Cryoablation Research Articles

EP022 - Cryoablation (CA) versus Radiofrequency Ablation (RFA) in kidney nodules: Which one is the best technique?

EP022 - Cryoablation (CA) versus Radiofrequency Ablation (RFA) in kidney nodules: Which one is the best technique?

Is balloon cryoablation effective in common pulmonary trunk?

Abstract Introduction Common pulmonary trunk (CPT) accounts for the most frequent pulmonary vein anatomical variation. The most frequent technique used for pulmonary vein isolation (PVI) is point-by-point radiofrequency, using cryoablation (CB) is still debatable. Some few studies have shown the feasibility and safety of CB in CPT atrial fibrillation (AF) patients (pts), most of them performed angio-CT prior to ablation. Purpose To analyzed AF pts with and without CPT submitted to CB in regarding of success rate and safety. Methods Single-center retrospective study of consecutive AF pts refractory to antiarrhythmics submitted to CB between 2017 and 2020. Before the procedure auriculography was performed in all pts to verify variations in pulmonary veins, however the procedure was not modify regarding the presence of CPT. Clinical records were analyzed to determine baseline characteristics, success rate and complications. Monitoring was performed with a 7-day event loop recorder at 3, 6 and 12 months and annually from the 2nd year. Success was defined by recurrence of AF (duration >30 seconds). Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using Chi-square and Mann-Whitney analysis. Results A total of 232 pts (60±12 years, 68% males) underwent CB. 29 pts had CPT (28 – common left pulmonary trunk and 2 – common right pulmonary trunk). Baseline characteristics were similar between groups, except for CHA2DS2VASc score and prior cerebrovascular disease history which were higher in CPT pts (3±2 vs 2±2, p=0.001; 24.1% vs 6.8%, p=0.007, respectively). The mean baseline CHA2DS2VASc was 2±2 and the median post-CB follow-up was 135 (IQ 32–249) days. Both the 1 and 3 year arrhythmic recurrence after AF ablation was not significantly different when comparing CPT and non CPT group with a 3 year success rate of 95.8% in pts with CPV against 86.5% in pts without CPT (p=0.299). There was no difference between groups (p=0.296; p=0,164, respectively) regarding the time of the procedure, radiation dose and rate of complications. Conclusions In our experience, balloon cryoablation for PVI is a safe and successful procedure in patients with CPT anatomical variation. Funding Acknowledgement Type of funding sources: None.

Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation.

BackgroundCatheter ablation (CA) is the first-choice treatment for tachyarrhythmia in children. Currently available CA techniques differ in mechanism of catheter navigation and energy sources. There are no large studies comparing long-term outcomes between available CA techniques in a pediatric population with atrioventricular reentry tachycardia (AVRT) or atrioventricular nodal reentry tachycardia (AVNRT) mechanisms.ObjectiveThis study aimed to compare procedural and long-term outcomes of remote magnetic navigation-guided radiofrequency (RF) ablation (RMN), manual-guided RF ablation (MAN) and manual-guided cryoablation (CRYO).MethodsThis single-center, retrospective study included all first consecutive CA procedures for AVRT or AVNRT performed in children without structural heart disease from 2008 to 2019. Three study groups were defined by the ablation technique used: RMN, MAN or CRYO. Primary outcome was long-term recurrence of tachyarrhythmia.ResultsIn total, we included 223 patients, aged 14 (IQR 12–16) years; weighting 56 (IQR 47–65) kilograms. In total, 108 procedures were performed using RMN, 76 using MAN and 39 using CRYO. RMN had significantly lower recurrence rates compared to MAN and CRYO at mean follow-up of 5.5 ± 2.9 years (AVRT: 4.3% versus 15.6% versus 54.5%, P < 0.001; AVNRT: 7.7% versus 8.3% versus 35.7%, P = 0.008; for RMN versus MAN versus CRYO respectively). In AVNRT ablation, RMN had significantly lower fluoroscopy doses compared to CRYO [30 (IQR 20–41) versus 45 (IQR 29–65) mGy, P = 0.040).ConclusionIn pediatric patients without structural heart disease who underwent their first AV(N)RT ablation, RMN has superior long-term outcomes compared to MAN and CRYO, in addition to favorable fluoroscopy doses.

