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1.
Tomography ; 8(5): 2604-2608, 2022 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-36287816

RESUMO

Percutaneous cryoablation has proved to be safe and effective for the treatment of stage T1a renal cell carcinoma (RCC). Patients with larger-sized RCCs may not be good surgical candidates or may have tumors located in anatomically unfavorable locations, which makes partial nephrectomy more challenging. In this patient population, percutaneous cryoablation can be considered a treatment option, given its less invasive nature when compared to surgery. The ablation of larger-sized RCCs requires careful planning to ensure that the tumor volume is completely covered within the ablation zone, while minimizing the risks of non-target injury to the surrounding critical organs. In this article, we share our institutional experience in treating larger-sized RCCs (> 4 cm) using percutaneous cryoablation alone. We discuss strategies to maximize the volume of the ablation zone through the precise placement of the probes. We also shed light on different techniques to protect the surrounding structures during cryoablation.


Assuntos
Carcinoma de Células Renais , Criocirurgia , Neoplasias Renais , Humanos , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Renais/etiologia , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Neoplasias Renais/etiologia , Estudos Retrospectivos , Nefrectomia/métodos
2.
Am J Cardiol ; 184: 22-30, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36184349

RESUMO

The purpose of this study was to compare the effectiveness and safety of 2 strategies for catheter treatment of patients with persistent atrial fibrillation in the long-term period, using cardiac implantable loop recorders. The research is a prospective, randomized, controlled study designed to compare the results of modern catheter technologies in patients with persistent atrial fibrillation. The study included 127 patients with persistent atrial fibrillation in the last 6 months before inclusion in the study, for whom at least 2 antiarrhythmic drugs of class I to III were not effective. By random distribution, 50 patients were included in group 1; they underwent cryoballoon ablation, using a cryoballoon of the second generation. Group 2 also included 50 patients who underwent radiofrequency ablation, where a catheter was used to control the contact force. Cardiac implantable loop electrocardiogram recorders were implanted in all patients after surgery. The average duration of follow-up was 36 months. The primary end point of efficacy occurred in 15 patients in the group with cryoballoon ablation and 14 patients in the group with radiofrequency ablation. In conclusion, the primary effectiveness was relatively the same in the groups; yet, in the long-term period, the superiority of radiofrequency ablation using catheters with pressure control was noted, but the difference in results was statistically insignificant (p <0.672) and there was no significant difference between the 2 methods in terms of overall safety.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Humanos , Criocirurgia/efeitos adversos , Estudos Prospectivos , Resultado do Tratamento , Ablação por Cateter/métodos , Recidiva , Veias Pulmonares/cirurgia
3.
Front Immunol ; 13: 990224, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36211329

RESUMO

Objective: To explore the effectiveness of cryoablation combined with arterial perfusion with programmed cell death protein 1 inhibitors in overcoming immune resistance in advanced solid cancers. Methods: In this pilot retrospective study, nine patients with solid cancers were treated with tumour cryoablation and arterial perfusion with programmed cell death protein 1 inhibitors, which had previously proven ineffective. The CIBERSORT software was used to estimate the levels of tumour-infiltrating immune cells in the challenged tumour. Changes in the levels of circulating T cells were assessed using flow cytometry. The primary endpoints were disease control and objective response rates, and the secondary endpoint was safety. Results: The nine patients with advanced solid tumours received cryoablation combined with arterial perfusion with programmed cell death protein 1 inhibitors between June and December 2021. The median follow-up time was 5.8 months. We recorded an objective response rate in two patients (22.22%). The best overall responses were partial responses in two patients (22.22%) and one case (11.11%) of stable disease, while six patients (66.67%) presented progressive disease. However, the median overall survival time was not reached. The median progression-free survival was 2.4 months. Treatment-related severe adverse events included one case of abdominal infection and one case of upper gastrointestinal bleeding, which were cured after the intervention. The CIBERSORT software confirmed the importance of cryoablation in regulating tumour-infiltrating immune cells. Thus, macrophage polarisation from the M2 to the M1 phenotype in the challenged tumour and a gradual increase in the levels of circulating CD4+ T cells were observed after administration of the combination therapy. Conclusion: Cryoablation combined with arterial perfusion with programmed cell death protein 1 inhibitors has the potential efficacy and safety to overcome immune resistance in patients with advanced solid cancers. The combination therapy leads to macrophage polarisation from the M2 to the M1 phenotype in the challenged tumour to enhance antitumour immunity.


