Clinical safety and efficacy of microwave ablation for small renal masses

ABSTRACT Purpose: CT-guided MWA is a safe and effective tool that should be utilized in the treatment of small renal masses (SRMs). We aim to clarify the utility of CT-guided MWA by examining patient outcomes such as recurrence, treatment success, changes in renal function, and complications. Methods: A retrospective review of consecutive patients with SRMs who underwent same day renal mass biopsy (RMB) and CT-guided MWA between 2015 and 2022 was performed. Treatment safety was assessed by 30-day complications according to the Clavien-Dindo system and change in eGFR >30 days post-procedure. Treatment efficacy was defined by local recurrence and incomplete treatment rates and calculated using the Kaplan-Meier method. Results: A total of 108 renal masses were found in 104 patients. The overall complication rate was 7.4% (8/108), of which 4 were major complications (3.7%). For those with renal function available >30 days post ablation, the median eGFR was 47.2 (IQR: 36.0, 57), compared to 52.3 (IQR: 43.7, 61.5) pre-ablation, p<0.0001. 5-year local recurrence free survival was 86%. Among those with biopsy proven malignancy (n= 66), there were five local recurrences (7.54%) occurring at a median of 25.1 months (IQR 19.9, 36.2) and one case (1.5%) of incomplete treatment. Conclusions: As the medical field continues to evolve towards less invasive interventions, MWA offers a valuable tool in the management of renal masses. With low major complication and recurrence rates, our findings support the utility of CT-guided MWA as a tool for treatment of SRMs.

Fotocoagulación láser guiada por ultrasonido para el tratamiento del secuestro broncopulmonar fetal. Reporte de dos casos exitosos en Venezuela / Ultrasound-guided laser photocoagulation for the treatment of fetal bronchopulmonary sequestration. Report of two successful cases in Venezuela

El secuestro broncopulmonar es una malformación del aparato respiratorio que consiste en tejido bronquial y pulmonar no funcionante, separado del árbol tráqueo-bronquial y alimentado por un vaso sanguíneo proveniente de la circulación sistémica. La incidencia es de 1 por cada 5000 nacimientos, comprende entre 0,15 % y 6,45 % de las patologías pulmonares. El pronóstico es, generalmente, favorable, reportándose regresión espontánea de la lesión en 50 % a 75 % de los pacientes. Puede ocasionar efecto de masa, comprimiendo el corazón y el pulmón hasta generar cambios hemodinámicos y falla cardíaca. Hay múltiples procedimientos para el tratamiento y manejo, principalmente en casos de gran tamaño y fetos hidrópicos, para mejorar el pronóstico perinatal. Se presentan los dos primeros casos de secuestro broncopulmonar tratados en Venezuela mediante fotocoagulación láser del vaso nutricio y su evolución perinatal, con sobrevida del 100 % y sin ninguna complicación registrada en el periodo perinatal(AU)

Bronchopulmonary sequestration is a malformation of the respiratory system consisting of non-functioning bronchial and pulmonary tissue, separated from the tracheo-bronchial tree and fed by a blood vessel from the systemic circulation. The incidence is 1 in 5000 births, ranging from 0.15% to 6.45% of pulmonary pathologies. The prognosis is generally favorable, with spontaneous regression of the lesion reported in 50% to 75% of patients. It can cause mass effect, compressing the heart and lung to the point of generating hemodynamic changes and heart failure. There are multiple procedures for treatment and management, mainly in large cases and hydropic fetuses, to improve perinatal prognosis. We present the first two cases of bronchopulmonary sequestration treated in Venezuela by laser photocoagulation of the nutrient vessel and their perinatal evolution, with 100% survival and without any complications recorded in the perinatal period(AU)

Ablación de venas pulmonares con campo pulsado: avances y perspectivas / Pulsed-field pulmonary vein ablation: advances and perspectives

It is presented as an innovative technique in the treatment of atrial fibrillation, with the aim of improving the quality of life of affected patients. OBJECTIVES: The study aims to describe the ablation procedure using the Boston Scientific System Farapulse medical equipment and analyze the results in a specific clinical case. METHODS: A pulmonary vein ablation procedure was performed using the aforementioned equipment. Details of the procedure were recorded, including catheter placement and applications performed in each pulmonary vein. RESULTS: Good tolerance was observed by the patient during the procedure, with an adequate number of applications in each pulmonary vein. Postablation electrocardiogram showed no significant abnormalities, suggesting electrical stability of the heart. It is concluded that the pulsed field pulmonary vein ablation technique using the Boston Scientific System medical equipment is safe and effective in the treatment of atrial fibrillation.

