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2.
Medicina (Kaunas) ; 57(5)2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34065174

RESUMO

In the management of atrial fibrillation in patients with heart failure, rate control is recommended, whereas the implication of rhythm control remains controversial. We experienced a 65-year-old man who had compensated heart failure due to hypertensive heart disease and atrial fibrillation with well-controlled heart rate (<100 bpm). At three months following the catheter ablation procedure, the left ventricular ejection fraction improved from 40% up to 65%. The implication of rhythm control using catheter ablation in improving cardiac reverse remodeling should be validated in large-scale clinical studies.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência Cardíaca , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Insuficiência Cardíaca/complicações , Humanos , Masculino , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
3.
Medicina (Kaunas) ; 57(5)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-34064587

RESUMO

Osteoid osteomas are one of the most common bone tumors. Although benign in nature, they can cause significant pain and distress to the afflicted patient. The main goal of treatment is to relieve pain. Historically, these tumors were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) or surgery. Percutaneous ablative techniques have since gained popularity because of their efficacy and low risk profiles. Radiofrequency ablation was the first of these technologies used in the treatment of these tumors. More recently, microwave ablation has gained popularity. However, the literature is sparse regarding the safety and efficacy of this treatment. Here, we discuss our experience with microwave ablation in the treatment of osteoid osteomas in two patients and review the current literature on this technique. Microwave ablation in the treatment of osteoid osteoma seems to be a safe and effective treatment for this tumor.


Assuntos
Neoplasias Ósseas , Ablação por Cateter , Osteoma Osteoide , Ablação por Radiofrequência , Neoplasias Ósseas/cirurgia , Humanos , Micro-Ondas/uso terapêutico , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/cirurgia , Resultado do Tratamento
4.
Zhonghua Xin Xue Guan Bing Za Zhi ; 49(6): 615-620, 2021 Jun 24.
Artigo em Chinês | MEDLINE | ID: mdl-34126730

RESUMO

Objective: To investigate the clinical and electrophysiological features of ventricular tachycardia (VT) in tetralogy of Fallot (TOF) patients post surgical repair (rTOF) and to analyze the therapeutic effect and prognosis of radiofrequency ablation of rTOF-VT. Methods: This is a retrospective study. Consecutive patients with rTOF-VT, who were treated in Fuwai Hospital from January 2015 to March 2020, were enrolled. All the patients underwent right ventricular voltage mapping following routine cardiac electrophysiological examination, followed by linear or homogenizing radiofrequency ablation based on the low-voltage substrate. The clinical features, 3-dimentional electrophysiological substrate mapping, radiofrequency ablation and long-term prognosis of the enrolled patients were analyzed. Acute ablation success was defined as completion of linear or homogenizing ablation or intraoperative evoked VT as destination of the procedure. Patients were followed up at 3 and 6 months post operation and every year thereafter. The endpoints were sudden cardiac death (SCD) and recurrence of ventricular tachycardia. Results: A total of 20 patients with rTOF-VT were enrolled including 14 males with an age of (35.8±11.8) years. The electrocardiogram identified 23 types of ventricular tachycardia, 19 of which were originated from right ventricular inflow tract outlet. The most common clinical manifestations were heart murmur (19 cases, 95%) and syncope (4 cases, 25%). Electroanatomical substrate mapping was performed in 20 patients and evidenced localized or diffuse scar or low-voltage area of right ventricle. Intraoperative electrophysiological tests provoked ventricular tachycardia in 6 patients (30%), including 5 patients with hemodynamics disturbance. The acute success rate of radiofrequency ablation was 95% (19/20). The follow-up time was (31.1±17.7) months and the recurrence rate of ventricular tachycardia was 30% during follow-up period and 5 cases received repeat radiofrequency ablation and there was no recurrent ventricular tachycardia during follow-up post repeat radiofrequency ablation. Conclusions: The voltage substrate mapping under sinus rhythm is a feasible mapping method for rTOF-VT. Linear or flaky radiofrequency ablation of the slow conduction zone is safe and effective treatment strategy, the recurrence rate after the first radiofrequency ablation is still high, and the effectiveness of repeat radiofrequency ablation is satisfactory in this patient cohort.


