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2.
J Cancer Res Ther ; 16(2): 350-355, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-455553

RESUMO

The coronavirus disease 2019 (COVID-19) has become a global pandemic since its outbreak in December 2019, which posed a threat to the safety and well-being of people on a global scale. Cancer patients are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and their critical morbidity and case fatality rates are high. The ablation expert committee of the Chinese Society of Clinical Oncology compiled corresponding expert recommendations. These recommendations summarize the preventive measures and management of tumor ablation treatment in medical institutions, including outpatient clinics, oncology wards, ablation operation room, and postablation follow-ups in accordance with the guidelines and protocols imposed by the National Health Commission of the People's Republic of China and the experience in management and prevention according to various hospitals. This consensus aims to reduce and prevent the spread of SARS-CoV-2 and its cross-infection between cancer patients in hospitals and provide regulatory advice and guidelines for medical personnel.


Assuntos
Betacoronavirus , Ablação por Cateter/efeitos adversos , Infecções Relacionadas a Cateter/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Neoplasias/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Infecções Relacionadas a Cateter/virologia , China/epidemiologia , Congressos como Assunto , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Neoplasias/patologia , Neoplasias/virologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
3.
Medicine (Baltimore) ; 99(26): e20795, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590762

RESUMO

To explore different posttreatment changes between multimode tumor ablation therapy (MTAT) and radiofrequency ablation (RFA) using intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and diffusion kurtosis imaging (DKI) in patients with hepatic malignancies.Eighty - seven patients with one hundred and twenty eight hepatic lesions receiving MTAT or RFA underwent IVIM-DWI and DKI before and after treatment. The mean value of apparent diffusion coefficient (ADC), IVIM-DWI parameters, including true diffusion coefficient (D), pseudo-diffusion coefficient (DP), perfusion fraction (f), and DKI parameters including diffusion coefficient (DK), apparent diffusional kurtosis (K) were retrospectively compared prior to and following treatment as well as between treatment groups. The degree of parameters change after ablation was compared between 2 treatment modalities.The mean value of ADC, D, and DK increased while f, and K decreased significantly in MTAT group. In RFA group, just ADC and K showed significantly change following treatment. The ADC and D value were higher in MTAT group than in RFA group 1 month after treatment. While f was lower in MTAT group after treatment compared with RFA group. The ADC, D and DK increased (21.89 ±â€Š24.95% versus 8.76 ±â€Š19.72%, P = .04 for ADC, 33.78 ±â€Š54.01% versus 7.91 ±â€Š25.16%, P = .03 for D, 25.91 ±â€Š36.28% versus 1.75 ±â€Š46.42%, P = .01 for DK) while f declined (-32.62 ±â€Š41.48% versus 6.51 ±â€Š44.16%, P < .001) more in MTAT group.The MTAT induced different posttreatment changes on water molecule diffusion and microvasculature related functional MR parameters compared to RFA in patients with liver tumors.


Assuntos
Ablação por Cateter , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Hepáticas , Imagem por Ressonância Magnética/métodos , Microvasos/diagnóstico por imagem , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Feminino , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Ablação por Radiofrequência/métodos
4.
J Cancer Res Ther ; 16(2): 350-355, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474523

RESUMO

The coronavirus disease 2019 (COVID-19) has become a global pandemic since its outbreak in December 2019, which posed a threat to the safety and well-being of people on a global scale. Cancer patients are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and their critical morbidity and case fatality rates are high. The ablation expert committee of the Chinese Society of Clinical Oncology compiled corresponding expert recommendations. These recommendations summarize the preventive measures and management of tumor ablation treatment in medical institutions, including outpatient clinics, oncology wards, ablation operation room, and postablation follow-ups in accordance with the guidelines and protocols imposed by the National Health Commission of the People's Republic of China and the experience in management and prevention according to various hospitals. This consensus aims to reduce and prevent the spread of SARS-CoV-2 and its cross-infection between cancer patients in hospitals and provide regulatory advice and guidelines for medical personnel.


Assuntos
Betacoronavirus , Ablação por Cateter/efeitos adversos , Infecções Relacionadas a Cateter/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Neoplasias/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Infecções Relacionadas a Cateter/virologia , China/epidemiologia , Congressos como Assunto , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Neoplasias/patologia , Neoplasias/virologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
5.
Medicine (Baltimore) ; 99(23): e20321, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501978