Se presenta como una técnica innovadora en el tratamiento de la fibrilación auricular, con el objetivo de mejorar la calidad de vida de los pacientes afectados. OBJETIVOS: El estudio tiene como objetivo describir el procedimiento de ablación utilizando el equipo médico Boston Scientific System Farapulse y analizar los resultados en un caso clínico específico. Métodos: Se realizó un procedimiento de ablación de venas pulmonares utilizando el equipo mencionado. Se registraron los detalles del procedimiento, incluyendo la colocación de catéteres y las aplicaciones realizadas en cada vena pulmonar. RESULTADOS: Se observó una buena tolerancia por parte del paciente durante el procedimiento, con un número adecuado de aplicaciones en cada vena pulmonar. El electrocardiograma postablación no mostró anomalías significativas, lo que sugiere una estabilidad eléctrica del corazón. Se concluye que la técnica de ablación de venas pulmonares con campo pulsado utilizando el equipo médico Boston Scientific System es segura y eficaz en el tratamiento de la fibrilación auricular.

Os Biomarcadores podem ser Utilizados para Prever Recorrência de Arritmia após a Ablação de Fibrilação Atrial Guiada pelo Ablation-Index? / Can Pre-Ablation Biomarkers Be Used to Predict Arrhythmia Recurrence after Ablation Index-Guided Atrial Fibrillation Ablation?

Resumo Fundamento: O software ablation index (AI) permitiu melhorar os resultados da ablação de fibrilação atrial (FA), mas as taxas de recorrência permanecem significativas. Biomarcadores séricos específicos têm sido associados a essa recorrência. Objetivos: Avaliar se certos biomarcadores podem ser utilizados (individualmente ou combinados) para predizer a recorrência de FA pós ablação guiada pelo AI. Métodos: Estudo multicêntrico, observacional, prospectivo de pacientes consecutivos, encaminhados para ablação de FA de janeiro de 2018 a março de 2021. Hemoglobina, peptídeo natriurético cerebral (BNP), proteína C reativa, troponina I ultrassensível, clearance de creatinina, Hormônio Tireoestimulante (TSH), e Tiroxina livre (T4) foram avaliados quanto à capacidade de prever a recorrência de arritmias durante o acompanhamento. Valores de p <0,05 foram aceitos como estatisticamente significativos. Resultados: Um total de 593 pacientes foram incluídos - 412 com FA paroxística e 181 com FA persistente. Durante o seguimento médio de 24±6 meses, 76,4% não apresentaram recidiva após ablação. Individualmente, os biomarcadores demonstraram um valor preditivo baixo ou nulo para recorrência. No entanto, TSH >1,8 μUI/mL [HR=1,82 (IC95%, 1,89-2,80), p=0,006] foi um preditor independente de recorrência. Avaliando-se a combinação de TSH, FT4 e BNP, a adição de cada valor "anormal" foi associada a uma menor sobrevida livre de recorrência (87,1% se nenhum vs. 83,5% se um vs. 75,1% se dois vs. 43,3% se três biomarcadores, p<0,001). Doentes com três biomarcadores "anormais" apresentaram três vezes maior probabilidade de recorrência de FA, comparativamente aos que não apresentaram nenhum biomarcador "anormal" (HR=2,88 [IC95%, 1,39-5,17], p=0,003). Conclusões: Quando combinados, valores anormais de TSH, FT4 e BNP podem ser uma ferramenta útil para prever a recorrência de FA pós ablação guiada pelo AI.

