parkinson White (WPW) patients according to the American Heart Association. We conducted this study to assess the success rate, recurrence rate, and rate of complications associated with the utilization of radiofrequency catheter ablation for managing patients with WPW. Method: We searched PubMed, Cochrane library, Web of Science and Scopus databases using all identified keywords and index terms through 4 January 2022. We included all studies conducted on WPW patients who were treated with ablation. We conducted the analysis using Open Meta Analyst and MedCalc version 19.1. Results: Among 2268 unique articles identified, only 11 articles met our inclusion criteria. The pooled effect estimates showed high success rate (94.1%[95%CI:92.3e95.9], p < 0.001)), low recurrence rate (6.2% [95%CI:4.5e7.8, p < 0.001]) and low rate of complications (1%[95%CI:0.4e1.5, p < 0.001]). Conclusion: RFA showed a high success rate, low recurrence rate and low rate of complications in WPW patients

Anti-PD-L1 antibody enhances curative effect of cryoablation via antibody-dependent cell-mediated cytotoxicity mediating PD-L1highCD11b+ cells elimination in hepatocellular carcinoma

Cryoablation (CRA) and microwave ablation (MWA) are two main local treatments for hepatocellular carcinoma (HCC). However, which one is more curative and suitable for combining with immunotherapy is still controversial. Herein, CRA induced higher tumoral PD-L1 expression and more T cells infiltration, but less PD-L1highCD11b+ myeloid cells infiltration than MWA in HCC. Furthermore, CRA had better curative effect than MWA for anti-PD-L1 combination therapy in mouse models. Mechanistically, anti-PD-L1 antibody facilitated infiltration of CD8+ T cells by enhancing the secretion of CXCL9 from cDC1 cells after CRA therapy. On the other hand, anti-PD-L1 antibody promoted the infiltration of NK cells to eliminate PD-L1highCD11b+ myeloid cells by antibody-dependent cell-mediated cytotoxicity (ADCC) effect after CRA therapy. Both aspects relieved the immunosuppressive microenvironment after CRA therapy. Notably, the wild-type PD-L1 Avelumab (Bavencio), compared to the mutant PD-L1 atezolizumab (Tecentriq), was better at inducing the ADCC effect to target PD-L1highCD11b+ myeloid cells. Collectively, our study uncovered the novel insights that CRA showed superior curative effect than MWA in combining with anti-PD-L1 antibody by strengthening CTL/NK cell immune responses, which provided a strong rationale for combining CRA and PD-L1 blockade in the clinical treatment for HCC.

Primer caso en Colombia de crioablación y mapeo de alta densidad en arritmia ventricular del músculo papilar / First case in Colombia of cryoablation and high-density mapping in ventricular arrhythmia of the papillary muscle

Resumen La ablación con catéter se ha convertido en un enfoque práctico para el tratamiento de las arritmias cardiacas, sobre todo cuando el manejo farmacológico óptimo no logra controlarlas. De esta manera se reduce la readmisión hospitalaria y se mejora la calidad de vida de los pacientes, incluso de aquellos en quienes no se logra la resolución completa de la arritmia. Hasta la fecha se han utilizado varias modalidades entre las que se incluyen la radiofrecuencia y la crioablación. Los principios de la criobiología se establecieron por primera vez con investigaciones sobre la congelación de los tumores y datos actuales sugieren que es necesaria una temperatura entre -30 a -40 °C para inducir muerte celular, ya sea por mecanismos inmediatos, como ruptura celular, lesión hipotérmica o daño vascular, o tardíos, como apoptosis. Se presenta el primer caso en Colombia de mapeo de alta densidad y crioablación como estrategias combinadas para el tratamiento efectivo de un paciente con alta carga de arritmia ventricular sintomática originada en el músculo papilar anterolateral, sin recurrencia de la arritmia en el tiempo de seguimiento.

Abstract Catheter ablation has become a practical approach for the treatment of cardiac arrhythmias, especially when optimal pharmacological management does not achieve adequate control of it, thus reducing hospital readmission and improving quality of life, even in patients in whom the complete resolution of the arrhythmia is not achieved. To date, a variety of modalities have been used, including radiofrequency and cryoablation. The principles of cryobiology were established for the first time with research on the freezing of tumors and current data suggest that a temperature of -30 to -40 °C is necessary to induce cell death either by immediate or delayed mechanisms; immediate as cellular rupture or hypothermic injury as well as vascular damage or apoptosis among the late. The first case in Colombia of high-density mapping and cryoablation is presented as combined strategies for the effective treatment of a patient with a high load of symptomatic ventricular arrhythmia originating in the anterolateral papillary muscle, without recurrence of the arrhythmia at the time of follow-up with symptoms, so it was to successful cryoablation, as the first case with this technique.