Assuntos
Ablação por Cateter , Taquicardia Ventricular , Tetralogia de Fallot , Adulto , Arritmias Cardíacas , Eletrocardiografia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taquicardia Ventricular/cirurgia , Tetralogia de Fallot/cirurgia , Resultado do Tratamento , Adulto Jovem
6.
World J Surg Oncol ; 19(1): 175, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127007

RESUMO

BACKGROUND: Repeat hepatectomy and radiofrequency ablation (RFA) are widely used to treat early recurrent hepatocellular carcinoma (RHCC) located in the subcapsular region, but the optimal treatment strategy remains to be controversial. METHODS: A total of 126 RHCC patients in the subcapsular location after initial radical hepatectomy were included in this study between Dec 2014 and Jan 2018. These patients were divided into the RFA group (46 cases) and the repeat hepatectomy group (80 cases). The primary endpoints include repeat recurrence-free survival (rRFS) and overall survival (OS), and the secondary endpoint was complications. The propensity-score matching (PSM) was conducted to minimize the bias. Complications were evaluated using the Clavien-Dindo classification, and severe complications were defined as classification of complications of ≥grade 3. RESULTS: There were no significant differences in the incidence of severe complications were observed between RFA group and repeat hepatectomy group in rRFS and OS both before (1-, 2-, and 3-year rRFS rates were 65.2%, 47.5%, and 33.3% vs 72.5%, 51.2%, and 39.2%, respectively, P = 0.48; 1-, 2-, and 3-year OS rates were 93.5%, 80.2%, and 67.9% vs 93.7%, 75.8%, and 64.2%, respectively, P = 0.92) and after PSM (1-, 2-, and 3-year rRFS rates were 68.6%, 51.0%, and 34.0% vs 71.4%, 42.9%, and 32.3%, respectively, P = 0.78; 1-, 2-, and 3-year OS rates were 94.3%, 82.9%, and 71.4% vs 88.6%, 73.8%, and 59.0%, respectively, P = 0.36). Moreover, no significant differences in the incidence of severe complications were observed between the RFA group and repeat hepatectomy group. CONCLUSION: Both repeat hepatectomy and RFA are shown to be effective and safe for the treatment of RHCC located in the subcapsular region.


Assuntos
Carcinoma Hepatocelular , Ablação por Cateter , Neoplasias Hepáticas , Ablação por Radiofrequência , Carcinoma Hepatocelular/cirurgia , Hepatectomia , Humanos , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
7.
Am J Case Rep ; 22: e930381, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34086663

RESUMO

BACKGROUND Cardiac perforation leading to cardiac tamponade is one of the possible complications of endocardial mapping during catheter-based ablation procedures. The early diagnosis of catheter-induced perforation is critical for effective management of these patients. We hereby present the diagnosis and management of left ventricular perforation during mapping of ventricular tachycardia in a patient with left ventricular aneurysm. CASE REPORT A 70-year-old man with a history of ischemic heart disease, arterial hypertension, type 2 diabetes mellitus, and obesity was referred to our institution for the ablative treatment of recurrent, sustained monomorphic ventricular tachycardia that was resistant to medication. One particularity was the presence of a left ventricular aneurysm secondary to a non-ST segment elevation myocardial infarction, which was unusual and could increase the risk of cardiac perforation. During left ventricular mapping, several points were acquired in an apparently unusual position and the pericardial location of the mapping catheter was confirmed fluoroscopically. After setting a pericardial pigtail catheter, we successfully finished the ablation procedure using a second ablation catheter. The perforating catheter was thereafter removed by open surgery, and no significant bleeding occurred. The patient did not experience tachycardia during the follow-up period of 29 months. CONCLUSIONS Left ventricular aneurysms might increase the cardiac perforation risk during endocardial mapping in ventricular tachycardia ablation procedures. In patients with this condition, a careful manipulation of the catheters could prevent such complications. The periodic fluoroscopic assessment of the catheter's position is essential for early recognition of the perforation.


Assuntos
Ablação por Cateter , Diabetes Mellitus Tipo 2 , Taquicardia Ventricular , Idoso , Eletrocardiografia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Masculino , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia
8.
Georgian Med News ; (313): 26-33, 2021 Apr.
Artigo em Russo | MEDLINE | ID: mdl-34103425

RESUMO

The aim of the study is to substantiate the surgical treatment tactics of recurrence varicose veins after endovenous interventions. Early and long-term results of the treatment, quality of life of patients with recurrence of varicose veins were studied. Among the admitted patients, there were 55 (65.5%) women and 29 (34.5%) men, the age of patients varied from 19 to 76 years. Of these, 9 patients underwent crossectomy, endovenous laser coagulation - 22, various stripping options - 4, echosclerotherapy - 20, intraoperative catheter sclerobliteration - 1, ligation of perforating veins - 28 patients. The choice of the treatment method depends on the data of duplex angioscanning, the source of recurrence, the diameter and length of the varicose veins. In the early postoperative period 18 (22.6%) patients had complications and side effects. Most often hyperpigmentation and neurological disorders developed, which were observed in 8 (9.5%) and 7 (8.3%) cases. 2 (2.4%) patients had a slightly painful dense cord after endovenous laser coagulation. 1 (1.2%) patient had a lymphocele in the inguinal incision area. This complication was eliminated by use of the puncture treatment method. Long-term results in terms of 1 to 3 years were studied in 82 (97.6%) patients. In the long-term period, 1 (1.2%) patient noted the varicose veins recurrence due to neovasculogenesis in the groin. The patient underwent micro-foam echosclerotherapy. Patient`s quality of life was studied by using the CIVIQ2 questionnaire before and 1 year after treatment. It was found that 4 main indicators of the quality of life in the long-term period improved by 35.6-48.8% of the preoperative values. At the same time, the most significant positive dynamics of psychological (48.8%) and pain (47.1%) factors was observed. The results justify the need for a differentiated approach, taking into account the individual characteristics of the disease, as well as the expediency of using minimally invasive techniques in patients with varicose veins recurrence.