Abstract Background: Ablation Index (AI) software has allowed better atrial fibrillation (AF) ablation results, but recurrence rates remain significant. Specific serum biomarkers have been associated with this recurrence. Objectives: To evaluate whether certain biomarkers could be used (either individually or combined) to predict arrhythmia recurrence after AI-guided AF ablation. Methods: Prospective multicenter observational study of consecutive patients referred for AF ablation from January 2018 to March 2021. Hemoglobin, brain natriuretic peptide (BNP), C-reactive protein, high sensitivity cardiac troponin I, creatinine clearance, thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were assessed for their ability to predict arrhythmia recurrence during follow-up. Statistical significance was accepted for p values of<0.05. Results: A total of 593 patients were included - 412 patients with paroxysmal AF and 181 with persistent AF. After a mean follow-up of 24±6 months, overall single-procedure freedom from atrial arrhythmia was 76.4%. Individually, all biomarkers had no or only modest predictive power for recurrence. However, a TSH value >1.8 μUI/mL (HR=1.82 [95% CI, 1.89-2.80], p=0.006) was an independent predictor of arrhythmia recurrence. When assessing TSH, FT4 and BNP values in combination, each additional "abnormal" biomarker value was associated with a lower freedom from arrhythmia recurrence (87.1 % for no biomarker vs. 83.5% for one vs. 75.1% for two vs. 43.3% for three biomarkers, p<0.001). Patients with three "abnormal" biomarkers had a threefold higher risk of AF recurrence compared with no "abnormal" biomarker (HR=2.88 [95% CI, 1.39-5.17], p=0.003). Conclusions: When used in combination, abnormal TSH, FT4 and BNP values can be a useful tool for predicting arrhythmia recurrence after AI-guided AF ablation.

Ablación por radiofrecuencia de nódulos tiroideos; a propósito de un caso exitoso en un hospital público en Perú / Radiofrequency ablation of thyroid nodules: a successful case in a public hospital in Perú

RESUMEN Se expone los resultados que sugieren la viabilidad de la ablación con radiofrecuencia (ARF) como una posible estrategia terapéutica efectiva en el caso de una mujer de 56 años con un nódulo tiroideo benigno en lugar de la cirugía tradicional en un Hospital Público del Perú. El seguimiento a los 6 meses reveló una reducción significativa en el tamaño del nódulo y reducción del 70% del volumen; además de mejorar la calidad de vida, mejora en los síntomas y función tiroidea normal. Este caso destaca la evolución en el tratamiento de nódulos tiroideos benignos, con la ARF como una posible opción mínimamente invasiva y segura, la cual se ofrece una alternativa prometedora a las intervenciones quirúrgicas convencionales para el manejo de nódulos tiroideos, marcando un cambio significativo en la práctica clínica, ya que es el primer hospital del MINSA (Ministerio de Salud) en realizar este tipo de procedimientos y que ofrece múltiples enfoques de tratamiento de nódulos tiroideos: ARF, tiroidectomía endoscópica transoral, tiroidectomía convencional y vigilancia activa.

ABSTRACT The results are presented, suggesting the viability of radiofrequency ablation (RFA) as an effective therapeutic strategy in the case of a 56-year-old woman with a benign thyroid nodule instead of traditional surgery at a Public Hospital in Peru. The 6-month follow-up revealed a significant reduction in the size of the nodule and a 70% reduction in volume; in addition to improved quality of life, symptom improvement, and normal thyroid function. This case highlights the evolution in the treatment of benign thyroid nodules, with RFA as a possible minimally invasive and safe option, offering a promising alternative to conventional surgical interventions for the management of thyroid nodules, marking a significant change in clinical practice. This is because it is the first hospital of the MINSA (Ministry of Health) to perform such procedures, offering multiple treatment approaches for thyroid nodules: RFA, transoral endoscopic thyroidectomy, conventional thyroidectomy, and active surveillance.

Ablação por Cateter para Fibrilação Atrial em Pacientes com Fração de Ejeção do Ventrículo Esquerdo ≤ 45%: Uma Metanálise de Ensaios Clínicos Randomizados / Catheter Ablation for Atrial Fibrillation in Patients with Left Ventricular Ejection Fraction ≤ 45%: A Meta-Analysis of Randomized Controlled Trials

Resumo Fundamento A fibrilação atrial (FA) e a insuficiência cardíaca (IC) coexistem frequentemente, resultando em desfechos adversos. No entanto, permanecem controvérsias quanto à eficácia da ablação por cateter (AC) em pacientes com FA com disfunção ventricular esquerda grave. Objetivos O objetivo deste estudo foi realizar uma metanálise de ensaios prospectivos randomizados e controlados para avaliar a eficácia da AC versus terapia médica (TM) em pacientes com FA com fração de ejeção do ventrículo esquerdo (FEVE) ≤45%. Métodos Procuramos na literatura estudos que comparassem AC com TM em pacientes com FA com FEVE ≤45%. Foi realizada uma metanálise de 7 ensaios clínicos, incluindo 1.163 pacientes com FA e IC. A análise de subgrupo foi realizada com base na FEVE basal. Todos os testes foram bilaterais; apenas o valor p <0,05 foi considerado estatisticamente significativo. Resultados Descobrimos que a AC estava associada a menor mortalidade por todas as causas (taxa de risco: 0,52, IC 95%: 0,37 a 0,72; p<0,01) e maiores melhorias na FEVE (diferença média: 4,80%, IC 95%: 2,29% a 7,31%; p<0,01) em comparação com TM. Os pacientes do grupo AC apresentaram menor risco de hospitalização por IC e recorrência de FA e qualidade de vida significativamente melhor do que aqueles do grupo TM. Os resultados da análise de subgrupo indicaram que pacientes com disfunção ventricular esquerda mais leve melhoraram a FEVE após a ablação de FA (diferença média: 6,53%, IC 95%: 6,18% a 6,88%; p<0,01) em comparação com pacientes com doença mais grave (diferença média : 2,02%, IC 95%: 0,87% a 3,16%; p<0,01). Conclusões Nossa metanálise demonstrou que a AC foi associada a melhorias significativas nos resultados de pacientes com FA com FEVE ≤45%. Além disso, pacientes com FA com disfunção ventricular esquerda mais leve poderiam se beneficiar mais com a AC.