INtra-procedural ultraSound Imaging for DEtermination of atrial wall thickness and acute tissue changes after isolation of the pulmonary veins with radiofrequency, cryoballoon or laser balloon energy: the INSIDE PVs study.

Preliminary data in human suggest that both Intracardiac echocardiography (ICE) and Intravascular ultrasound (IVUS) can be used for real-time information on the left atrial (LA) wall thickness and on the acute tissue changes produced by energy delivery. This pilot study was conducted to compare ICE and IVUS for real-time LA wall imaging and assessment of acute tissue changes produced by radiofrequency (RF), cryo and laser catheter ablation. Patients scheduled for RF, cryoballoon or laser balloon Pulmonary Vein Isolation (PVI) catheter ablation were enrolled. Each pulmonary vein (PV) was imaged before and immediately after ablation with either ICE or IVUS. The performance of ICE and IVUS for imaging were compared. Pre- and post-ablation measurements (lumen and vessel diameters, areas and sphericity indexes, wall thickness and muscular sleeve thickness) were taken at the level of each PV ostium. A total of 48 PVs in 12 patients were imaged before and after ablation. Both ICE and IVUS showed acute tissue changes. Compared to IVUS, ICE showed higher imaging quality and inter-observer reproducibility of the PV measurements obtained. Acute wall thickening suggestive of oedema was observed after RF treatment (p = 0.003) and laser treatment (p = 0.003) but not after cryoablation (p = 0.69). Our pilot study suggests that ICE might be preferable to IVUS for LA wall thickness imaging at the LA-PV junctions during ablation. Ablation causes acute wall thickening when using RF or laser energy, but not cryoenergy delivery. Larger studies are needed to confirm these preliminary findings.

MP59-07 LONG TERM COMPARATIVE OUTCOMES OF ROBOTIC PARTIAL NEPHRECTOMY AND CRYOABLATION IN PATIENTS WITH SOLITARY KIDNEYS: A SINGLE CENTER ANALYSIS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP59)1 Sep 2021MP59-07 LONG TERM COMPARATIVE OUTCOMES OF ROBOTIC PARTIAL NEPHRECTOMY AND CRYOABLATION IN PATIENTS WITH SOLITARY KIDNEYS: A SINGLE CENTER ANALYSIS Alp Tuna Beksac, Dillon Corrigan, Mahmoud Abou Zeinab, Zeyad Schwen, Alireza Aminsharifi, and Jihad Kaouk Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Dillon CorriganDillon Corrigan More articles by this author , Mahmoud Abou ZeinabMahmoud Abou Zeinab More articles by this author , Zeyad SchwenZeyad Schwen More articles by this author , Alireza AminsharifiAlireza Aminsharifi More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002094.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with solitary kidneys are sensitive to postoperative acute kidney injury (AKI) following partial nephrectomy (PN). Cryoablation (CA) is a viable alternative to partial nephrectomy (PN) in treating small renal masses of patients with solitary kidneys. In this study, we compared the functional and oncological outcomes of CA and PN in patients with solitary kidney. METHODS: From a single institution, 74 patients with a solitary kidney who underwent small renal mass treatment were selected. 31 patients underwent PN and 43 patients underwent CA. Functional and oncological outcomes were compared between the two groups, with a median follow up of 59.4 months. AKI is defined according to RIFLE (Risk, Injury, and Failure; and Loss; and End-stage kidney disease) criteria. Linear and logistic regression models were used for functional outcomes analysis, whereas oncological outcomes were analyzed using the Kaplan-Meier method. RESULTS: At baseline, the PN group had lower median age (59 years vs 68, p<0.001) and larger median tumor size (2.80 cm vs 2.0, p=0.003). AKI at discharge was more common in the PN group (58% vs 2.8%, p<0.001). eGFR preservation at discharge was higher in the CA group (100% vs 71%, p<0.001). However, eGFR preservation was similar at one year (92% vs. 88.7%, p=0.177) and last follow up (84% vs. 83%, p=0.443). Recurrence rate was higher in the CA group (26.3% vs 3.2%, p=0.009). Majority of recurrences were treated with repeat ablation (55.4%). Lower recurrence free survival (RFS) rate was seen in the CA group (p=0.027), however, overall survival (OS) was comparable between the two groups (p=0.16). CONCLUSIONS: CA is shown to decrease the transient AKI in the immediate outcome compared to PN. However, long term functional outcome is similar. Oncologically, CA has significantly higher recurrence rate and repeat treatment rate. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1032-e1032 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alp Tuna Beksac More articles by this author Dillon Corrigan More articles by this author Mahmoud Abou Zeinab More articles by this author Zeyad Schwen More articles by this author Alireza Aminsharifi More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement Loading ...