Assuntos
Antineoplásicos Imunológicos , Criocirurgia , Neoplasias , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Criocirurgia/efeitos adversos , Humanos , Inibidores de Checkpoint Imunológico/efeitos adversos , Neoplasias/tratamento farmacológico , Neoplasias/genética , Estudos Retrospectivos
4.
World J Surg Oncol ; 20(1): 284, 2022 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-36064369

RESUMO

BACKGROUND: To summarize our clinical experience of cryoablation in renal cell carcinoma (RCC) of Chinese population and to evaluate the long-term outcomes of laparoendoscopic single-site (LESS) cryoablation (LCA) as well as percutaneous CT-guided cryoablation (PCA) for biopsy-proven T1a and T1b RCC. METHODS: This was a multi-center, retrospective study investigating T1 stage RCC patients from 2011 to 2021. The patients were treated by LCA or PCA according to individual situation. Overall survival (OS), cancer-related survival (CSS), and progression-free survival (PFS) were evaluated for oncological outcomes, and kidney function, complications, and hospital stay were used to estimate technical outcomes. RESULTS: A total of 163 consecutive patients were included. Among them, 59 cases were treated by LCA and PCA was performed in 104 cases. All operations were processed successfully. Mean diameter of the mass was (2.9±1.4) cm; median blood volume was 45ml (10~200 ml). The mean operation time was 84.0 ± 24.5 min. The median postoperative hospital stay was 3 days (1~6 days). Compared with LCA, procedure time of PCA was shortened, the volume of bleeding was reduced, and the hospital stay was decreased. The overall adverse events rate was 9.8% (16/163). The mean preoperative and postoperative eGFR of LCA were 77.6±15.3 ml/min and 75.6±17.4 ml/min, respectively. Analogously, the values of PCA were 78.7±12.9 ml/min and 76.7±14.3 ml/min. Mean follow-up time was 64.2 ± 30.2 months (range, 7-127 months). Local recurrence was observed in 13 patients (8.0%), 4 (6.8%) cases of LCA and 9 (8.7%) cases of PCA. PFS at 5 and 10 years were 95.5% and 69.2% for LCA and 96.7% and 62.8% for PCA. In total, 26 patients (16.0%) (11 patients from LCA and 15 from PCA) died throughout the follow-up period. OS at 5 and 10 years were 93.8% and 31.4% for LCA, and 97.4% and 52.7% for PCA. Six patients (3.7%) (3 cases from LCA and 3 from PCA) died of metastatic RCC. CCS for LCA were 98.0% and 82.8% at 5 and 10 years, while the data were 100% and 86.4% for PCA. CONCLUSION: LCA and PCA for T1 stage RCC provides satisfactory long-term oncological and renal function preservation outcomes, with acceptable complication rates.


Assuntos
Carcinoma de Células Renais , Criocirurgia , Neoplasias Renais , Laparoscopia , Biópsia , Carcinoma de Células Renais/cirurgia , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Humanos , Neoplasias Renais/patologia , Laparoscopia/efeitos adversos , Estudos Retrospectivos
5.
BMC Cardiovasc Disord ; 22(1): 400, 2022 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-36071377

RESUMO

BACKGROUND: Early recurrence (ER) after catheter ablation for atrial fibrillation (AF) has been considered as a common phenomenon but its mechanism and implication in long-term outcome has not been fully elucidated. We aimed to clarify the relation between post-ablation inflammation and ER after cryoballoon ablation (CBA) or radio-frequency ablation (RFA) and evaluate the clinical significance of ER. METHODS: A total of 154 patients with paroxysmal AF undergoing ablation were consecutively recruited, including 90 patients undergoing RFA (RF group) and 64 patients undergoing CBA (CB group). Myocardial injury and inflammation biomarkers were analyzed before and 6 h, 24 h and 48 h after ablation. Acute early recurrence (AER), non-acute early recurrence (NAER) and late recurrence (LR) was defined as recurrence of atrial tachyarrhythmia during 0-3, 4-90 days and beyond a 90-day blanking period after ablation. RESULTS: Cardiac troponin I was significantly higher in CB group while C reactive protein (CRP) and Ratio Neutrophil/Lymphocyte were more elevated in RF group. Higher CRP level after RFA was significantly associated with AER in RF group and lower CRP level after CBA was predictive of AER in CB group. In addition, average cryoablation duration was positively correlated with CRP level after CB group. Cox regression revealed that NAER and left atrial diameter were associated with LR in RF group, while AER and NAER were predictive of LR after CBA. CONCLUSIONS: Post-ablation inflammation was greater in RFA than in CBA. Excessive inflammatory response may be an important factor of AER after RFA. AER after CBA was related with lower inflammation and predictive of LR. Further investigations are still warranted to address on these findings.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Ablação por Radiofrequência , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Doença Crônica , Criocirurgia/efeitos adversos , Humanos , Inflamação
6.
Heart Surg Forum ; 25(4): E594-E600, 2022 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-36052903