Abstract Background Atrial fibrillation (AF) and heart failure (HF) frequently coexist, resulting in adverse outcomes. However, controversies remain regarding the efficacy of catheter ablation (CA) in AF patients with severe left ventricular dysfunction. Objectives The purpose of this study was to perform a meta-analysis of prospective randomized controlled trials to evaluate the efficacy of CA versus medical therapy (MT) in AF patients with left ventricular ejection fraction (LVEF) ≤45%. Methods We searched the literature for studies that compared CA to MT in AF patients with LVEF ≤45%. A meta-analysis of 7 clinical trials was performed, including 1163 patients with AF and HF. Subgroup analysis was performed based on baseline LVEF. All tests were 2-sided; only the p-value <0.05 was considered statistically significant. Results We found that CA was associated with lower all-cause mortality (risk ratio: 0.52, 95% CI: 0.37 to 0.72; p<0.01) and greater improvements in LVEF (mean difference: 4.80%, 95% CI: 2.29% to 7.31%; p<0.01) compared to MT. Patients in the CA group had a lower risk of HF hospitalization and AF recurrence and a significantly better quality of life than those in the MT group. The results of subgroup analysis indicated that patients with milder left ventricular dysfunction improved LVEF after AF ablation (mean difference: 6.53%, 95% CI: 6.18% to 6.88%; p<0.01) compared to patients with more severe disease (mean difference: 2.02%, 95% CI: 0.87% to 3.16%; p<0.01). Conclusions Our meta-analysis demonstrated that CA was associated with significant improvements in outcomes of AF patients with LVEF ≤45%. Additionally, AF patients with milder left ventricular dysfunction could benefit more from CA.

Progressão da Lesão Miocárdica após Ablação por Radiofrequência em Crianças em Idade Escolar / Myocardial Injury Progression after Radiofrequency Ablation in School-Age Children

Resumo Fundamento As últimas décadas têm assistido ao rápido desenvolvimento do tratamento invasivo de arritmias por procedimentos de ablação por cateter. Apesar da sua segurança e eficácia bem estabelecida em adultos, até o momento, há poucos dados nos cenários pediátricos. Uma das principais preocupações é a possível expansão da cicatriz do procedimento de ablação nessa população e suas consequências ao longo dos anos. Objetivos Este estudo teve como objetivo analisar o risco da progressão da lesão miocárdica após ablação por cateter de radiofrequência em pacientes pediátricos. Métodos Este é um estudo retrospectivo de 20 pacientes pediátricos com tratamento prévio de arritmia supraventricular com ablação, submetidos à ressonância magnética cardíaca e angiografia coronária para avaliação de fibrose miocárdica e da integridade das artérias coronárias durante o acompanhamento. Resultados A idade mediana no procedimento de ablação foi 15,1 anos (Q1 12,9, Q3 16,6) e 21 anos (Q1 20, Q3 23) quando a ressonância magnética cardíaca foi realizada. Quatorze dos pacientes eram mulheres. Taquicardia por reentrada nodal e síndrome de Wolf-Parkinson-White foram os principais diagnósticos (19 pacientes), com um paciente com taquicardia atrial. Três pacientes apresentaram fibrose miocárdica ventricular, mas com um volume inferior a 0,6 cm 3 . Nenhum deles desenvolveu disfunção ventricular e nenhum paciente apresentou lesões coronarianos na angiografia. Conclusão A ablação por cateter de radiofrequência não mostrou aumentar o risco de progressão de lesão miocárdica ou de lesões na artéria coronária.