MP46-18 PATIENTS REPORT SATISFACTION/REGRET FOLLOWING FOCAL THERAPY FOR LOCALIZED PROSTATE CANCER: A PROSPECTIVE MULTICENTER EVALUATION

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy (MP46)1 Sep 2021MP46-18 PATIENTS REPORT SATISFACTION/REGRET FOLLOWING FOCAL THERAPY FOR LOCALIZED PROSTATE CANCER: A PROSPECTIVE MULTICENTER EVALUATION Alireza Ghoreifi, Masatomo Kaneko, Samuel Peretsman, Atsuko Iwata, Aliasger Shakir, Dordaneh Sugano, Jie Cai, Giovanni Cacciamani, Daniel Park, Osamu Ukimura, Duke Bahn, Inderbir Gill, and Andre Luis Abreu Alireza GhoreifiAlireza Ghoreifi More articles by this author , Masatomo KanekoMasatomo Kaneko More articles by this author , Samuel PeretsmanSamuel Peretsman More articles by this author , Atsuko IwataAtsuko Iwata More articles by this author , Aliasger ShakirAliasger Shakir More articles by this author , Dordaneh SuganoDordaneh Sugano More articles by this author , Jie CaiJie Cai More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Daniel ParkDaniel Park More articles by this author , Osamu UkimuraOsamu Ukimura More articles by this author , Duke BahnDuke Bahn More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Andre Luis AbreuAndre Luis Abreu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002067.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The objective is to evaluate the treatment decision satisfaction and regret among patients who underwent Focal Therapy (FT) for localized prostate cancer (PCa) with high-intensity focused ultrasound (HIFU) or cryoablation (CRYO). METHODS: We identified consecutive patients who underwent hemi-gland HIFU or CRYO FT as primary treatment for localized PCa at three US institutions (IRB# HS-17-00749). A survey with validated questionnaires was mailed between February and December of 2020, including: 5-question Decision Regret Scale (DRS); International Prostate Symptom Score (IPSS); and International Index of Erectile Function (IIEF-5). Potency was defined as IIEF-5 ≥ 18. The regret score was calculated based on the 5 items of DRS (Figure). Agreement with each item is measured on a 5-point scale and the final score is converted to a 0-100 scale. Regret was defined as DRS ≥ 26. Multivariable logistic regression models were applied to assess baseline and post-FT predictors for treatment decision regret. Statistically significant if p<0.05. RESULTS: Out of 236 patients, 143 (61%) responded the survey (71/116 HIFU and 72/120 CRYO). Baseline characteristics were similar between responders and no-responders. For the responders, the median (IQR) follow-up was 43 (26-68) months. The treatment decision regret rate was 19.6%, being CRYO 23.6% vs. HIFU 15.5% (OR 1.7, p=0.22). The Figure shows the details of patients’ responses to each DRS question. Higher PSA at nadir (OR 1.48, 95%CI 1.1-2, p=0.009) post FT, presence of PCa on the follow-up biopsy (OR 3.98, 95%CI 1.5-10.6, p=0.006), higher IPSS after FT (OR 1.18, 95%CI 1.01-1.04, p=0.03), and de-novo impotence (OR 6.67, 95%CI 1.57-27, p=0.03) were independent predictors of treatment decision regret. CONCLUSIONS: Focal therapy for localized PCa is well-accepted by the patients. Higher PSA at nadir, presence of cancer on the follow-up biopsy, higher post-operative IPSS, and de-novo impotence are independent predictors of treatment decision regret. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e820-e821 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi More articles by this author Masatomo Kaneko More articles by this author Samuel Peretsman More articles by this author Atsuko Iwata More articles by this author Aliasger Shakir More articles by this author Dordaneh Sugano More articles by this author Jie Cai More articles by this author Giovanni Cacciamani More articles by this author Daniel Park More articles by this author Osamu Ukimura More articles by this author Duke Bahn More articles by this author Inderbir Gill More articles by this author Andre Luis Abreu More articles by this author Expand All Advertisement Loading ...