RESUMO

INTRODUCTION: Pulmonary vein isolation is the primary goal in treating patients with paroxysmal atrial fibrillation using catheter ablation. This study's purpose is a comparative assessment of the efficacy and safety of two strategies for catheter treatment in patients with persistent atrial fibrillation. PATIENTS AND METHODS: The study included 127 patients with persistent atrial fibrillation during the last six months before inclusion in the study. The average follow-up period was 24 months. RESULTS: The primary efficacy endpoint (death, cerebrovascular event, or serious complications associated with treatment) occurred in 15 patients in the cryoballoon ablation group and 14 patients in the radiofrequency ablation group. The Kaplan-Meier survival estimates were 30% and 28%, and the risk ratio   0.96 and 95% of the confidence interval. CONCLUSIONS: The treatment in patients with persistent atria fibrillation, using catheter ablation with contact force control catheter treatment with the pulmonary vein isolation, was more efficient.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Fibrilação Atrial/etiologia , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Humanos , Veias Pulmonares/cirurgia , Recidiva , Resultado do Tratamento
7.
Expert Rev Med Devices ; 19(8): 623-631, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36168922

RESUMO

INTRODUCTION: Atrial fibrillation (AF) is a common chronic and progressive heart rhythm disorder. For those in whom sinus rhythm is desired, contemporary clinical practice guidelines recommend antiarrhythmic drugs (AADs) as the initial therapy. However, these medications have modest efficacy and are associated with significant adverse effects. AREAS COVERED: The current article reviews the evidence surrounding first-line catheter ablation, particularly the emerging evidence surrounding the use of cryoballoon ablation as a first-line therapy. The focus of the review is on the outcomes of arrhythmia freedom, quality of life, health-care utilization, and safety. In addition, the article will review novel cryoablation systems. EXPERT OPINION: Recent evidence suggests that cryoballoon ablation significantly improves arrhythmia outcomes (e.g. freedom from any atrial tachyarrhythmia or symptomatic atrial tachyarrhythmia, reduction in arrhythmia burden), patient-reported outcomes (e.g. symptoms and quality of life), and health-care resource utilization (e.g. hospitalization), without increasing the risk of adverse events. These findings are relevant to patients, providers, and health-care systems, as they help inform the decision-making regarding the initial choice of rhythm-control therapy in patients with treatment-naive AF.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Humanos , Criocirurgia/efeitos adversos , Fibrilação Atrial/cirurgia , Antiarrítmicos/uso terapêutico , Qualidade de Vida , Resultado do Tratamento , Ablação por Cateter/efeitos adversos , Taquicardia/tratamento farmacológico , Taquicardia/etiologia , Taquicardia/cirurgia
8.
Cancer ; 128(21): 3824-3830, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36107496