Abstract Background The past decades have seen the rapid development of the invasive treatment of arrhythmias by catheter ablation procedures. Despite its safety and efficacy being well-established in adults, to date there has been little data in pediatric scenarios. One of the main concerns is the possible expansion of the ablation procedure scar in this population and its consequences over the years. Objectives This study aimed to analyze the risk of myocardial injury progression after radiofrequency catheter ablation in pediatric patients. Methods This is a retrospective study of 20 pediatric patients with previous ablation for treatment of supraventricular arrhythmia that underwent cardiac magnetic resonance and coronary angiography for evaluation of myocardial fibrosis and the integrity of the coronary arteries during follow-up. Results The median age at ablation procedure was 15.1 years (Q1 12.9, Q3 16.6) and 21 years (Q1 20, Q3 23) when the cardiac magnetic resonance was performed. Fourteen of them were women. Nodal reentry tachycardia and Wolf-Parkinson-White Syndrome were the main diagnosis (19 patients), with one patient with atrial tachycardia. Three patients had ventricular myocardial fibrosis, but with a volume < 0.6 cm 3 . None of them developed ventricular dysfunction and no patient had coronary lesions on angiography. Conclusion Radiofrequency catheter ablation did not show to increase the risk of myocardial injury progression or coronary artery lesions.

Progress of clinical research in arrhythmias and pacing 2023 / 中国介入心脏病学杂志

Reviewing important clinical trials in the field of arrhythmia in 2023,involving atrial fibrillation,pacing,and other aspects.Both the CIRDA-DOSE study and the EARLY-AF study affirmed the efficacy of cryoballoon ablation in treating atrial fibrillation,alter its progression to persistent atrial fibrillation.The MANIFEST-PF study examined the success rate and safety of pulse field ablation in atrial fibrillation,and the ADVENT study also confirmed its safety and effectiveness not inferior to conventional thermal ablation.In the LBBAP study,LBBAP reduced the occurrence of sustained VT/VF and new-onset atrial fibrillation compared to BVP.For patients with a high right ventricular pacing burden and reduced ejection fraction in pacemakers or ICDs,the BUDAPEST CRT upgrade study affirmed the benefits of upgrading to CRT-D.The DANPACE Ⅱ study showed that minimizing atrial pacing in patients with sinus node dysfunction does not reduce the incidence of atrial fibrillation.The IDE study demonstrated the safety of Aveir DR dual-chamber leadless pacemaker at 3 months post-operation,providing reliable atrial pacing and atrioventricular synchrony.The iSUSI study is a registry study of subcutaneous implantable cardioverter-defibrillators,finding similar inappropriate and appropriate shock rates in patients with and without heart failure.

The impact of different contrast agent concentrations on excimer laser ablation:an in vitro study / 中国介入心脏病学杂志

Objective To explore the impact of contrast agent concentration on the excimer laser's effect on plaque ablation.Methods Using a laser catheter with a diameter of 0.9 mm,we conducted plaque model ablation experiments employing a 308-nanometer xenon chloride excimer laser.During the excimer laser ablation process,five groups were formed based on the injected contrast agent concentrations:a saline group,25%concentration group,50%concentration group,75%concentration group,and 100%concentration group.Optical coherence tomography was utilized to assess the changes in plaque lumen area after excimer laser ablation,evaluating the impact of contrast agent concentration on the excimer laser's ablation efficacy.Simultaneously,a water manometer was used to measure the shockwave pressure generated by the excimer laser in liquids with different contrast agent concentrations,aiming to explore the correlation between the shockwave pressure of the excimer laser and its ablative effect.Results The ablation areas in the 75%concentration group and the 100%concentration group were similar(P＞0.05),both exceeding those in the 50%concentration contrast agent group,25%concentration group,and saline group(all P＜0.001).Specifically,the ablation area in the 50%concentration group was significantly larger than that in the 25%concentration group and saline group(both P＜0.001),while the 25%concentration group was larger than the saline group(P＜0.001).The influence of contrast agent concentration on the shockwave pressure of the excimer laser exhibited a similar trend.Additionally,there was a significant positive correlation between the shockwave pressure generated by the excimer laser and its ablation area(r=0.9987,P＜0.001).Conclusions The intensity of excimer laser ablation on plaque tissue can be modulated by altering the contrast agent concentration.These findings offer guidance for the application of excimer laser in conjunction with contrast agent injection techniques in the treatment of coronary artery disease.