Neuromodulación percutánea utilizando radiofrecuencia pulsada versus crioablación en pacientes con síndrome facetario lumbar / Percutaneous neuromodulation with pulsating radiofrequency vs cryoablation for the treatment of patients with lumbar facet syndrome

Resumen: Introducción: El dolor en columna lumbar afecta a un alto porcentaje de la población y presenta un significativo impacto socioeconómico. El síndrome facetario lumbar tiene una prevalencia entre 15-31% con incidencia a lo largo de la vida de hasta 52% en algunas series. Debido al empleo de distintos tipos de tratamiento y diversos criterios de selección de los pacientes, la tasa de éxito varía en la literatura. Objetivo: Comparar resultados de tratamiento con rizólisis aplicando radiofrecuencia pulsada versus crioablación en pacientes con diagnóstico de síndrome facetario lumbar. Material y métodos: De Enero de 2019 a Noviembre de 2019, ocho pacientes fueron divididos aleatoriamente en dos grupos: el grupo A tratados con radiofrecuencia pulsada y el grupo B tratados con crioablación. Se evaluó el dolor con la escala visual análoga y el índice de discapacidad de dolor lumbar de Oswestry a las cuatro semanas, además de tres y seis meses. Resultados: El seguimiento fue de seis meses. De forma inmediata los ocho pacientes (100%) refirieron mejoría de los síntomas y del dolor. De los cuatro pacientes que se encontraban en limitación funcional intensa, uno pasó a estar sin limitación funcional, dos de ellos pasaron a limitación funcional mínima y uno a limitación funcional moderada al primer mes; se reportaron diferencias estadísticamente significativas. Conclusiones: Ambos tratamientos controlan el dolor en el corto plazo; también hay una mejoría de las capacidades físicas. La morbilidad que acompaña a la neurólisis, ya sea radiofrecuencia o crioablación, es muy baja.

Abstract: Introduction: Lumbar spine pain affects a high percentage of the population and has a significant socioeconomic impact. Lumbar facet syndrome has a prevalence between 15-31% with lifetime incidence of up to 52% in some series. Due to the use of different types of treatment and different patient selection criteria, the success rate varies in the literature. Objective: To compare results of treatment with rhizolysis applying pulsed radiofrequency versus cryoablation in patients diagnosed with lumbar facet syndrome. Material and methods: From January 2019 to November 2019, eight patients were randomly divided into two groups: group A treated with pulsed radiofrequency and group B treated with cryoablation. Pain was assessed with the visual analogue scale and the Oswestry low back pain disability index at four weeks, in addition to three and six months. Results: Follow-up was six months. Immediately the eight patients (100%) reported improvement in symptoms and pain. Of the four patients who were in intense functional limitation, one of them became without functional limitation, and two of them went to minimum functional limitation and one to moderate functional limitation at the first month, statistically significant differences were reported. Conclusions: Both treatments control pain in the short term; there is also an improvement in physical abilities. The morbidity accompanying neurolysis either radiofrequency or cryoablation is very low.

Crioablación percutánea de tumores renales cT1 como alternativa al tratamiento quirúrgico / Percutaneous cryoablation of cT1 kidney tumors as alternative to surgical treatment

Resumen El cáncer renal representa el 3 al 4% de todas las lesiones malignas y su detección incidental es cada vez más frecuente. Para los tumores renales cT1a la cirugía es el tratamiento de elección. No todos los pacientes son candidatos a este tipo de tratamiento por elevado riesgo quirúrgico debido a comorbi lidades asociadas o antecedentes de cirugía en dicho órgano. Las guías de la Asociación Americana de Urología recomiendan la termoablación como alternativa a la cirugía en tumores menores a 3 cm. La experiencia con crioablación percutánea en tumores renales es escasa en Latinoamérica y hay pocas publicaciones al respecto en esta región. El objetivo de este trabajo fue describir la efectividad y seguridad de la crioablación percutánea en una cohorte de pacientes adultos con cáncer renal cT1 (menores a 5 cm) como alternativa al tratamiento quirúrgico. Los procedimientos fueron realizados con guía de tomografía computarizada o con un angiógrafo, en condiciones estériles y bajo anestesia general. Los pacientes fueron tratados en condiciones ambulatorias. El seguimiento se realizó con estudios por imágenes, análisis de laboratorio y consulta clínica. Todos tuvieron una respuesta completa constatada por imágenes en los controles evolutivos. El 61% no tuvo complicaciones y en el resto se observaron complicaciones grado 1 como hematuria, retención urinaria y hematoma perirrenal. Se concluyó que la crioablación percutánea es segura y efectiva como alternativa a la cirugía en pacientes con tumores renales.