RESUMO

BACKGROUND: This study reports the oncological and functional outcomes in men with localized prostate cancer (Pca) who were treated with primary whole gland cryoablation (WGC) of the prostate. METHODS: The authors retrospectively reviewed their prospectively collected cryosurgery database between January 2002 and September 2019 for men who were treated with WGC of the prostate at a tertiary referral center. Primary outcome includes biochemical recurrence-free survival (BRFS). Secondary outcomes include failure-free survival (FFS), metastasis-free survival (MFS) and adverse events. RESULTS: A total of 260 men were included in the study. Men having had prior treatment for Pca were excluded. Median follow-up was 107 months (interquartile range [IQR], 68.3-132.5 months). BRFS, FFS, and MFS at 10 years were 84%, 66%, and 96%, respectively. High risk D'Amico classification was associated with a lower BRFS and FFS on multivariable analysis. No patient had any Pca-related death during follow-up. American Urological Association symptoms score and bother index were unchanged following cryoablation. Median International Index of Erectile Function score precryoablation and post-cryoablation was 7 (IQR, 3-11) and 1 (IQR, 1-5), respectively. Stress urinary incontinence, defined as requiring any protective pads only occurred in five patients (2%). No patient developed a fistula. Grade > 2 Clavien-Dindo adverse events occurred in six (2.3%) patients. CONCLUSION: WGC of the prostate can achieve excellent oncological and functional outcomes in men with localized Pca at the 10-year mark. Primary WGC may be a good option for men who desire to preserve urinary continence and have an excellent oncologic outcome. LAY SUMMARY: Primary whole gland cryoablation is an alternative treatment option to radical prostatectomy and radiotherapy for men with organ-confined prostate cancer. Patients had excellent cancer outcomes 1 years after whole gland cryoablation, and patients with PSA nadir 0.1 ng/ml or lower after treatment were less likely to have disease recurrence.


Assuntos
Criocirurgia , Neoplasias da Próstata , Criocirurgia/efeitos adversos , Humanos , Masculino , Recidiva Local de Neoplasia/diagnóstico , Próstata/cirurgia , Antígeno Prostático Específico , Estudos Retrospectivos , Resultado do Tratamento
9.
Medicina (Kaunas) ; 58(8)2022 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-36013508

RESUMO

Background and Objectives: To assess efficacy and safety of Percutaneous Cryoablation (PCA) of small renal masses (SRMs) using Trifecta outcomes in a large cohort of patients who were not eligible for surgery. Materials and methods: All PCAs performed in four different centers between September 2009 and September 2019 were retrospectively evaluated. Patients were divided in two different groups depending on masses dimensional criteria: Group-A: diameter ≤ 25 mm and Group-B: diameter > 25 mm. Complications rates were reported and classified according to the Clavien-Dindo system. The estimate glomerular filtration rate (eGFR) was calculated before PCA and during follow-up schedule. Every patient received a Contrast Enhanced Ultrasound (CEUS) evaluation on the first postoperative day. Radiological follow-up was taken at 3, 6, and 12 months for the first year, then yearly. Radiological recurrence was defined as a contrast enhancement persistence and was reported in the study. Finally, Trifecta outcome, which included complications, RFS, and preservation of eGFR class, was calculated for every procedure at a median follow-up of 32 months. Results: The median age of the patients was 74 years. Group-A included 200 procedures while Group-B included 140. Seventy-eight patients were eligible for Trifecta evaluation. Trifecta was achieved in 69.6% of procedures in Group-A, 40.6% in Group-B (p = 0.02). We observed an increased rate of complication in Group-B (13.0% vs. 28.6; p < 0.001). However, 97.5% were <II Clavien-Dindo grade. No differences were found between the two groups regarding eGFR before and after treatment. Further, 24-months RFS rates were respectively 98.0% for Group-A and 92.1% in Group-B, while at 36 months were respectively 94.5% and 87.5% (p = 0.08). Conclusions: PCA seems to be a safe and effective treatment for SRM but in the need of more strict dimensional criteria to achieve a higher possible success rate.


Assuntos
Criocirurgia , Neoplasias Renais , Idoso , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Taxa de Filtração Glomerular , Humanos , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Estudos Retrospectivos , Resultado do Tratamento
10.
J Am Heart Assoc ; 11(15): e026290, 2022 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-35862178

RESUMO

Background Pharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BrS) is challenging. In addition, patients with BrS with an implantable cardioverter-defibrillator (ICD) might experience inappropriate shocks for fast AF. Long-term outcome of pulmonary vein isolation in BrS has not been well established yet, and it is still unclear whether pulmonary vein triggers are the only pathophysiological mechanism of AF in BrS. The aim of the study is to assess the long-term outcomes in patients with BrS undergoing pulmonary vein isolation for paroxysmal AF compared with a matched cohort of patients without BrS. Methods and Results Sixty patients with BrS undergoing pulmonary vein isolation with cryoballoon catheter ablation for paroxysmal AF were matched with 60 patients without BrS, who underwent the same procedure. After a mean follow-up of 58.2±31.7 months, freedom from atrial tachyarrhythmias was achieved in 61.7% in the BrS group and in 78.3% in the non-BrS group (log-rank P=0.047). In particular, freedom from AF was 76.7% in the first group and in 83.3% in the second (P=0.27), while freedom from atrial tachycardia/atrial flutter was 85% and 95% (P=0.057). In the BrS group, 29 patients (48.3%) had an ICD and 8 (27.6%) had a previous ICD-inappropriate shock for fast AF. In the BrS cohort, ICD-inappropriate interventions for AF were significantly reduced after ablation (3.4% versus 27.6%; P=0.01). Conclusions Pulmonary vein isolation in patients with BrS was associated with higher rate of arrhythmic recurrence. Despite this, catheter ablation significantly reduced inappropriate ICD interventions in BrS patients and can be considered a therapeutic strategy to prevent inappropriate device therapies.