RESUMO

BACKGROUND: In recent years, there has been considerable uncertainty about the optimal treatment option for very early hepatocellular carcinoma (HCC) with tumor size less than 2 cm. Therefore, we performed a systematic review and meta-analysis to evaluate the outcomes of the different treatments. METHODS: This study was designed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA). PubMed, EMBASE, and Cochrane library were searched for calculating the survival rates, and the "time to event" method was used to compare the outcomes of liver resection (LR) and radiofrequency ablation (RFA). All studies focusing on the treatment of solitary HCC up to 2 cm by different techniques were included in our analysis. The Hazard ratios (HR) and 95% confidence intervals (CI) derived from multivariate and univariate analysis were utilized to assess the treatment risks. RESULTS: We included 32 studies in our systematic review. The median 5-year overall survival (OS) and recurrence-free survival rate (RFS) for LR were 73% and 47%, respectively, and those for RFA were 73% and 43%, respectively. RFA was found to be associated with increased risk of mortality and recurrence compared to LR (HR = 1.61, 95% CI: 1.35-1.92, P < .0001 for OS and HR = 1.75, 95% CI: 1.56-1.96, P < .0001 for RFS). CONCLUSION: Our meta-analysis demonstrated that LR is superior to RFA in the treatment of solitary HCC up to 2 cm, with reduction in mortality and recurrence risk and improved long-term outcome.


Assuntos
Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Hepatectomia/métodos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Carcinoma Hepatocelular/mortalidade , Ablação por Cateter/efeitos adversos , Hepatectomia/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Recidiva Local de Neoplasia , Modelos de Riscos Proporcionais , Taxa de Sobrevida , Carga Tumoral
6.
Int J Cardiovasc Imaging ; 36(9): 1599-1607, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32447632

RESUMO

To evaluate predictors of zero-X ray procedures for supraventricular arrhythmias (SVT) using minimally fluoroscopic approach (MFA). Patients referred for RF catheter ablation of SVT were admitted for a MFA with an electro-anatomical navigation system or a conventional fluoroscopic approach (ConvA). Exclusion criterion was the need to perform a transseptal puncture. 206 patients (98 men, age 53 ± 19 years) underwent an EP study, 93 (45%) with an MFA and 113 (55%) with a ConvA. Fifty-five had no inducible arrhythmias (EPS). Fifty-four had AV nodal reentrant tachycardia (AVNRT), 49 patients had typical atrial flutter (AFL), 37 had AV reciprocating tachycardia (AVRT/WPW), 11 had focal atrial tachycardia (AT), and underwent a RF ablation. X-ray was not used at all in 51/93 (58%) procedures (zero X ray). MFA was associated with a significant reduction in total fluoroscopy time (5.5 ± 10 vs 13 ± 18 min, P = 0.01) and operator radiation dose (0.8 ± 2.5 vs 3 ± 8.2 mSV, P < 0.05). The greatest absolute dose reduction was observed in AVNRT (0.1 ± 0.3 vs 5.1 ± 10 mSV, P = 0.01, 98% relative dose reduction) and in AFL (1.3 ± 3.6 vs 11 ± 16 mSV, P = 0.003, 88% relative dose reduction) groups. Both AVNRT or AFL resulted the only statistically significant predictors of zero x ray at multivariate analysis (OR 4.5, 95% CI 1.5-13 and OR 5, 95% CI 1.7-15, P < 0.001, respectively). Success and complication rate was comparable between groups (P = NS). Using MFA for SVT ablation, radiological exposure is significantly reduced. Type of arrhythmia is the strongest predictor of zero X ray procedure.


Assuntos
Flutter Atrial/cirurgia , Ablação por Cateter , Exposição Ocupacional/prevenção & controle , Doses de Radiação , Exposição à Radiação/prevenção & controle , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Supraventricular/cirurgia , Potenciais de Ação , Adulto , Idoso , Flutter Atrial/diagnóstico por imagem , Flutter Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Técnicas Eletrofisiológicas Cardíacas , Feminino , Fluoroscopia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Segurança do Paciente , Exposição à Radiação/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico por imagem , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
7.
Asia Pac J Clin Oncol ; 16(4): 259-265, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32368843