Abstract Renal cancer represents 3-4% of all malignancies. Its incidental detection is becoming more frequent. Surgery is the gold standard treatment for T1 renal cancer. Still, surgery is not suitable for every patient due to comorbidities or previous kidney surgery. Guidelines provided by The American Urological Association recommend thermoablation therapies as an alternative to surgery in tumors under 3 cm. Experience regarding percutaneous cryoablation in renal tumors is scarce in Latin America and there are only a handful of publications in this region regarding this subject. The objective of this study was to assess the effectiveness and security of percutaneous cryoablation in a cohort of adult patients with cT1 renal cancer (smaller than 5 cm) as an alternative to surgery. The procedures were performed with CT or Cone Beam CT guidance and under general anesthesia in sterile conditions. Cryoablation was carried out on an outpatient basis. Follow up was done with imaging studies, blood test and clinical consultation. All patients had complete response in imaging studies. There were no complications in 61% of all of them, the remaining patients suffered grade-1 complications such as hematuria, urinary reten tion and perirenal hematoma. In conclusion, percutaneous cryoablation for renal tumors is a safe and effective alternative to surgery.

Experiencia latinoamericana en crioablación de fibrilación auricular paroxística y persistente con criobalón de segunda generación. Resultados en agudo y a 12 meses / Latin-American experience in cryoablation of paroxysmal and persistent atrial fibrillation using second generation cryo-balloon. Acute success and 12 months of follow-up

Resumen Objetivo: La ablación por catéteres es una técnica habitual para tratar la fibrilación auricular (FA). Son escasos los datos prospectivos y multicéntricos con resultados a mediano plazo de la crioablación de venas pulmonares en América Latina. El objetivo es evaluar la seguridad y la eficacia de la ablación por criobalón de segunda generación en pacientes con FA paroxística o persistente en América Latina. Método: Se evaluaron las características del procedimiento y los resultados en agudo y a 12 meses Se incluyeron pacientes con FA mayores de 18 años a quienes se realizara desconexión de venas pulmonares con criobalón de segunda generación. Se definió como fallo al tratamiento cualquier episodio de FA, aleteo auricular o taquicardia auricular de más de 30 segundos fuera del periodo de cegamiento de 90 días. Resultados: Se incluyeron 218 pacientes (57 ± 11 años, 66.5% hombres, CHA2DS2-VASc 1.2 ± 1.1). Presentaron FA paroxística el 83.9%, FA persistente el 12.8% y FA persistente de larga duración el 2.3%. Quince pacientes presentaban antecedentes de aleteo auricular. Habían fracasado a una droga antiarrítmica el 89.4%. El éxito en agudo se obtuvo en 211 pacientes (96.8%). El tiempo promedio del procedimiento fue de 73.2 ± 26.7 minutos, el tiempo de fluoroscopia fue de 21.4 ± 23.9 minutos y el tiempo total de ocupación del laboratorio fue de 114.6 ± 41.3 minutos. Durante los 12 meses de seguimiento, el tiempo libre de recurrencia de FA fue del 88.6% en FA paroxística y del 73.1% en FA persistente. Veintiún pacientes (9.6%) presentaron eventos adversos relacionados con el procedimiento. Conclusiones: Estos resultados indican que la desconexión de venas pulmonares con criobalón es un tratamiento seguro y efectivo para la FA en América Latina.