Assuntos
Fibrilação Atrial , Flutter Atrial , Síndrome de Brugada , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Síndrome de Brugada/complicações , Síndrome de Brugada/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Humanos , Veias Pulmonares/cirurgia , Recidiva , Resultado do Tratamento
11.
Kardiologiia ; 62(6): 23-29, 2022 Jun 30.
Artigo em Russo | MEDLINE | ID: mdl-35834338

RESUMO

Aim      To identify risk factors for recurrence of atrial fibrillation (AF) following cryoballoon ablation (CBA).Material and methods  This prospective study included patients with paroxysmal AF who had undergone CBA (141 patients, median age 60 years, 3% men). The evaluation prior to CBA included clinical instrumental parameters (electrocardiography (ECG), 24-h ECG monitoring, echocardiography, contrast-enhanced cardiac multispiral computed tomography). Also, possible intraoperative indexes that could affect the CBA effectivity, were evaluated. The postoperative follow-up duration was 12 months. Effectivity was assessed during in-person visits at 3, 6, and 12 months, when questioning of patients and 24-h ECG monitoring were performed. CBA was considered ineffective if the patient had recurrences of any atrial tachyarrhythmia longer than 30 sec after the end of the 3-month "blind" period.Results During the 12-month follow-up, recurrences of atrial tachyarrhythmia were observed in 46 (32.6 %) patients. Patients with ineffective CBA more frequently had AF during the first 3 months (71.7 % vs. 11.6 %; р<0.001). Such patients had a history of multiple ineffective treatments with antiarrhythmic drugs (AAD), common pulmonary venous (PV) collector (41.3 % vs. 20.0 %; р=0.008), and stroke/recurrent ischemic attacks (15.2 % vs. 5.2 %; р=0.047). Multifactorial regression analysis showed that the factors of AF recurrence included common PV collector (relative risk (RR) 2.35; 95 % confidence interval (CI) 1.29-4.25; р=0.005), multiple ineffective AADs (RR 1.42; 95 % CI 1.08-1.86; р=0.011), and early AF recurrence (RR 7.57; 95 % CI 3.84-14.90; р<0.001).Conclusion      Common PV collector and multiple ineffective AADs are risk factors of ineffective CBA. Early recurrences during the first 3 postoperative months are a significant risk factor of long-term AF recurrences.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/cirurgia , Recidiva , Fatores de Risco , Resultado do Tratamento
12.
JACC Clin Electrophysiol ; 8(8): 1034-1039, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35907755

RESUMO

Ultra-low temperature cryoablation (ULTC) is a novel ablation modality aiming to combine the effectiveness of surgical lesion delivery with percutaneous safety to improve outcomes in catheter ablations of atrial fibrillation, particularly in persistent AF (PsAF). In the Cryocure-2 study (NCT02839304) 78 patients (56.4% PsAF) received ULTC pulmonary vein isolation plus posterior wall ablation, and linear left and right atrial lesions as needed. The safety and acute success of ULTC appear consistent with current catheter ablation techniques and, together with Kaplan-Meier 85.9% 1-year freedom from AF observed in Cryocure-2 PsAF patients, warrant further evaluation in larger clinical trials, which are currently ongoing.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Humanos , Temperatura , Resultado do Tratamento
13.
JACC Clin Electrophysiol ; 8(7): 857-868, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35863811