Comparison on TACE+microwave ablation+programmed death-1 and TACE+microwave ablation for treating primary hepatic carcinoma / 中国介入影像与治疗学

Objective To compare the value of TACE+microwave ablation(MWA)+programmed death-1(PD-1)and TACE+MWA for treating primary hepatic carcinoma(PHC).Methods Data of 80 PHC patients who underwent TACE+MWA+PD-1(observe group)or TACE+MWA treatment(control group)were retrospectively analyzed(each n=40).The baseline data,therapeutic efficacy of PHC and complications were compared between groups.Results No significant difference of baseline data was found between groups(all P＞0.05).The objective response rate(ORR)of observe group and control group was 90.00％and 72.50％,respectively,while the disease control rate(DCR)was 97.50％and 95.00％,respectively,with no significant difference between groups(both P＞0.05).The median overall survival(OS)of observe group and control group was 30.80 months and 15.70 months,respectively,while the median progression free survival(PFS)was 23.35 months and 6.80 months,respectively.OS and PFS of observe group were both longer than those of control group(both P＜0.05).No significant difference of the incidence of complications was detected between groups(all P＞0.05),and all were improved after symptomatic treatment.Conclusion TACE+MWA+PD-1 was superior to TACE+MWA for treating PHC.

Combination of diffusion weighted imaging and dynamic contrast-enhanced MRI for predicting recurrence of hepatocellular carcinoma after TACE combined with radiofrequency ablation / 中国介入影像与治疗学

Objective To explore the value of combination of diffusion weighted imaging(DWI)and dynamic contrast-enhanced MRI(DCE-MRI)for predicting recurrence of hepatocellular carcinoma(HCC)after TACE combined with radiofrequency ablation.Methods Date of 80 HCC patients who underwent TACE combined with radiofrequency ablation were retrospectively analyzed.Abdominal DWI and DCE-MRI were performed 10 days before as well as 20,60 and 90 days after treatment.The sensitivity,specificity and accuracy of combination of DWI and DCE-MRI for predicting recurrence of HCC 20 days after TACE combined with radiofrequency ablation were calculated,and receiver operating characteristic(ROC)curve was drawn to evaluate the efficacy of apparent diffusion coefficient(ADC)value for predicting recurrence of HCC 20 days after treatment.Results Patients with HCC were divided into stable group(n=47)and progressive group(n=33)according to modified response evaluation criteria in solid tumors.Twenty days after TACE combined with radiofrequency ablation,most HCC lesions in stable group presented as uneven DWI signals and high ADC signals without enhancement,while those in progressive group mainly presented as high DWI signals and low ADC signals with mild enhancement.The sensitivity,specificity and accuracy of combination of DWI and DCE-MRI for predicting recurrence of HCC 20 days after TACE combined with radiofrequency ablation was 97.75％(87/89),92.31％(24/26)and 96.52％(111/115),respectively,and the AUC of ADC value was 0.82.Taken 1.42X10-3 mm2/s as the cutoff value of ADC,the sensitivity and specificity of ADC value for predicting recurrence of HCC 20 days after TACE combined with radiofrequency ablation was 72.13％and 82.25％,respectively.Conclusion Combination of DWI and DCE-MRI had certain value for predicting recurrence of HCC after TACE combined with radiofrequency ablation,and ADC could be used as an effective predicting index.

Research Progress on Ventricular Arrhythmia Ablation Therapy via Coronary Venous System / 中国循环杂志

Ablation of ventricular arrhythmia originating from the epicardial and intramural sites tends to be challenging in clinical practice.As the reflux system of cardiac blood flow,tributaries of the coronary venous system widely covers the surface and the myocardium tissue of the heart,which could serve as alternative access route for auxiliary mapping and ablation.This review updated the research progress on the novel ablation methods via the coronary venous system.