RESUMO

AIM: Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is a rare condition, but it can lead to hepatic failure and is associated with poor prognosis. Treatment for HCC with BDTT remains a challenge. This study aimed to retrospectively evaluate the safety and feasibility of percutaneous endobiliary radiofrequency ablation (EB-RFA) and biliary metal stent placement as an alternative treatment for patients with HCC with BDTT. METHODS: From October 2014 to December 2016, nine patients (all men, mean age 53.2 ± 12.0; range 40-70) who underwent percutaneous EB-RFA and biliary metal stent placement for HCC with BDTT were included. Stent patency, overall survival, technical and clinical success rate and complications were investigated. RESULTS: Median stent patency from the time of the first EB-RFA was 6.0 months (95% CI, 5.4-6.6 months) and survival from the time of diagnosis was 6.0 months (95% CI, 2.2-9.8 months). Two of 9 patients underwent bilateral EB-RFA and stent placement, one underwent unilateral EB-RFA and stent-in-stent procedure, and one EB-RFA as treatment for biliary metal stent occlusion. One patient who presented with stent occlusion underwent repeat ablations 182 days after the first ablation procedure and 53 days after the re-ablation procedure. Combination therapy was administered to five patients. The technical and clinical success rate were 100% and 89% per patient. After treatment, serum direct bilirubin levels were notably decreased in eight patients. No major complications were observed. Minor complications included one bile duct bleeding, three postoperative abdominal pain and two cholangitis. CONCLUSION: Percutaneous EB-RFA and biliary metal stent placement might be technically safe and feasible therapeutic options for patients with HCC with BDTT.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/efeitos adversos , Neoplasias Hepáticas/cirurgia , Stents/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
Arch Cardiovasc Dis ; 113(8-9): 492-502, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32461091

RESUMO

The population of patients with congenital heart disease (CHD) is continuously increasing, and a significant proportion of these patients will experience arrhythmias because of the underlying congenital heart defect itself or as a consequence of interventional or surgical treatment. Arrhythmias are a leading cause of mortality, morbidity and impaired quality of life in adults with CHD. Arrhythmias may also occur in children with or without CHD. In light of the unique issues, challenges and considerations involved in managing arrhythmias in this growing, ageing and heterogeneous patient population and in children, it appears both timely and essential to critically appraise and synthesize optimal treatment strategies. The introduction of catheter ablation techniques has greatly improved the treatment of cardiac arrhythmias. However, catheter ablation in adults or children with CHD and in children without CHD is more technically demanding, potentially causing various complications, and thus requires a high level of expertise to maximize success rates and minimize complication rates. As French recommendations regarding required technical competence and equipment are lacking in this situation, the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Affiliate Group of Paediatric and Adult Congenital Cardiology have decided to produce a common position paper compiled from expert opinions from cardiac electrophysiology and paediatric cardiology. The paper details the features of an interventional cardiac electrophysiology centre that are required for ablation procedures in adults with CHD and in children, the importance of being able to diagnose, monitor and manage complications associated with ablations in these patients and the supplemental hospital-based resources required, such as anaesthesia, surgical back-up, intensive care, haemodynamic assistance and imaging. Lastly, the need for quality evaluations and French registries of ablations in these populations is discussed. The purpose of this consensus statement is therefore to define optimal conditions for the delivery of invasive care regarding ablation of arrhythmias in adults with CHD and in children, and to provide expert and - when possible - evidence-based recommendations on best practice for catheter-based ablation procedures in these specific populations.


Assuntos
Arritmias Cardíacas/cirurgia , Procedimentos Cirúrgicos Cardíacos , Cardiologistas/normas , Serviço Hospitalar de Cardiologia/normas , Ablação por Cateter/normas , Competência Clínica/normas , Criocirurgia/normas , Cardiopatias Congênitas/cirurgia , Adolescente , Adulto , Fatores Etários , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Criança , Pré-Escolar , Consenso , Criocirurgia/efeitos adversos , Criocirurgia/mortalidade , Técnicas Eletrofisiológicas Cardíacas/normas , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Frequência Cardíaca , Humanos , Lactente , Recém-Nascido , Fatores de Risco , Sobreviventes , Resultado do Tratamento , Adulto Jovem
9.
Cancer Imaging ; 20(1): 37, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460898

RESUMO

BACKGROUND: Combination therapy using hepatic resection (HR) and intra-operative thermal ablation is a treatment approach for patients with technically unresectable liver malignancies. The aim of this study was to investigate safety, survival and local recurrence rates for patients with technically unresectable liver tumors undergoing HR and separate percutaneous MR-guided thermoablation procedure as an alternative approach. METHODS: Data from all patients with primary or secondary hepatic malignancies treated at a single institution between 2004 and 2018 with combined HR and MR-guided percutaneous thermoablation was collected and retrospectively analyzed. Complications, procedure related information and patient characteristics were collected from institutional records. Overall survival and disease-free survival were estimated using the Kaplan-Meier method. RESULTS: A total of 31 patients (age: 62.8 ± 9.1 years; 10 female) with hepatocellular carcinoma (HCC; n = 7) or hepatic metastases (n = 24) were treated for 98 hepatic tumors. Fifty-six tumors (mean diameter 28.7 ± 23.0 mm) were resected. Forty-two tumors (15.1 ± 7.6 mm) were treated with MR-guided percutaneous ablation with a technical success rate of 100%. Local recurrence at the ablation site occurred in 7 cases (22.6%); none of these was an isolated local recurrence. Six of 17 patients (35.3%) treated for colorectal liver metastases developed local recurrence. Five patients developed recurrence at the resection site (16.1%). Non-local hepatic recurrence was observed in 18 cases (58.1%) and extrahepatic recurrence in 11 cases (35.5%) during follow-up (43.1 ± 26.4 months). Ten patients (32.3%) developed complications after HR requiring pharmacological or interventional treatment. No complication requiring therapy was observed after ablation. Median survival time was 44.0 ± 7.5 months with 1-,3-, 5-year overall survival rates of 93.5, 68.7 and 31.9%, respectively. The 1-, 3- and 5-year disease-free survival rates were 38.7, 19.4 and 9.7%, respectively. CONCLUSION: The combination of HR and MR-guided thermoablation is a safe and effective approach in the treatment of technically unresectable hepatic tumors and can achieve long-term survival.