Percutaneous cryoablation for high-complexity renal masses: complications, functional and oncological outcomes.

During the past two decades cryoablation (CA) has become a therapeutic option for the management of localized cT1 renal masses in comorbid patients. We analyzed the mid-term functional and oncological outcomes of CA in the treatment of cT1 renal masses which were classified as high-complexity masses according to the PADUA system. A total of 299 patients underwent percutaneous CA between November 2007 and December 2018 in 4 institutions for cT1N0M0 renal masses. All patients with high-complexity (PADUA≥10) renal tumors were included. Technical failure of CA was considered an exclusion criterion. Inclusion criteria were met by 45 patients. Median Charlson Comorbidity Index (CCI) was 6.0 (IQR: 5.0-7.0), median age was 74 years (IQR: 64.5-79.5). Seven Clavien 1 and 1 Clavien 2 procedure-related complications were reported. Median eGFR at baseline was 64.3mL/min (IQR: 52.0-82.3) while at the 1-year follow-up was 61.4 mL/min (IQR: 44.0-74.5). The median follow-up was 32 months (IQR: 13.25-47.5). Local recurrences were detected in 6 patients; 3 of them underwent re-cryoablation while the others started active surveillance. Median time to recurrence was 17.5 months (IQR: 7.8-27.3). Cancer-specific survival and metastasis-free survival were 100%, while overall survival was 86.7%. CA proved to be a valuable therapeutic option for the management of patients with cT1 high-complexity PADUA≥10 renal tumors as it provides a low rate of procedural morbidity and good preservation of renal function. However, these results are counterbalanced by a recurrence rate that appears to be higher than those reported on surgically treated patients.

MP42-02 PERCUTANEOUS IMAGE GUIDED CRYOABLATION AND RADIO-FREQUENCY ABLATION VERSUS PARTIAL NEPHRECTOMY FOR SMALL RENAL CELL CARCINOMAS: A TEN-YEARS, SINGLE CENTRE OBSERVATIONAL STUDY

INTRODUCTION AND OBJECTIVE:There is a lack of long-term evidence supporting the use of cryoablation (CRYO) and radio-frequency ablation (RFA) when compared to partial nephrectomy (PN) for the manag...

MP46-16 CRYOABLATION, HIGH-INTENSITY FOCUSED ULTRASOUND, IRREVERSIBLE ELECTROPORATION, AND VASCULAR TARGETED PHOTODYNAMIC THERAPY FOR PROSTATE CANCER: A SYSTEMIC REVIEW AND META-ANALYSIS

INTRODUCTION AND OBJECTIVE:Cryoablation (CA), high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), and vascular targeted photodynamic therapy (VTP) have been evaluated as n...