Assuntos
Ablação por Cateter , Terapia a Laser , Varizes , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Recidiva , Veia Safena/cirurgia , Escleroterapia , Resultado do Tratamento , Varizes/cirurgia , Adulto Jovem
9.
Medicine (Baltimore) ; 100(20): e25903, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011057

RESUMO

BACKGROUND: Some new trials have reported the effectiveness of chronic kidney disease on recurrence of atrial fibrillation following catheter ablation. Limited by small number of studies and insufficient outcomes, previous meta-analyses also failed to draw a consistent conclusion on this topic. We thus conducted a new meta-analysis to systematically analyze the effect of chronic kidney disease on recurrence of atrial fibrillation following catheter ablation. METHODS: Two independent investigators followed The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines to conduct the present meta-analysis. From the inception to June 2021, the EMBASE, PubMed, Web of Science, and Cochrane Library electronic databases were searched using the key phrases "atrial fibrillation," "chronic kidney disease," "catheter ablation," "renal failure," "renal function," "renal insufficiency," "end-stage renal disease," and "dialysis" for all relevant English-language trials. Observational or randomized controlled trial focusing on assessing the effectiveness of chronic kidney disease on recurrence of atrial fibrillation following catheter ablation was included. P < .05 was set as the significance level. RESULTS: Our hypothesis was that chronic kidney disease is associated with increased atrial fibrosis and a higher risk of arrhythmia recurrence and that restoration of normal rhythm through catheter ablation is associated with improved kidney function. REGISTRATION NUMBER: 10.17605/OSF.IO/3WJAE.


Assuntos
Fibrilação Atrial/epidemiologia , Ablação por Cateter/estatística & dados numéricos , Átrios do Coração/patologia , Insuficiência Renal Crônica/epidemiologia , Fibrilação Atrial/patologia , Fibrilação Atrial/cirurgia , Causalidade , Fibrose , Taxa de Filtração Glomerular/fisiologia , Átrios do Coração/cirurgia , Humanos , Metanálise como Assunto , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Revisões Sistemáticas como Assunto , Resultado do Tratamento
17.
J Int Med Res ; 49(5): 3000605211018432, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34038209

RESUMO

OBJECTIVE: To compare the pregnancy outcomes of radiofrequency ablation (RFA) for complicated multiple pregnancies between fetal abdominal and dorsal needle insertion angles. METHODS: We performed a historical cohort study of patients who underwent selective reduction using RFA through different needle insertion angles from 2015 to 2018 at a local hospital. Dorsal needle insertion cases were consecutively selected and abdominal needle insertion cases were selectively enrolled. The Cox proportional hazards model was constructed to identify predictors of fetal survival time with different needle insertion angles. RESULTS: The RFA procedure was performed in 28 women through an abdominal insertion angle and in 28 women through a dorsal insertion angle. There were no significant differences in perinatal outcomes between the two groups. The overall live birth rate after RFA in the two groups was 73.5% and the mean gestation was 31.6 ± 6.5 weeks. The Cox model showed that gestational age at RFA was a predictor of the duration of the period between RFA and delivery. CONCLUSION: RFA conducted through the dorsal insertion angle is technically feasible for selective reduction in complex monochorionic multiple pregnancies. Gestational age at this procedure is an independent risk factor for the duration of pregnancy post-RFA.


Assuntos
Ablação por Cateter , Ablação por Radiofrequência , Estudos de Coortes , Feminino , Humanos , Gravidez , Resultado da Gravidez , Redução de Gravidez Multifetal , Gravidez de Gêmeos , Estudos Retrospectivos
18.
Herzschrittmacherther Elektrophysiol ; 32(2): 244-249, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33977306