Abstract Objective: Catheter ablation has become a usual technique to treat atrial fibrillation (AF). Medium-term results of prospective and multicenter data concerning pulmonary veins cryoablation in Latin America are limited. The objective is to assess the safety and efficacy of ablation by second generation cryoballoon in patients with paroxysmal atrial fibrillation (PAF) or persistent atrial fibrillation (PerAF) in Latin America. Method: We evaluate the characteristics of the procedure and the acute and 12-month results. Inclusion criteria include patients over 18 years old with AF who have a planned procedure of pulmonary veins isolation with second generation cryoballoon. Treatment failure was defined as any episode of AF, atrial flutter or atrial tachycardia greater than 30 seconds outside the 90-day blinded period. Results: A total of 218 patients (57 ± 11 years, 66.5% men, CHA2DS2-VASc 1.2 ± 1.1) were included in the study. Of these, 83.9% evidenced PAF, 12.8% PerAF, and 2.3% long-standing PerAF. Fifteen with history of atrial flutter. Most patients had failed at least one antiarrhythmic drug (89.4%). The acute success of the procedure was obtained in 211 patients (96.8%). The average procedure time was 73.2 ± 26.7 min, the fluoroscopy time was 21.4 ± 23.9 min, and the total lab occupancy time was 114.6 ± 41.3 min. During the 12-month follow-up, freedom from AF recurrence was 88.6% in PAF, and 73.1% in PerAF. Twenty-one patients experienced device or procedure-related complications (9.6%). Conclusions: These results support pulmonary veins electrical isolation with cryoballoon as an effective treatment for AF in Latin America.

Early and mid-term outcomes of concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery / 中国胸心血管外科临床杂志

@#Objective    To analyze the early and mid-term safety and effectiveness of concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery. Methods    We retrospectively reviewed the clinical data of 68 patients (28 males and 40 females with a mean age of 38.7±9.3 years) who underwent concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve and tricuspid surgery in the Department of Cardiovascular Surgery of the Second Xiangya Hospital from August 2013 to October 2017. The heart rhythm of the patients after surgery was supervised by 24 hour holter monitoring eletrocardiogram. Results    No death occurred during operation and follow-up. One patient underwent reexploration for bleeding. The rate of sinus rhythm restored at the time of discharge was 95.8%. The rate of sinus rhythm restored at 6 months, 12 months, 24 months, 36 months after surgery was 93.5%, 91.6%, 90.3% and 89.5% respectively. Conclusion    Concomitant cryosurgical Cox-Maze Ⅳ procedure in minimally invasive mitral valve surgery is quite safe and effective in treatment of rheumatic mitral valve disease and atrial fibrillation in the early and mid-term follow-up.

Clinical analysis of cryotherapy in patients with primary tumor recurrence after radical radiotherapy for prostate cancer / 中华泌尿外科杂志

Objective:To explore the clinical value of cryoablation technology in the treatment of patients with primary tumor recurrence after radical radiotherapy for prostate cancer.Methods:The clinical data of 21 patients with prostate cancer recurrence after radical radiotherapy in the Fudan University Affiliated Cancer Hospital from August 2017 to February 2021 was retrospectively analyzed. The average age was 73.1 (57.3-85.0) years old, and the Gleason score was 6 in 5 cases, 7 in 8 cases, and ≥8 in 8 cases. The clinical stage of the first diagnosis: 13 cases of cT 2 stage; 8 cases of cT 3 stage. The baseline PSA before radiotherapy was 35.3 (6.4-78.5) ng/ml, and the lowest PSA after radiotherapy was 1.8 ng/ml. After a median follow-up of 8 (3-12) months, all patients were detected with persistently elevated PSA. Pelvic MRI and PSMA SPECT showed that the primary prostate lesion had recurred. PSA before cryoablation was 4.1 (1.8-14.4) ng/ml. Comprehensive assessment of preoperative examination showed that the patient only had a recurrence of the primary tumor, and no lymph node or distant metastasis was seen. An argon-helium cryogenic surgical treatment system was used to place 1 to 3 cryo-needles for recurring lesions, and cryoablation was performed using two cold and hot cycles. Observation indicators include prognostic indicators such as PSA, recurrence and metastasis, and the occurrence of adverse reactions. Results:Complications after cryoablation include: 2 cases of urinary retention, 1 case of urinary tract infection, and 2 cases of urination with tissue shedding. The PSA of 11 cases decreased rapidly 2 to 3 months after operation, and dropped to the lowest median value of 0.4 (0.003 to 2.8) ng/ml. After cryoablation, the median follow-up was 18 (6-51) months. Imaging examinations in 1 case showed that the prostate still had limited diffusion or increased PSMA uptake, and 4 cases had PSA progression but no recurrence or metastasis. The median recurrence time for advanced patients was 13 (4-36) months. Larger prostate volume ( P<0.001) and higher blood PSA before ablation( P=0.021) were related to biochemical recurrence. Conclusions:Prostate cryoablation could delay the progression of the primary tumor after radical radiotherapy for prostate cancer. The incidence of complications such as urinary retention and urinary tract infection is not high, and it is generally safe and controllable.