Assuntos
Carcinoma Hepatocelular/terapia , Ablação por Cateter/métodos , Neoplasias Hepáticas/terapia , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Ablação por Cateter/efeitos adversos , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
10.
Expert Rev Med Devices ; 17(6): 555-563, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32401089

RESUMO

INTRODUCTION: Catheter ablation (CA) for atrial fibrillation (AF) is an effective treatment option with encouraging clinical outcome data. Further improvement of catheter technologies is desirable, in particular for patients with persistent and long-standing persistent AF. The aim of this review is to provide an overview of novel ablation tools in AF-ablation. AREAS COVERED: The most widely used ablation tool still is the single-tip catheter for radiofrequency (RF) ablation. Contact-force (CF) catheters and the introduction of individualized ablation protocols may overcome limitations of single-tip RF-based ablation. Furthermore, balloon-based pulmonary vein isolation (PVI) - first and foremost the cryoballoon (CB) - based ablation - moved into the foreground especially for the treatment of paroxysmal AF, because of its ease of use and proven safety. Upcoming RF balloon technologies are also promising. Moreover, new mapping and imaging technologies might help to identify non-PV-triggers in patients with arrhythmia recurrence and may have the potential to enable real-time therapy assessment. EXPERT OPINION: New ablation tools such as CF-sensing catheters or novel balloon-devices could help to overcome the major limitation of PV-reconnection and lead to improved outcomes. Moreover, novel mapping tools to identify extra-PV-triggers may improve ablation success in patients with persistent and long-standing persistent AF.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Invenções , Ablação por Cateter/efeitos adversos , Eletrodos , Humanos , Imageamento Tridimensional , Veias Pulmonares/cirurgia
11.
Int J Cardiovasc Imaging ; 36(7): 1293-1309, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32248332

RESUMO

The usefulness of peak atrial longitudinal strain (PALS) in identifying patients at high risk of atrial fibrillation (AF) recurrence after radiofrequency ablation (RFA) has been investigated in several small AF populations. The aim of this systematic review and meta-analysis was to investigate whether PALS predicts recurrence of AF after RFA treatment. MEDLINE, EMBASE and the Cochrane Library were searched. Studies investigating the value of PALS in predicting successful RFA in AF patients were selected. Patients underwent echocardiography prior to RFA. Risk of bias was evaluated using the Quality in Prognosis Studies (QUIPS) Tool. Twelve studies and a total of 1025 patients suffering from paroxysmal or persistent AF were included. Odds ratios (OR) were assessed in a random and fixed effects model for univariable and multivariable pooled analyses respectively. PALS was found to be a significant predictor of AF recurrence after RFA across study populations (Univariable: OR: 1.17, CI95% [1.03-1.34], p = 0.018, per 1% decrease) (Multivariable: OR: 1.16, CI95% [1.09-1.24], p < 0.001, per 1% decrease). Patients with recurrence had significantly lower PALS prior to RFA than patients who maintained sinus rhythm (15.7 ± 5.7% vs. 23.0 ± 7.0%, p = 0.016). A pooled analysis of weighted mean differences (WMD) also showed a significant difference in PALS between the two groups (WMD: - 6.57, CI95% [- 8.49: - 4.65], p < 0.001). Lower values of PALS are associated with an increased risk of AF recurrence after RFA. PALS provides prognostic value in clinical practice.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Feminino , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Medição de Risco , Fatores de Risco , Resultado do Tratamento
12.
Medicine (Baltimore) ; 99(17): e19897, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332665