The ECLIPSE Study: Efficacy of Cryoablation on Metastatic Lung Tumors With a 5-Year Follow-Up

IntroductionThe ECLIPSE study aimed to evaluate the feasibility and efficacy of cryoablation (CA) for local tumor control in patients with pulmonary metastatic disease in 5 years of follow-up. MethodsECLIPSE was a prospective, multicenter, single-arm study that included patients treated with CA if they had one to five metastatic lung tumors, each with a diameter of less than or equal to 3.5 cm. Patients were followed up in the course of 5 years. The primary end point was local tumor control, both per tumor and per patient; secondary end points included cancer-specific survival, overall survival, and quality of life (QoL). QoL was evaluated using the Karnofsky Performance Score, the Eastern Cooperative Oncology Group performance score, and the Short Form-12 health survey. ResultsThe study included 40 patients across four sites (three in United States and one in Europe). A total of 60 metastatic pulmonary tumors were treated with 48 CA procedures. Overall local tumor control rates were 87.9% (29 of 33) and 79.2% (19 of 24) per tumor, 83.3% (20 of 24) and 75.0% (15 of 20) per patient, at 3 and 5 years, respectively. A total of five treated patients had local progression throughout the duration of the study. Disease-specific survival rate was 74.8% at 3 years and 55.3% at 5 years, whereas overall survival at 3 and 5 years was 63.2% and 46.7%, respectively. Patient QoL scores did not reach statistical significance. ConclusionsCA is an effective means of long-term local tumor control in patients with metastatic pulmonary tumors.

B-PO05-098 LOCAL IMPEDANCE CHARACTERISTICS OF PULMONARY VEIN RECONNECTIONS DURING REPEATED ATRIAL FIBRILLATION ABLATION PROCEDURES: INSIGHT FROM AN ITALIAN MULTICENTER REGISTRY

AF recurrence is highly associated with pulmonary vein (PV) reconnection. Limited data exist on PV gaps characterized by Local Impedance (LI). to characterize PV gaps and ablated tissue with a novel LI algorithm after repeated AF ablation procedures according to previous ablation strategy. Consecutive patients (pts) undergoing redo AF ablation from the CHARISMA registry at 6 Italian centers were included. Rhythmia mapping system was used to map the left atrium and PVs before and after ablation. LI characteristics were collected through a RF ablation catheter equipped with a dedicated LI algorithm (DirectSense). Each gap was characterized in terms of LI and its variations during the procedure. Ablation endpoint was PVI as assessed by entrance and exit block. A total of 41 PV gaps (mean number of gaps per pt=2.3±1.1) from 18 cases were detected: 20 gaps from 9 cases after RF ablation and 21 gaps from 9 cases after cryoablation. One gap was identified in 5 (28%) pts, 2 gaps in 7 (39%) and >3 gaps in 6 (33%). The mean LI at gap sites was 113.9±15Ω prior to ablation: it was significantly higher than LI at scar tissue closer to gap (99.7±8Ω, p<0.0001) but was significantly lower than LI at healthy tissue (120.2±12Ω, p<0.0001). Distances measurement between lesions previously performed at the roof, at the inferior and posterior wall were 53±22 mm, 44±19mm and 43±18mm, respectively, and were similar between previous ablation strategy (p=0.7449, p=0.9251 and p=0.8028). LI parameters did not differ between prior ablation approach (RF vs Cryo: 115.5±13Ω vs 112.2±16Ω for LI at gap, p=0.4739; 102.2±6Ω vs 97.3±10Ω LI at scar tissue, p=0.0591; 16.4±4Ω vs 15.8±13Ω for LI drop at gap, p=0.6647). In 14 cases (34.1%) the difference between LI at healthy tissue and LI at gap was lower than 5Ω, suggesting that this spot was not treated by RF or Cryo delivery in the previous ablation (13 out 21 after Cryo ablation vs 1 out 20 after RF ablation, p<0.0001). No complications during the procedures were reported. All PVs were successfully isolated in all study pts. LI characteristics at PV gaps significantly differ from both scar and healthy tissue. No significant difference was recorded between prior ablation approaches in terms of lesion extension.

The immediate trends in atrial electrical remodeling for paroxysmal atrial fibrillation across different modes of catheter ablation.