Experiência de um Centro Brasileiro com Crioablação para Isolamento Elétrico das Veias Pulmonares na Fibrilação Atrial Paroxística e Persistente - Resultados Preliminares no Brasil / Experience in a Brazilian Center with Cryoablation for Electric Isolation of the Pulmonary Veins in Paroxysmal and Persistent Atrial Fibrillation - Preliminary Results in Brazil

Resumo Fundamento O isolamento elétrico das veias pulmonares é reconhecidamente base fundamental para o tratamento não farmacológico da fibrilação atrial (FA) e, portanto, tem sido recomendado como passo inicial na ablação de FA em todas as diretrizes. A técnica com balão de crioenergia, embora amplamente utilizada na América do Norte e Europa, ainda se encontra em fase inicial em muitos países em desenvolvimento, como o Brasil. Objetivo Avaliar o sucesso e a segurança da técnica de crioablação em nosso serviço, em pacientes com FA paroxística e persistente. Métodos Cento e oito pacientes consecutivos com FA sintomática e refratária ao tratamento farmacológico foram submetidos à crioablação para isolamento das veias pulmonares. Os pacientes foram separados em dois grupos, de acordo com a classificação convencional da FA paroxística (duração de até sete dias) e persistente (FA por mais de sete dias). Dados de recorrência e segurança do procedimento foram analisados respectivamente como desfechos primário e secundário. O nível de significância adotado foi de 5%. Resultados Cento e oito pacientes, com idade média de 58±13 anos, 84 do sexo masculino (77,8%), foram submetidos ao procedimento de crioablação de FA. Sessenta e cinco pacientes apresentavam FA paroxística (60,2%) e 43, FA persistente (39,2%). O tempo médio do procedimento foi de 96,5±29,3 minutos e o tempo médio de fluoroscopia foi de 29,6±11,1 minutos. Foram observadas cinco (4,6%) complicações, nenhuma fatal. Considerando a evolução após os 3 meses iniciais, foram observadas 21 recorrências (19,4%) em período de um ano de seguimento. As taxas de sobrevivência livre de recorrência nos grupos paroxístico e persistente foram de 89,2% e 67,4%, respectivamente. Conclusão A crioablação para isolamento elétrico das veias pulmonares é um método seguro e eficaz para tratamento da FA. Nossos resultados estão consoantes com demais estudos, que sugerem que a tecnologia pode ser utilizada como abordagem inicial, mesmo nos casos de FA persistente. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Electrical isolation of the pulmonary veins is recognized as the cornerstone of non-pharmacological treatment of Atrial Fibrillation (AF), and therefore, has been recommended as the first step in AF ablation according to all guidelines. Even though the cryoballoon technology is widely used in North America and Europe, this experience is still incipient in many developing countries such as Brazil. Objective To evaluate initial results regarding success and safety of the new technology in patients with persistent and paroxysmal AF. Methods One hundred and eight consecutive patients with symptomatic AF refractory to pharmacological treatment were submitted to cryoablation for isolation of the pulmonary veins. Patients were separated into two groups according to AF classification: persistent (AF for over one week); or paroxysmal (shorter episodes). Recurrence and procedural safety data were analyzed respectively as primary and secondary outcomes. The level of significance was 5%. Results One hundred and eight patients, with mean age 58±13 years, 84 males (77.8%), underwent cryoablation. Sixty-five patients had paroxysmal AF (60.2%) and 43 had persistent AF (39.2%). The mean time of the procedure was 96.5±29.3 minutes and the mean fluoroscopy time was 29.6±11.1 minutes. Five (4.6%) complications were observed, none fatal. Considering a blanking period of 3 months, 21 recurrences (19.4%) were observed in a one-year follow-up period. The recurrence-free survival rates of AF in the paroxysmal and persistent groups were 89.2% and 67.4%, respectively. Conclusion Cryoablation for electrical isolation of the pulmonary veins is a safe and effective method for the treatment of AF. Our results are consistent with other studies suggesting that this technology can be used as an initial technique even in cases of persistent AF.