RESUMO

This study aimed to evaluate the impact of the echocardiographic parameter ratio E/E' on the late recurrence of paroxysmal atrial fibrillation in patients after receiving radiofrequency catheter ablation.We retrospectively examined total of 288 paroxysmal atrial fibrillation (PAF) patients that underwent a preliminary radiofrequency catheter ablation (RFCA) in our hospital. During the first phase in this study, the patients were divided into 2 groups upon AF recurrence after RFCA: Recurrent group, n = 67 patients with rapid trial arrhythmia that lasted for more than 30 seconds at 3 months after RFCA and the Nonrecurrent group, n = 221. The clinical conditions were compared between the 2 groups. During the second phase of this study, based on the results in the first phase, the patients were divided into another 2 groups according to whether the ratio of E/E' ≥13 .45: Higher ratio of E/E' group, n = 55 and Lower ratio of E/E' group n = 233. The late AF recurrent rates were also compared between the 2 groups.During the first phase, the univariate analysis indicated that the risk factors(P < .05)for PAF late recurrence included early recurrence, E', and the ratio E/E'. The Cox multivariate analysis showed that the ratio of E/E' and early recurrence were the independent predictors for late PAF recurrence. The ratio of E/E' that was cut off at 13.45 also predicted atrial tachyarrhythmia recurrence with 40.3% sensitivity and 87.3% specificity. In the second phase, after completing the 1:1 matching, the Kaplan-Meier analysis indicated that the ratio of E/E' ≥ 13.45 was associated with further recurrences after RFCA (log-rank P = .009), compared to the patients with a ratio of E/E' < 13.45. The univariate Cox analysis indicated that an elevated ratio of E/E'(≥13.45) was the independent predictor for late PAF recurrence (HR = 3.322, 95%CI: 1.560-7.075, P = .002). However, the ratio of E/E' cut off at 13.25 predicted atrial tachyarrhythmia recurrence with 75% sensitivity and 62.2% specificity.The ratio of E/E' ≥ 13.25 is an important predictor of the late recurrence of paroxysmal atrial fibrillation (PAF) after radiofrequency catheter ablation (RFCA).


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ecocardiografia/instrumentação , Assistência ao Convalescente , Idoso , Fibrilação Atrial/etiologia , Velocidade do Fluxo Sanguíneo/fisiologia , Ablação por Cateter/métodos , China , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Fatores de Risco
13.
Arq Bras Cardiol ; 114(5): 775-782, 2020 03 30.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32236324

RESUMO

BACKGROUND: Simultaneous ablation of atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter can be performed when both arrythmias had been recorded before the procedure. However, the best approach has not been defined in case of patients referred for ablation with CTI-dependent atrial flutter, without history of AF. OBJECTIVES: To assess the prevalence and to identify predictors of the first episode of AF after ablation of CTI-dependent atrial flutter in patients without history of AF. METHODS: Retrospective cohort of patients with CTI-dependent atrial flutter without history of AF undergoing catheter ablation. Clinical characteristics were compared between patients who developed AF and those who did not have AF after the procedure. Significance level was set at 5%. In the analysis of predicting factors, the primary outcome was occurrence of AF after CTI-dependent atrial flutter ablation. RESULTS: Of a total of 227 patients undergoing ablation of CTI-dependent atrial flutter (110 with history of AF and 33 without adequate follow-up), 84 were included, and 45 (53.6%) developed post-ablation AF. The HATCH and CHA2DS2-VASC scores were not different between the groups. Recurrence rate of CTI-dependent atrial flutter and complication rate were 11.5% and 1.2%, respectively, after ablation. CONCLUSIONS: Although ablation of CTI-dependent atrial flutter is a safe and effective procedure, 50% of the patients developed AF after the procedure. However, the role of combined ablation (CTI-dependent atrial flutter plus AF) aiming at preventing AF is still uncertain. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).


Assuntos
Fibrilação Atrial/epidemiologia , Flutter Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Fibrilação Atrial/etiologia , Fibrilação Atrial/prevenção & controle , Flutter Atrial/diagnóstico , Flutter Atrial/epidemiologia , Ablação por Cateter/métodos , Humanos , Prevalência , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
14.
Medicine (Baltimore) ; 99(17): e19599, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332606