BackgroundCatheter ablation has emerged as a major strategy for paroxysmal atrial fibrillation (PAF). Atrial electrical remodeling (AER) plays a critical role in the recurrence of PAF after ablation.HypothesisTo characterize the immediate trends of AER during ablations in patients with PAF, and assess the relationship between immediate trends and recurrence.MethodsWe performed this prospective observational study of 135 patients to investigate AER following three ablation modes: radiofrequency ablation (RFA), cryoablation (CA) and 3D mapping‐guided cryoablation (3D‐CA). The atrial effective refractory period (AERP) and atrial conduction time (ACT) were measured via electrophysiology before and immediately after ablation, and P‐wave indices were measured via electrocardiography before and within 24 h after ablation. Follow‐up visits were conducted for at least 1 year or until relapse.ResultsDifferent approaches of ablation caused a fairly significant increase in the shortest P‐wave duration and AERP in both the proximal coronary sinus (PCS) and distal coronary sinus (DCS) but caused a shortened P‐wave dispersion. No different effect was found at the AERP among the three modes. Compared to patients who received CA, among patients who received RFA, a significant reduction in total ACT and right ACT was seen. Statistically, there was a weakly positive association between changes in total ACT and early recurrence.ConclusionsInjury during ablation for PAF was associated with an increase in the AERP but not in the ACT. Total ACT and right ACT were shorter after RFA than after CA. The increase in total ACT were slightly predictive of early recurrence.

Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction – Catheter ablation (CA) is a first-choice treatment for tachyarrhythmia in pediatric patients. The currently available CA techniques differ in manner of catheter steering technique and energy sources. There are no large studies comparing long-term outcomes between the available CA techniques in pediatric patients with atrioventricular reentry (also known as accessory pathway mediated) tachycardia (AVRT) or atrioventricular nodal reentry tachycardia (AVNRT) mechanisms. Objective – The aim of this study was to compare procedural parameters and outcomes of remote magnetic navigation-guided radiofrequency (RF) ablation (RMN), manual-guided RF ablation (MAN) and manual-guided cryoablation (CRYO). Methods – This single-center, retrospective study included all first consecutive CA procedures for AVRT or AVNRT mechanisms performed in pediatric patients with no structural heart disease from January 2008 until June 2019. Three study groups were defined by the ablation technique used: RMN, MAN or CRYO. Primary outcome was recurrence of tachyarrhythmia and/or pre-excitation on ECG. Baseline clinical parameters, procedure times and complication rates were also evaluated. Results – In total, we included 223 patients, aged 13.8 ± 2.8 years, with a mean weight of 55.6 ± 14 kilograms. In total, 108 procedures were performed using RMN, 76 using MAN and 39 using Cryo. RMN had the lowest recurrence rates at a mean follow-up of 5.5 ± 2.9 years (AVRT ablation: 4% vs. 16% vs. 55%, P &amp;lt; 0.001; AVNRT ablation: 8% vs. 8% vs. 36%, P = 0.008; for RMN vs. MAN vs. CRYO respectively). In AVRT ablation, procedure and fluor times were comparable between groups. However, in AVNRT ablation, RMN and MAN had significantly lower fluoroscopy times compared to Cryo (10 (IQR 7-14) vs. 9 (IQR 6-26) vs. 15 (IQR 10-22) minutes respectively, P = 0.040). Moreover, procedure times were shortest in MAN and second in RMN ablation (101 (IQR 87-121) vs. 88 (IQR 62-99) vs. 120 (IQR 88-143) minutes respectively, P = 0.018). We observed minor complications in 3 patients (1%), which were comparable between groups and no major complications. Conclusion – In pediatric patients with no structural heart disease who underwent their first AV(N)RT ablation, RMN has the most favorable long-term outcomes, in addition to favorable fluoroscopy and procedure times. Abstract Figure. AVRT and AVNRT ablation recurrence rates