Efficacy of CARTO Three-dimensional Mapping and Zero X-ray Radiofrequency Catheter Ablation of Ventricular Premature Contraction Originating From Aortic Sinus / 中国循环杂志

Objectives:To finely divide the aortic sinus into sections and accurately localize the coronary ostium through CARTO three-dimensional mapping,and to assess the clinical effects of treating aortic sinus cusps premature ventricular contraction(ASC-PVC)and the ablation risk in the corresponding area with zero X-ray radiofrequency ablation. Methods:A total of 66 patients who underwent radiofrequency ablation for ASC-PVC from January 2020 to January 2023 were included in this analysis,patients were divided into experimental group(n=34)and conventional group(n=32).In the conventional group,the CARTO 3 system was used to create an aortic sinus model through the conventional method.The earliest stimulating target was identified by using electrical stimulation mapping(ESM).Radiofrequency ablation treatment was performed after the distance between the target and the coronary ostium was precisely measured by coronary angiography through the hollow tube of the ablation catheter or coronary angiography tube.In the experimental group,the CARTO 3 system was used to build a model of the aortic sinus and the coronary ostium and aortic sinus were divided into sections.The earliest stimulating target was identified by ESM.After localizing coronary ostium through the impedance changing pattern on the ablation catheter tips,catheter ablation was performed with zero X-ray.The data regarding the impedance of the ablation catheter in the aortic sinus were collected.The total operative time,the operative time in the aortic sinus,contrast dosage,X-ray exposure time,immediate and short-term success rates of the operation and complication rates were compared between the two groups.Besides,the distribution of successfully ablated targets and their relationship with the risk of ablation were analyzed in both groups. Results:There was no significant statistical difference in the immediate and short-term success rates between the two groups(93.8%vs.94.1%;90.6%vs.88.2%,both P>0.05).The experimental group did not receive contrast agents during the operation,and the total operation time and intra-aortic sinus operation time in the experimental group were significantly shorter than those in the conventional group([58.76±4.94]min vs.[66.91±5.94]min,P<0.001;[43.12±4.49]min vs.[50.31±5.18]min,P<0.001).During the process of moving the ablation catheter from the intra-aortic sinus to the coronary artery opening and into the coronary artery,the impedance suddenly increased,which was significantly different from the impedance in other parts of the intra-aortic sinus(all P<0.001). Conclusions:Radiofrequency ablation of ASC-PVC with zero X-ray can simplify the procedures and shorten the operative time.The steep increase in impedance at the tip of the ablation catheter can be used as a basis for localizing the coronary ostium.Dividing the aortic sinus into sections allows a detailed assessment of the risk for ablation treatment at the targets.

The effect of high-power atrial fibrillation ablation on intraoperative acute pulmonary vein isolation and postoperative troponin levels / 中国医师杂志

Objective:To compare the effects of high-power and conventional power atrial fibrillation ablation on intraoperative acute pulmonary vein isolation, postoperative troponin levels, and atrial fibrillation recurrence.Methods:A retrospective selection was conducted on 105 patients with paroxysmal atrial fibrillation admitted to the Baoding NO.1 Central Hospital from January 2017 to December 2020. According to different treatment methods, they were divided into a high-power ablation group of 52 cases and a conventional power ablation group of 53 cases. The intraoperative rate of single circle acute pulmonary vein isolation, the recovery of electrical conduction after acute pulmonary vein isolation, and the location and number of points that need to be added were compared between the two groups; At the same time, two groups were compared in terms of surgical time, ablation time, surgical radiation exposure time and radiation dose, intraoperative complications postoperative cardiac troponin levels at 12 hours, and recurrence of atrial fibrillation within 1 year after ablation.Results:The intraoperative single loop pulmonary vein isolation rate and postoperative troponin levels in the high-power atrial fibrillation ablation group were higher than those in the conventional atrial fibrillation ablation group (all P<0.05). The surgical time, ablation time, and the number of sites and points that need to be added during surgery were less than those in the conventional atrial fibrillation ablation group (all P<0.05). There was no statistically significant difference in the incidence of intraoperative complications and postoperative atrial fibrillation recurrence between the two groups (all P>0.05). Conclusions:High power atrial fibrillation ablation has a higher single loop acute pulmonary vein isolation rate, fewer patch sites and points, shorter surgical time, and greater ablation damage compared to conventional ablation, and the clinical efficacy of the two groups is similar after surgery.

Ultrasound-guided percutaneous ethanol injection combined with microwave ablation for treatment of thyroid benign partially cystic masses / 中国医学影像技术