RESUMO

BACKGROUND: Epicardial radiofrequency ablation for stand-alone atrial fibrillation under total video-assisted thoracoscopy has gained popularity in recent years. However, severe cardiopulmonary disturbances during the surgery may affect cerebral perfusion and oxygenation. We therefore hypothesized that regional cerebral oxygen saturation (rSO2) would decrease significantly during the surgery. In addition, the influencing factors of rSO2 would be investigated. METHODS: A total of 60 patients scheduled for selective totally thoracoscopic ablation for stand-alone atrial fibrillation were enrolled in this prospective observational study. The rSO2 was monitored at baseline (T0), 15 min after anesthesia induction (T1), 15 minute after 1-lung ventilation (T2), after right pulmonary vein ablation (T3), after left pulmonary vein ablation (T4) and 15 minute after 2-lung ventilation (T5) using a near-infrared reflectance spectroscopy -based cerebral oximeter. Arterial blood gas was analyzed using an ABL 825 hemoximeter. Associations between rSO2 and hemodynamic or blood gas parameters were determined with univariate and multivariate linear regression analyses. RESULTS: The rSO2 decreased greatly from baseline 65.4% to 56.5% at T3 (P < .001). Univariate analyses showed that rSO2 correlated significantly with heart rate (r = -0.173, P = .186), mean arterial pressure (MAP, r = 0.306, P = .018), central venous pressure (r = 0.261, P = .044), arterial carbon dioxide tension (r = -0.336, P = .009), arterial oxygen pressure (PaO2, r = 0.522, P < .001), and base excess (BE, r = 0.316, P = .014). Multivariate linear regression analyses further showed that it correlated positively with PaO2 (ß = 0.456, P < .001), MAP (ß = 0.251, P = .020), and BE (ß = 0.332, P = .003). CONCLUSION: Totally thoracoscopic ablation for atrial fibrillation caused a significant decrease in rSO2. There were positive correlations between rSO2 and PaO2, MAP, and BE.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Circulação Cerebrovascular/fisiologia , Oxigênio/sangue , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Ablação por Cateter/efeitos adversos , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho , Cirurgia Torácica Vídeoassistida/efeitos adversos
15.
Pain Physician ; 23(2): 159-164, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214295

RESUMO

BACKGROUND: Chronic degeneration of the zygapophyseal joints in the cervical or lumbar spine are common causes of axial back pain. Radiofrequency (RF) ablation is a treatment modality in the denervation of facet joint-related pain. Although multiple factors have been theorized to contribute to the size of the optimal RF lesion, the addition of hypertonic saline solution has been posited to create larger RF lesion sizes. OBJECTIVES: This study compares lesion of 20-gauge RF monopolar probe using 2% lidocaine, 0.9% normal saline solution, and 3% saline solution administered through the RF needle prior to ablation, with subsequent lesion sizes recorded. STUDY DESIGN: Randomized, double-blinded, ex vivo study using clinically relevant conditions. SETTING: Procedural laboratory in an academic institution. METHODS: RF ablation lesions were reproduced in room temperature (21°C ± 2°C) chicken breast specimens with 20-gauge monopolar RF probes inserted. RF was applied for 90 seconds at 80°C after injection of 1 mL of either 2% lidocaine, 2% lidocaine and 0.9% normal saline solution in a 1:1 ratio, or 2% lidocaine and 3% saline solution in a 1:1 ratio. Tissues were dissected, measured, and ellipsoid volumes of burn calculated. Homogeneity of variances was assessed via the Bartlett's test, and heteroskedasticity with the studentized Breusch-Pagan test. One-way analysis of variance (ANOVA) (alpha of 0.05) was used to evaluate statistical significance between volume means across groups. When the null hypothesis of no difference in burn volume between samples could not be rejected, a predefined equivalence volume of ± 0.05 cm3 was used with Welch's 2 one-sided t-tests (TOST) with a Bonferroni adjusted alpha of 0.0167 to evaluate for null acceptance. RESULTS: The mean lesion volume for monopolar RF with 1 mL 2% lidocaine was 0.16 cm3. Monopolar RF with 1 mL 2% lidocaine + 0.9% normal saline solution had a mean lesion volume of 0.15 cm3, and treatment with 1 mL 2% lidocaine + 3% saline solution measured 0.17 cm3. ANOVA failed to reject the null, and TOST accepted as equivalent all 3 comparisons. LIMITATIONS: In vivo anatomy and physiology of a human organism was not used for this study. Samples were not warmed to physiologic temperature. Randomization resulted in slightly unequal sample sizes, although all groups were of sufficient size that the central limit theorem should apply. CONCLUSIONS: Three commonly used solutions were found to have equivalent lesion sizes from monopolar probe RF ablation. KEY WORDS: Radiofrequency, ablation, lesion shape, lesion size, monopolar RF, hypertonic saline solution.


Assuntos
Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Lidocaína/toxicidade , Solução Salina Hipertônica/toxicidade , Solução Salina/toxicidade , Animais , Galinhas , Método Duplo-Cego , Eletrodos , Feminino , Injeções , Lidocaína/administração & dosagem , Glândulas Mamárias Animais/efeitos dos fármacos , Glândulas Mamárias Animais/patologia , Distribuição Aleatória , Solução Salina/administração & dosagem , Solução Salina Hipertônica/administração & dosagem
16.
Int J Surg ; 77: 85-93, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32173611