RESUMO

BACKGROUND: Three-dimensional mapping systems and the use of ultra-low dose radiation protocols have supported minimization of radiation dose during left atrial ablation procedures. By using optimal shielding, scattered radiation reaching the operator can be further reduced. This prospective study was designed to determine the remaining operator radiation exposure during left atrial catheter ablations using real-time dosimetry. METHODS: Radiation dose was recorded using real-time digital dosimetry badges outside the lead apron during 201 consecutive left atrial fibrillation ablation procedures. All procedures were performed using the same X­ray system (Siemens Healthineers Artis dBc; Siemens Healthcare AG, Erlangen, Germany) programmed with ultra-low dose radiation settings including a low frame rate (two frames per second), maximum copper filtration, and an optimized detector dose. To reduce scattered radiation to the operators, table-suspended lead curtains, ceiling-suspended leaded plastic shields, and radiation-absorbing shields on the patient were positioned in an overlapping configuration. RESULTS: The 201 procedures included 139 (69%) pulmonary vein isolations (PVI) (20 cryoballoon ablations, 119 radiofrequency ablations, with 35 cases receiving additional ablation of the cavotricuspid isthmus) and 62 (31%) PVI plus further left atrial substrate ablation. Mean radiation dose measured as dose area product for all procedures was 128.09 ± 187.87 cGy ∙ cm2 with a mean fluoroscopy duration of 9.4 ± 8.7 min. Real-time dosimetry showed very low average operator doses of 0.52 ± 0.10 µSv. A subanalysis of 51 (25%) procedures showed that the radiation burden for the operator was highest during pulmonary vein angiography. CONCLUSION: The use of ultra-low dose radiation protocols in combination with optimized shielding results in extremely low scattered radiation reaching the operator.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/cirurgia , Fluoroscopia , Alemanha , Humanos , Estudos Prospectivos , Veias Pulmonares/cirurgia
19.
J Int Med Res ; 49(5): 3000605211014375, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33983087

RESUMO

OBJECTIVE: The present study aimed to investigate the effect of functional mitral regurgitation (FMR) on recurrence of paroxysmal atrial fibrillation (PAF) in patients undergoing radiofrequency catheter ablation. METHODS: This prospective cohort study comprised 107 patients with PAF. The patients were divided into the FMR and non-FMR groups. FMR was assessed by Doppler echocardiography before index ablation. All patients initially underwent circumferential pulmonary vein isolation (CPVI) and were followed up for 12 months after ablation. PAF, atrial tachycardia, or atrial flutter served as the endpoint indicator. RESULTS: The median duration of PAF was 24 (3-60) months. Binary logistic univariate and multivariate analyses showed that FMR was not a risk factor for recurrence of catheter ablation for PAF (hazard ratio=0.758, 95% confidence interval: 0.191-3.004; hazard ratio=0.665, 95% confidence interval: 0.134-3.300, respectively). Kaplan-Meier analysis showed no significant difference in the recurrence rate between the groups. Fifteen (15/107, 14%) cases of PAF were triggered by the pulmonary vein. Three (3/107, 2.8%) cases of PAF were triggered by the superior vena cava. CONCLUSIONS: FMR is not an independent risk factor for predicting recurrence of catheter ablation for PAF. FMR does not affect patients undergoing radiofrequency catheter ablation for PAF.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência da Valva Mitral , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Veia Cava Superior/cirurgia
20.
World J Gastroenterol ; 27(18): 2205-2218, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34025074

RESUMO

BACKGROUND: Surgical resection and radiofrequency ablation (RFA) represent two possible strategy in treatment of hepatocellular carcinoma (HCC) in Milan criteria. AIM: To evaluate short- and long-term outcome in elderly patients (> 70 years) with HCC in Milan criteria, which underwent liver resection (LR) or RFA. METHODS: The study included 594 patients with HCC in Milan criteria (429 in LR group and 165 in RFA group) managed in 10 European centers. Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching (PSM) and Cox regression. RESULTS: After PSM, we compared 136 patients in the LR group with 136 patients in the RFA group. Overall survival at 1, 3, and 5 years was 91%, 80%, and 76% in the LR group and 97%, 67%, and 41% in the RFA group respectively (P = 0.001). Disease-free survival at 1, 3, and 5 years was 84%, 60% and 44% for the LR group, and 63%, 36%, and 25% for the RFA group (P = 0.001).Postoperative Clavien-Dindo III-IV complications were lower in the RFA group (1% vs 11%, P = 0.001) in association with a shorter length of stay (2 d vs 7 d, P = 0.001).In multivariate analysis, Model for End-stage Liver Disease (MELD) score (> 10) [odds ratio (OR) = 1.89], increased value of international normalized ratio (> 1.3) (OR = 1.60), treatment with radiofrequency (OR = 1.46) ,and multiple nodules (OR = 1.19) were independent predictors of a poor overall survival while a high MELD score (> 10) (OR = 1.51) and radiofrequency (OR = 1.37) were independent factors associated with a higher recurrence rate. CONCLUSION: Despite a longer length of stay and a higher rate of severe postoperative complications, surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients (> 70 years) with HCC in Milan criteria.


Assuntos
Carcinoma Hepatocelular , Ablação por Cateter , Doença Hepática Terminal , Neoplasias Hepáticas , Ablação por Radiofrequência , Idoso , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/efeitos adversos , Hepatectomia/efeitos adversos , Humanos , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
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