RESUMO

BACKGROUND: The right ventricular moderator band and papillary muscle (RV MB-PM) complex is an uncommon source of ventricular arrhythmias (VAs). Success rates following the ablation of intracavity structures are lower than for other sites of origin of VAs because of challenging catheter stability and a tendency for hemodynamically unstable automaticity when radiofrequency (RF) is delivered. OBJECTIVES: This study sought to describe the institutional experience of RV MB-PM VAs across a 2-year period and compare the outcomes from ablations performed using RF ablation and cryoablation. METHODS: Electronic health records of patients who underwent catheter ablation of RV MB-PM arrhythmias between January 2018 and November 2021 were reviewed, including imaging, intraprocedural data, and follow-up. RESULTS: Eleven patients underwent ablation of RV MB-PM arrhythmias throughout the duration of the study. Five patients underwent catheter ablation with RF, and 6 patients underwent cryoablation. Three patients in the cryoablation group had previous attempted ablation with RF. Four patients in the RF group and 4 patients in the cryoablation group had structurally abnormal hearts. Acute VA suppression was achieved in 4 of 5 patients with RF and 6 of 6 patients with cryoablation. During follow-up, the rate of arrhythmia recurrence was lower in the cryoablation group (HR: 0.12; 95% CI: 0.016-0.90; P = 0.0396). CONCLUSIONS: Compared to RF, cryoablation offers improved catheter stability and reduced propensity for automaticity during ablation. The use of cryoablation as a first-line strategy is reasonable when RV MB-PM origin of premature ventricular contractions is suspected.


Assuntos
Ablação por Cateter , Criocirurgia , Taquicardia Ventricular , Complexos Ventriculares Prematuros , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Humanos , Músculos Papilares/cirurgia , Taquicardia Ventricular/cirurgia , Complexos Ventriculares Prematuros/cirurgia
14.
PLoS One ; 17(7): e0265482, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35895713

RESUMO

BACKGROUND: Cryoballoon ablation was established as an effective and safe modality to achieve pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF). However, its role in persistent atrial fibrillation (PersAF) remains unclear. OBJECTIVE: This study aimed to evaluate the efficacy and safety of cryoballoon PVI in PAF and PersAF comparing conventional radiofrequency catheter ablation (RFCA). METHODS: Two hundred patients undergoing cryoballoon ablation for symptomatic AF were consecutively enrolled in this retrospective study. For comparison, 210 patients undergoing RFCA in the same period were included. The primary outcome was a recurrence of any atrial tachyarrhythmias (ATas) after the index ablation. 12-lead ECG and 24-hour Holter monitoring were obtained at 1,3,6 and 9-12 months. RESULTS: PVI by cryoablation alone was achieved in 197 patients (98.5%). ATas-free survival at 12 months post-ablation was 72.7% in the cryoablation and 80.6% in the RFCA group (P = 0.123), respectively. The cryoablation showed comparable efficacy maintaining sinus rhythm compared with RFCA in PAF (P = 0.539), whereas in PersAF, ATas-free survival was significantly lower in cryoablation (P = 0.039). PV reconnection was observed in the majority of patients (14/16, 87.5%) who receive redo RFCA. Complications were encountered in 10 patients, including femoral arteriovenous fistula (n = 1), transient phrenic nerve palsy (n = 8), and minimal amount pericardial effusion (n = 1). CONCLUSION: The efficacy of cryoballoon PVI is comparable with conventional RFCA in PAF, whereas PVI alone using cryoballoon may not be insufficient to maintaining sinus rhythm in PersAF. The safety of cryoballlon PVI is tolerable.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Humanos , Veias Pulmonares/cirurgia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
15.
Int Urol Nephrol ; 54(10): 2529-2535, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35864430

RESUMO

OBJECTIVE: The purpose of this study is to compare oncologic and functional outcomes of men with unilateral, localized PCa treated with stereotactic body radiotherapy (SBRT) versus focal cryoablation (FC). METHODS: Patients from our IRB-approved PCa database who underwent FC or SBRT and were eligible for both treatments were included. Patients with less than 1 year of follow-up or prior PCa treatment were excluded. The primary outcome was treatment failure, defined as salvage treatment or a Gleason group (GG) of ≥ 2 on post-treatment biopsy. Biochemical recurrence (BCR) was evaluated with Phoenix. Functional outcomes were based on EPIC surveys. Complications were categorized with the CTCAE 5.0. Outcomes were compared using descriptive statistics, univariate analyses, and Kaplan-Meier curve for failure-free survival (FFS) and BCR-free survival. P < 0.05 was significant. RESULTS: 68 FC and 51 SBRT patients with a median age of 68 years (48-86) and a median follow-up time of 84 (70-101) months were included in this analysis. There was no difference in tumor risk (p = 0.47), GG (p = 0.20), or PSA (p = 0.70) among the two cohorts at baseline. At 7-year follow-up, no difference in FFS was found between the two cohorts (p = 0.70); however, significantly more FC patients had BCR (p < 0.001). At 48 months, no differences existed in urinary or bowel function; however, SBRT patients had significantly worse sexual function (p = 0.032). CONCLUSION: FC and SBRT are associated with similar oncologic and functional outcomes 7-year post-treatment. These results underscore the utility of FC and SBRT for the management of unilateral low-to-intermediate-risk PCa.