RESUMO

BACKGROUND: Microwave ablation (MWA) is an important method in the treatment of liver cancer. This systematic review compared MWA with liver resection (LR) for liver cancer treatment. In recent years, the MWA has been also reported to play an important role. Studies comparing MWA and LR are lacking. This study aims to compare the efficacy of MWA and LR in the treatment of hepatocellular carcinoma (HCC). METHODS: A systematic search of PubMed, Embase, Cochrane Library and Web of Science up to April 1, 2019 was conducted for relevant studies that compared the efficacy of MWA and LR in the treatment of HCC. The primary outcomes were local tumor recurrence (LTR) and overall survival (OS) of patients. The secondary outcomes included disease free survival (DFS), extrahepatic metastasis, intrahepatic de novo lesions, length of stay, complications, intraoperative blood loss and operative time. RESULTS: A total of 16 studies including 2622 patients were identified. Incidence of LTR was significantly higher in patients with MWA than LR, with a pooled OR of 2.69 (95% CI 1.33-5.41; P = 0.006). No significant difference in 1-year OS was found. However, patients with MWA experienced higher 3- and 5-year OS, with pooled ORs of 1.40 (95% CI 1.07-1.84; P = 0.01) and 1.41 (95% CI 1.10-1.80; P = 0.007) respectively. In secondary measures, the 1- and 3-year DFS were significantly higher in patients with MWA. However, no significant difference of 5-year DFS was observed. In addition, lower incidence of complications, less intraoperative blood loss and shorter operative time and shorter length of stay were observed in MWA. CONCLUSIONS: Though MWA may lead to higher incidence of recurrence, it may be an effective and safe alternative in patients with HCC or liver metastases. MWA may have benefits in patients' survival and safety. Randomized studies should be performed to determine the target population that benefits most from MWA in the future.


Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Hepatectomia/métodos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Micro-Ondas/uso terapêutico , Perda Sanguínea Cirúrgica , Carcinoma Hepatocelular/mortalidade , Ablação por Cateter/efeitos adversos , Feminino , Hepatectomia/efeitos adversos , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Micro-Ondas/efeitos adversos
17.
Medicine (Baltimore) ; 99(11): e19147, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176041

RESUMO

INTRODUCTION: Trans-catheter closure of peri-membranous ventricular septal defects (VSDs) using Amplatzer-Type devices, has been widely reported in the past decade. We hereby report a rare complication of frequent premature ventricular contractions (PVCs) and paroxysmal ventricular tachycardia (PVT) sustained 48 days after the closure of VSD.More importantly, the arrhythmias were successfully treated with radiofrequency catheter ablation (RFCA) after medical therapy failed to restore and maintain sinus rhythm. PATIENT CONCERNS: We reported an 8-year-old boy with frequent PVCs and PVT sustained 48 days after the closure of VSD. The boy has no palpitation, chest distress and other uncomfortable symptoms. DIAGNOSIS: This patient was diagnosed as frequent PVCs and PVT by Holter monitoring for 24 hours. INTERVENTIONS: RFCA was administered. OUTCOMES: The patient was discharged 48 hours with no complication and remained asymptomatic 12 months after the ablation. CONCLUSION: Radiofrequency ablation helps treat PVCs and PVT in children and has a higher efficacy in restoring and maintaining sinus rhythm.


Assuntos
Ablação por Cateter/efeitos adversos , Comunicação Interventricular/cirurgia , Taquicardia Paroxística/etiologia , Taquicardia Ventricular/etiologia , Ablação por Cateter/métodos , Criança , Eletrocardiografia , Humanos , Masculino , Taquicardia Paroxística/diagnóstico , Taquicardia Ventricular/diagnóstico
18.
Circ Arrhythm Electrophysiol ; 13(4): e007900, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32188285