Impact of pulmonary veins anatomy on outcome of cryoablation or radiofrequency catheter ablation for atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Pulmonary vein isolation is the cornerstone of interventional treatment of atrial fibrillation (AF). Pulmonary veins frequently display anatomic variants. If this influences the recurrence of AF after catheter ablation is still a matter of debate. PURPOSE Our aim was to determine if pulmonary vein anatomy variants influences the recurrence of AF after catheter ablation with radiofrequency or cryoablation. METHODS Retrospective analysis of patients with paroxysmal or persistent atrial fibrillation who underwent pulmonary vein isolation by radiofrequency (RF) or cryoablation (CA) in a single center between January 2017 and September 2019. All patients underwent computed tomography before AF ablation. Within each treatment group (RF or CA), patients were stratified according to their PV anatomy in: regular (2 left PVs and 2 right PVs) or variant (left common trunk, right common trunk, bilateral common trunk, right intermediate branch or other). The primary end-point was 1-year recurrence of AF. Recurrence was defined as electrical documented AF. RESULTS A total of 425 patients (RF = 300 and CA = 125), aged 56.6 ± 11.7 years, 277 men (65.0%) were enrolled. The majority of patients had paroxysmal AF (n = 343, 81.5%). Mean CHA2DS2-VASc score was 1.12 ± 1.28. Regular PV anatomy was identified in 357 patients (84.0%), a left common trunk in 53 patients (12.5%), a bilateral common trunk in 5 patients (1.2%), a right intermediate branch in 3 patients (0.7%) and other mixed variants in 7 patients (1.6%). There were no significant differences in the baseline clinical and echocardiographic characteristics between groups. At 1-year follow-up, patients with atypical PV anatomy had more AF recurrence (regular 8.1% vs variant 16.2%; p = 0.037). Analyzing according to the ablation technique there was no difference in AF recurrence between PV anatomy groups in patients submitted to radiofrequency (regular 8.3% vs variant 13.0%; p = 0.224). On the other hand, in cryoablation group, patients with PV anatomic variant had significantly higher rates of 1-year AF recurrence (regular 7.8% vs variant 22.8%; p= 0.033). CONCLUSION The presence of atypical PVs anatomy seems to be associated with higher rates of AF recurrence at 1-year in patients undergoing cryoablation. Further prospective studies are needed to confirm the PV anatomy impact in the success of the procedure and if this needs to be accounted in the choice of ablation technique. Abstract Figure. Recurrence in AF after cryoablation

Characteristics of pulmonary vein gaps through a novel local impedance algorithm at repeat AF ablation procedures: preliminary results from the CHARISMA registry

Abstract Funding Acknowledgements Type of funding sources: None. Background A high incidence of pulmonary vein (PV) reconnection has been reported in patients with clinical recurrences of AF. Detailed characterization of PV gaps in terms of local impedance (LI) is still lacking. Purpose to characterize PV gaps with a novel local impedance algorithm during redo PV ablation in AF patients (pts). Methods Consecutive pts undergoing repeated AF ablation from the CHARISMA registry with complete characterization of PV gaps through local impedance at 6 Italian centers were included. A complete map of the left atrium and PVs was performed prior and after ablation through the Rhythmia mapping system. A novel RF ablation catheter with dedicated algorithm (DirectSense) was used to measure LI at the distal electrode of this catheter. Each gap was characterized in terms of LI and its variations during ablation procedure according to different ablation sites around the PVs. 7 sites around the left and right pair of PV for LI evaluation during ablation were defined: 2 for posterior sites (PS) (posterior inferior and posterior superior), 2 for anterior sites (AN) (anterior inferior and anterior superior), 1 for interior site (INF), 1 for superior site (SUP) and 1 for the carina (CAR). Ablation endpoint was PVI as assessed by entrance and exit block. Results Eighteen cases of redo AF ablation were analyzed (9 after prior RF ablation, 9 after prior cryoablation). A total of 41 PV gaps were detected (20 after RF ablation, 21 after cryoablation; mean number of gaps per pt = 2.3 ± 1.1): one gap was identified In five (27.8%) pts, 2 gaps were present in 7 (38.9%) pts, 3 gaps were detected in 2 (11.1%) pts and 4 gaps were identified in the remaining 4 (22.2%) pts. PV gaps were most common at AN sites (17, 41.5%), followed by PS sites (12, 29.3%) and CAR sites (11, 28.6%). The mean LI at gap sites was 113.9 ± 15Ω prior to ablation: it was significantly higher than LI at scar tissue closer to gap (99.7 ± 8Ω, p &amp;lt; 0.0001) but was significantly lower than LI at healthy tissue (120.2 ± 12Ω, p &amp;lt; 0.0001). LI parameters did not differ between prior ablation approach (RF vs Cryo: 115.5 ± 13Ω vs 112.2 ± 16Ω for LI at gap, p = 0.4739; 102.2 ± 6Ω vs 97.3 ± 10Ω LI at scar tissue, p = 0.0591; 16.4 ± 4Ω vs 15.8 ± 13Ω for LI drop at gap, p = 0.6647). In 14 cases (34.1%) the difference between LI at healthy tissue and LI at gap was lower than 5Ω, suggesting that this spot was not treated by RF or Cryo delivery in the previous ablation session (13 out 21 after Cryo ablation vs 1 out 20 after RF ablation, p &amp;lt; 0.0001). No complications during the procedures were reported. The acute procedural success was 100%, with all PVs successfully isolated in all study patients. Conclusion In our preliminary experience, PV gaps after failed PVI were most common at anterior, followed by posterior and carina sites. LI characteristics at PV gaps significantly differ from both scar and healthy tissue and could be used to target ablation deliveries.