Assuntos
Criocirurgia , Neoplasias da Próstata , Radiocirurgia , Idoso , Idoso de 80 Anos ou mais , Criocirurgia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Resultado do Tratamento
16.
Urol Oncol ; 40(10): 451.e15-451.e20, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35851186

RESUMO

OBJECTIVE: To understand oncologic outcomes of focal cryoablation for prostate cancer and efficacy MRI and PSA to predict residual disease and recurrence. METHODS: We retrospectively analyzed patients who underwent focal cryotherapy at a single institution. Inclusion criteria included clinically localized biopsy-proven cancer that was clearly visible on MRI or ultrasound. The primary outcomes were failure-free survival (FFS) defined as no transition to radical, whole-gland or systemic therapy and biochemical recurrence (Phoenix PSA nadir +2 increases), and secondary outcomes included changes in the Gleason grade group (GG) and MRI findings. RESULTS: 75 patients completed post cryotherapy biopsy with a median follow-up of 1.89 [IQR 1.19-2.77] years. Failure free survival was met by 96.2% of patients at 2 year follow up and of those who did not meet this outcome, 3 had metastasis, 1 had a salvage prostatectomy and 5 underwent radiation. On the treated side of the prostate, 7 (9.5%) of patients had residual ≥GG2 disease compared to 7 (9.5%) patients on the untreated side. Out of the 12 patients who had residual ≥GG2 disease at follow up biopsy (either on treated or untreated side of the prostate), 11 (91.7%) had PI-RADS 1-3 on follow up MRI. Using a multivariate cox proportional hazards model, Phoenix criteria for recurrence (PSA nadir +2) was not predictive for FFS. CONCLUSIONS: Focal cryotherapy is effective for treating focal lesions of prostate cancer, but patients require continued surveillance. MRI and PSA are not reflective of residual disease on follow up biopsy.


Assuntos
Criocirurgia , Neoplasias da Próstata , Criocirurgia/efeitos adversos , Progressão da Doença , Humanos , Imageamento por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia/cirurgia , Antígeno Prostático Específico , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
17.
Europace ; 24(9): 1420-1429, 2022 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-35737685

RESUMO

AIM: Evaluate the novel PolarX Cryoballoon in atrial fibrillation (AF) catheter ablation through a propensity-matched comparison with the Arctic Front Advance (AFA). The aim was also to identify cryoablation metrics that are predictive of successful pulmonary vein isolation (PVI) with the PolarX Cryoballoon. METHODS AND RESULTS: This prospective multi-centre study included patients that underwent cryoablation for AF. All patients underwent PVI with reconnection assessed after a 30-min waiting period and adenosine. Safety, efficacy, and cryoablation metrics were compared between PolarX and a propensity-matched AFA cohort. Seventy patients were included with 278 veins treated. In total, 359 cryoablations were performed (1.3 ± 0.6 per vein) to achieve initial PVI with 205 (73.7%) veins isolating with a single cryoablation. Independent predictors for achieving initial PVI included temperature at 30 s [odds ratio (OR) 1.26; P = 0.003] and time to reach -40°C (OR 1.88; P < 0.001) with an optimal cut-off of ≤-38.5°C at 30 s [area under the curve (AUC) 0.79; P < 0.001] and ≤-40°C at ≤32.5 s (AUC 0.77; P < 0.001), respectively. Of the 278 veins, 46 (16.5%) veins showed acute reconnection. Temperature at 30 s (≤-39.5°C, OR 1.24; P = 0.002), nadir temperature (≤-53.5°C, OR 1.35; P = 0.003), and time to isolation (≤38.0 s, OR 1.18; P = 0.009) were independent predictors of sustained PVI. Combining two of these three targets was associated with reconnection in only 2-5% of PVs. Efficacy and safety of the PolarX Cryoballoon were comparable to AFA Cryoballoon, however, cryoablation metrics were significantly different. CONCLUSIONS: The PolarX Cryoballoon has a different cryoablation profile to AFA Cryoballoon. Prospective testing of these proposed targets in large outcomes studies is required.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Adenosina , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Benchmarking , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Humanos , Estudos Prospectivos , Veias Pulmonares/cirurgia , Recidiva , Fatores de Tempo , Resultado do Tratamento
18.
JACC Clin Electrophysiol ; 8(6): 795-799, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35738857