RESUMO

BACKGROUND: Vagal hyperactivity is directly related to several clinical conditions as reflex/functional bradyarrhythmias and vagal atrial fibrillation (AF). Cardioneuroablation provides therapeutic vagal denervation through endocardial radiofrequency ablation for these cases. The main challenges are neuromyocardium interface identification and the denervation control and validation. The finding that the AF-Nest (AFN) ablation eliminates the atropine response and decreases RR variability suggests that they are related to the vagal innervation. METHOD: Prospective, controlled, longitudinal, nonrandomized study enrolling 62 patients in 2 groups: AFN group (AFN group 32 patients) with functional or reflex bradyarrhythmias or vagal AF treated with AFN ablation and a control group (30 patients) with anomalous bundles, ventricular premature beats, atrial flutter, atrioventricular nodal reentry, and atrial tachycardia, treated with conventional ablation (non-AFN ablation). In AFN group, ablation delivered at AFN detected by fragmentation/fractionation of the endocardial electrograms and by 3-dimensional anatomic location of the ganglionated plexus. Vagal response was evaluated before, during, and postablation by 5 s noncontact vagal stimulation at the jugular foramen, through the internal jugular veins (extracardiac vagal stimulation [ECVS]), analyzing 15 s mean heart rate, longest RR, pauses, and atrioventricular block. All patients had current guidelines arrhythmia ablation indication. RESULTS: Preablation ECVS induced sinus pauses, asystole, and transient atrioventricular block in both groups showing a strong vagal response (P=0.96). Postablation ECVS in the AFN group showed complete abolishment of the cardiac vagal response in all cases (pre/postablation ECVS=P<0.0001), demonstrating robust vagal denervation. However, in the control group, vagal response remained practically unchanged postablation (P=0.35), showing that non-AFN ablation promotes no significant denervation. CONCLUSIONS: AFN ablation causes significant vagal denervation. Non-AFN ablation causes no significant vagal denervation. These results suggest that AFNs are intrinsically related to vagal innervation. ECVS was fundamental to stepwise vagal denervation validation during cardioneuroablation. Visual Overview A visual overview is available for this article.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Átrios do Coração/inervação , Frequência Cardíaca , Vagotomia , Estimulação do Nervo Vago , Potenciais de Ação , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Vagotomia/efeitos adversos , Estimulação do Nervo Vago/efeitos adversos
19.
Circ Arrhythm Electrophysiol ; 13(4): e008128, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32191539

RESUMO

BACKGROUND: The optimal timing of catheter ablation for atrial fibrillation (AF) in reference to the time of diagnosis is unknown. We sought to assess the impact of the duration between first diagnosis of AF and ablation, or diagnosis-to-ablation time (DAT), on AF recurrence following catheter ablation. METHODS: We conducted a systematic electronic search for observational studies reporting the outcomes associated with catheter ablation for atrial fibrillation stratified by diagnosis-to-ablation time. The primary meta-analysis using a random effects model assessed AF recurrence stratified by DAT ≤1 year versus >1 year. A secondary analysis assessed outcomes stratified by DAT ≤3 years versus >3 years. RESULTS: Of the 632 screened studies, 6 studies met inclusion criteria for a total of 4950 participants undergoing AF ablation for symptomatic AF. A shorter DAT ≤1 year was associated with a lower relative risk of AF recurrence compared with DAT >1 year (relative risk, 0.73 [95% CI, 0.65-0.82]; P<0.001). Heterogeneity was moderate (I2=51%). When excluding the one study consisting of only patients with persistent AF, the heterogeneity improved substantially (I2=0%, Cochran's Q P=0.55) with a similar estimate of effect (relative risk, 0.78 [95% CI, 0.71-0.85]; P<0.001). CONCLUSIONS: Shorter duration between time of first AF diagnosis and AF ablation is associated with an increased likelihood of ablation procedural success. Additional study is required to confirm these results and to explore implementation of earlier catheter AF ablation and patient outcomes within the current AF care pathway. Visual Overview A visual overview is available for this article.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Frequência Cardíaca , Tempo para o Tratamento , Potenciais de Ação , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Recidiva , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Cardiovasc Drugs Ther ; 34(2): 209-214, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32080786

RESUMO

INTRODUCTION: Catheter ablation (CA) of atrial fibrillation (AF) is an important rhythm control strategy for patients with drug-refractory AF. We aimed to perform an updated meta-analysis of direct oral anticoagulants (DOACs) vs vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients undergoing AF ablation to assess safety and efficacy of DOAC, after the publication of recent data on edoxaban in CA of AF. METHODS: We performed a meta-analysis of RCTs enrolling patients undergoing AF ablation. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% CIs for thromboembolic events, major bleeding (MB), and non-major bleeding (NMB). RESULTS: A total of 2118 patients have been included in the analysis. Compared with patients receiving VKA, patients receiving DOACs had a lower, although non-significant, risk of thromboembolic events (RR, 0.40; 95% CI, 0.09-1.76; P = 0.23). MB rates in patients treated with DOACs were statistically significantly lower than VKA (RR, 0.61; 95% CI, 0.39-0.93, P = 0.02). The incidence of NMB was not significantly different (RR, 0.98; 95% CI, 0.83-1.57, p n.s.). CONCLUSIONS: In a meta-analysis of RCTs, an uninterrupted DOACs strategy for CA of AF appears to be superior to uninterrupted VKA in terms of safety; a non-significant trend favoring DOACs in terms of efficacy is also evident.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/cirurgia , Ablação por Cateter , Inibidores do Fator Xa/administração & dosagem , Tromboembolia/prevenção & controle , Varfarina/administração & dosagem , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Ablação por Cateter/efeitos adversos , Inibidores do Fator Xa/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Tromboembolia/diagnóstico , Tromboembolia/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Vitamina K/antagonistas & inibidores , Varfarina/efeitos adversos
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