Objective To observe the value of ultrasound-guided percutaneous ethanol injection(PEI)combined with microwave ablation(MWA)for treating thyroid benign partially cystic masses.Methods A total of 100 patients with single benign partially cystic mass who would undergo ultrasound-guided ablation treatment were prospectively enrolled.The patients were randomly assigned into PEI group(received PEI combined with MWA sequential ablation)or control group(received simple MWA),each n=50.Data before and after treatments were compared within groups,the therapeutic efficacy were compared between groups after treatments,and the value of sequential ablation was analyzed.Results Ultrasound-guided ablation was successfully performed for all 100 masses.During follow-up,5 cases in PEI group and 3 cases in control group were lost.The operation time of MWA,total MWA energy and patients'pain level during treatments in PEI group were all lower than those in control group(all P＜0.05).Significant difference of thyroid mass volumes were found before and 3,6 and 12 months after treatments in both groups(all P＜0.05).The volume reduction rate(VRR)in PEI group before and 1,3,6 and 12 months after treatments were all higher than that in control group(all P＜0.05).The success rate was 95.56％(43/45)in PEI group and 89.36％(42/47)in control group 12 months after treatments,respectively,without significant difference(P=0.451).There were significant differences of neck aesthetics scores and symptom scores before and 3,6 and 12 months after treatments in both groups(all P＜0.05).The incidence of complications in PEI group was 6.67％(3/45),while in control group was 14.89％(7/47),the former was lower than the latter(P＜0.05).Conclusion Ultrasound-guided PEI combined with MWA sequential ablation had better effect for treating thyroid benign partially cystic masses than single MWA.

Ultrasound-Guided Microwave Ablation for the Treatment of Abdominal Wall Endometriosis / 中国医学影像学杂志

Purpose To investigate the safety and effectiveness of ultrasound-guided microwave ablation(MWA)in the treatment of abdominal wall endometriosis(AWE).Materials and Methods A total of 17 patients(19 lesions)with AWE who underwent MWA in Beijing Friendship Hospital from August 2014 to June 2023 were retrospectively analyzed.Grey-scale and color Doppler flow ultrasonography,and contrast-enhanced ultrasonography were used to observe the lesions before and after treatment.The AWE lesion volume,volume reduction rate,pain relief,and complications were recorded 3,6,and 12 months after treatment to evaluate the treatment efficacy.Results Contrast-enhanced ultrasound showed that all lesions underwent successful treatment with single MWA.The average initial nodule volume was(7.46±5.82)ml,which decreased significantly to(4.32±2.76)ml,(2.47±1.68)ml,(1.72±1.16)ml at 3,6 and 12 months follow-up(t=0.423,P=0.005;t=0.198,P=0.001;t=0.556,P=0.002)with a mean volume reduction rate of(46.18±24.36)%,(61.43±18.72)%,(74.25±13.26)%,respectively.Notably,all 17 patients experienced a significant decrease or complete alleviation of periodic abdominal incision pain at 12-month after treatment.One patient experienced local skin burns after the procedure,while the remaining patients did not experience severe complications.Conclusion MWA is safe and effective for treating AWE,and further research is warranted.

Preliminary application of three-dimensional ultrasound fusion imaging visualization technology guiding precise needle placement for thermal ablation of hepatocellular carcinoma / 中华超声影像学杂志

Objective:To preliminarily explore the clinical value of three-dimensional ultrasound fusion imaging(3DUS FI) visualization technology in guiding precise needle placement during thermal ablation of hepatocellular carcinoma (HCC).Methods:A total of 56 HCC patients (59 lesions)who underwent 3DUS FI guided thermal ablation were retrospectively analyzed in the First Affiliated Hospital of Sun Yat-sen University from November 2019 to December 2021. All patients were collected with three-dimensional ultrasound volume image before ablation which were fused with real-time two-dimensional ultrasound image for registration, and then the tumor and the safety margin of 5 mm were segmented and marked. Finally, the thermal ablation was performed under three-dimensional visualization. Contrast-enhanced CT/MRI was performed 1 month after thermal ablation to evaluate whether the lesion was completely ablated and measure the ablative margin, and the relationship between ablative margin and the incidence of local tumor progression (LTP) was also analyzed.Results:During the ablation, all lesions could be successfully registered and displayed in three-dimension. Postoperative contrast-enhanced ultrasound showed that all lesions were completely ablated. A total of 37 lesions could be evaluated for ablative efficacy and ablative margin based on contrast-enhanced CT/MRI 1 month after themal ablation, of which 32 (86.5%) lesions achieved complete ablation and obtained at least 5 mm ablative margin. During the follow-up period, LTP was occurred in 4 lesions, 3 of the lesions occurred at the ablative margin< 5 mm. Both 1-year and 2-year cumulative LTP rates were all 7.1%. None of patients had serious complications or deaths associated with thermal ablation.Conclusions:3DUS FI real-time guidance technology is feasible and safe in visually guiding precise needle placement during thermal ablation of HCC.