RESUMO

Thirty-eight patients had assessment of pulmonary vein occlusion with the dielectric mapping system and injection of saline as an alternative to contrast. Contrast injection was required to ascertain pulmonary vein occlusion in 31.6% (12 of 38) of subjects and 17.4% (27 of 155) of veins. No contrast was required in the last 13 subjects. In this single center study, a novel mapping-guided cryoablation approach appeared to minimize the use of contrast in pulmonary vein isolation for the treatment of atrial fibrillation.


Assuntos
Fibrilação Atrial , Criocirurgia , Veias Pulmonares , Pneumopatia Veno-Oclusiva , Fibrilação Atrial/cirurgia , Criocirurgia/efeitos adversos , Estudos de Viabilidade , Humanos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Pneumopatia Veno-Oclusiva/cirurgia , Resultado do Tratamento
19.
Eur Respir J ; 60(5)2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35710261

RESUMO

BACKGROUND: In patients with interstitial lung diseases (ILD), histopathological input is often required to obtain a diagnosis. Surgical lung biopsy (SLB) is considered the reference standard, but many patients are clinically unfit to undergo this invasive procedure, and adverse events, length of hospitalisation and costs are considerable. This European Respiratory Society (ERS) guideline provides evidence-based clinical practice recommendations for the role of transbronchial lung cryobiopsy (TBLC) in obtaining tissue-based diagnosis in patients with undiagnosed ILD. METHODS: The ERS Task Force consisted of clinical experts in the field of ILD and/or TBLC and methodological experts. Four PICO (Patient, Intervention, Comparator, Outcomes) questions and two narrative questions were formulated. Systematic literature searches were performed in MEDLINE and Embase (up to June 2021). GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology was applied. RESULTS: In patients with undiagnosed ILD and an indication to obtain histopathological data: 1) TBLC is suggested as a replacement test in patients considered eligible to undergo SLB, 2) TBLC is suggested in patients not considered eligible to undergo SLB, 3) SLB is suggested as an add-on test in patients with a non-informative TBLC, 4) no recommendation is made for or against a second TBLC in patients with a non-informative TBLC and 5) TBLC operators should undergo training, but no recommendation is made for the type of training required. CONCLUSIONS: TBLC provides important diagnostic information in patients with undiagnosed ILD. Diagnostic yield is lower compared to SLB, at reduced serious adverse events and length of hospitalisation. Certainty of the evidence is mostly "very low".


Assuntos
Criocirurgia , Doenças Pulmonares Intersticiais , Humanos , Biópsia/métodos , Broncoscopia/métodos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Pulmão/patologia , Doenças Pulmonares Intersticiais/patologia
20.
Europace ; 24(Supplement_2): ii14-ii21, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35661868

RESUMO

Atrial fibrillation (AF) is a commonly encountered chronic and progressive heart rhythm disorder, characterized by exacerbations and remissions. Contemporary clinical practice guidelines recommend a trial of antiarrhythmic drugs (AADs) as the initial therapy for sinus rhythm maintenance; however, these medications have modest efficacy and are associated with significant adverse effects. Recently, several trials have demonstrated that an initial treatment strategy of cryoballoon catheter ablation significantly improves arrhythmia outcomes (e.g. freedom atrial tachyarrhythmia and reduction in arrhythmia burden), produces clinically meaningful improvements in patient-reported outcomes (e.g. symptoms and quality of life), and significantly reduces subsequent healthcare resource utilization (e.g. hospitalization), without increasing the risk of serious or any adverse events. These findings are relevant to patients, providers, and healthcare systems, helping inform the decision regarding the initial choice of rhythm-control therapy in patients with treatment-naïve AF.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Antiarrítmicos/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Humanos , Qualidade de Vida , Resultado do Tratamento
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