Ablación tumoral percutánea guiada por imágenes / Image-Guided Percutaneous Tumor Ablation

RESUMEN La incidencia de enfermedades oncológicas se incrementa cada día. Las terapias ablativas tumorales percutáneas guiadas por imagen constituyen una alternativa de tratamiento para pacientes sin criterio de resección quirúrgica. El objetivo del estudio es argumentar la necesidad del uso de las terapias ablativas tumorales percutáneas en Cuba mediante la revisión de su estado actual en el mundo. Se realizó una revisión bibliográfica descriptiva, en bases de datos Google Escolar, MEDLINE (Pubmed) y SciELO. Se seleccionaron 31 artículos, que fueron útiles para actualizar la información. Con la ablación tumoral percutánea se intentó erradicar completamente todas las células malignas viables dentro del tumor. La ablación química, la térmica y otras no térmicas, son las más usadas. Este tratamiento ha demostrado ser efectivo y seguro. Debido su elevado costo, no ha sido posible su introducción en el país(AU)

ABSTRACT The incidence of oncological diseases increases every day. Image-guided percutaneous tumor ablative therapies are treatment alternatives for patients not eligible based on surgical resection criteria. The objective of the study is support the need for the use of percutaneous tumor ablative therapies in Cuba, by reviewing its current state in the world. A descriptive bibliographic review was carried out using the databases Google Scholar, MEDLINE (Pubmed) and SciELO, from which 31 articles were selected, useful to update the information. Percutaneous tumor ablation was performed in view of completely eradicating all viable malignant cells within the tumor. Chemical, thermal and other non-thermal ablations are the most used. This treatment has proven effective and safe. Due to its high cost, its introduction in the country has not been possible(AU)

Recovery rule of atrial contractility after Maze Ⅳ in patients with valvular atrial fibrillation / 中国胸心血管外科临床杂志

@#Objective    To analyze the recovery rule of atrial contractility (AC) function after Maze Ⅳ procedure of valvular atrial fibrillation (AF). Methods    In our hospital from March 2016 to April 2018, 103 patients who underwent cryoablation Maze Ⅳ procedure due to mitral valve lesions associated with persistent or long-term persistent AF were enrolled. There were 42 males and 61 females, with an average age of 58.5±9.1 years. Electrocardiogram and echocardiography were followed up at discharge and 1, 3, 6, 12 months after procedure. A multivariate Cox analysis of predictive factors for AC recovery was applied. Results    All the 103 patients were followed up for 1 year. The recovery rate of AC increased gradually after operation. It was not until 3 months after procedure that most of the right atrial contractility (RAC) was accompanied by synchronous recovery of the corresponding left atrial contractility (LAC, Kappa coefficient≥0.40, P<0.05). However, the coexistence of sinus rhythm (SR) and bilateral AC was not consistent well until 1 year after operation (Kappa coefficient≥0.40, P<0.05). One year after procedure, the recovery rates of SR and bilateral AC were 86.4% (89/103) and 66.0% (68/103) respectively. By Cox multivariate regression analysis, longer preoperative AF duration (P=0.040), larger preoperative left atrial diameter (LAD, P=0.003), and AC deletion 3 months after surgery (P=0.037) were predictive factors for AF recurrence in the middle and advanced stages (>3 months) after Maze surgery. At the same time, longer preoperative AF duration and larger preoperative LAD were also negative predictors of middle and late recovery of LAC and bilateral AC (All P<0.05). Receiver operating characteristic curve analysis showed that the best critical value of preoperative AF time and preoperative LAD for prediction of AC recovery was 37 months (sensitivity 99.6%, specificity 76.3%) and 60.5 mm (sensitivity 98.5%, specificity 78.9%), respectively. Conclusion    The recovery of AC after Maze procedure is a dynamic improvement process. Early recovery of AC is beneficial to the stable maintenance of SR in the future. Prolonged duration of AF and enlarged LAD have adverse effects on the outcome of Maze Ⅳ procedure.

Crioablación en taquicardia ortodrómica por vía accesoria oculta parahisiana: caso clínico y revisión de la literatura / Crioablation of orthodromic supraventricular tachycardia win an occult accessory pathway

Abstract An 18-year-old woman with recurrent tachycardia was shown to have orthodromic supraventricular tachycardia through an antero-septal occult pathway near the His. Cryoablation was selected to avoid A-V block. The accesory pathway was finally interrupted after 360 sec of cryoablation. No recurrence was documented after a 12 month follow-up