Abstract No. 467 Analysis of healthcare cost and resource utilization associated with thermal ablation of renal cell carcinoma

To compare hospital expenditures and resource utilization associated with radiofrequency (RFA), cryoablation (CA), and microwave (MWA) for cT1N0M0 renal cell carcinoma (RCC) A retrospective evaluation was conducted in 470 of computer tomography (CT)-guided thermal ablations of biopsy-proven RCC treated with between October 2006 and June 2019. Components of direct and indirect costs were tabulated and compared across the three different ablation modalities. Deterministic sensitivity analysis was performed to evaluate the effect of the individual cost components in the overall cost of ablative treatment. In-hospital resource utilization incurred from the start of the procedure to 30 days after hospital discharge was examined for each ablative technique. Continuous variables were analyzed using the one-way ANOVA test, and categorical variables were analyzed using Pearson’s chi-squared test and the Kruskal-Wallis test. A total of 470 T1N0M0 RCCs with a mean size of 3.2 cm (range, 0.5–6.9 cm) were treated with MWA (n = 86, 18%), RFA (n = 344, 73%) or CA (n = 40, 9%). Baseline patient or tumor characteristics did not differ significantly between the three groups. The median cost of MWA was significantly lower than that of RFA and CA with a cost advantage of $3835 and $2714, respectively (P = 0.0001). The number of ablation probes used was a major determinant of the overall cost, and MWA used the least number of probes (P = 0.0001). Additionally, MWA was associated with the lowest utilization of procedure room time, anesthesia medications, and radiation dose when compared to RFA and CA (P = 0.001, P = 0.001, and P = 0.001, respectively). Hospital spending and resource utilization in the 30 days immediately after the procedure are similar among the three ablative techniques. Microwave ablation is associated with lowest procedural costs and resource utilization compared to RFA and CA for the treatment of T1 RCC. These findings may incentivize wider use of MWA to optimize value-based care in ablation practice.

Abstract No. 23 Thermal ablation for anatomically complex renal tumors: assessment of periprocedural and treatment outcomes of microwave ablation, radiofrequency ablation, and cryoablation

To evaluate whether the choice of thermal ablative modality impacts the rate of perioperative complications and treatment outcomes for anatomically complex renal cell carcinoma (RCC) A retrospective analysis was performed for 83 patients (M:F = 51:32, mean age = 75 years) who underwent computer tomography (CT)-guided thermal ablation between October 2008 and March 2019. Tumor complexity was assessed by the RENAL nephrometry scoring system, wherein an RCC with a score greater than 10 is considered to be anatomically complex. The rate of complications, residual disease, and local recurrence were compared among radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation (CA), using the Chi-Square test. The Kaplan-Meier method was used to compute cancer-specific survival rates in each group, which were compared using the log-rank test. A total of 83 anatomically complex RCC measuring between 1.9 to 5.2 cm in diameter were treated with CT-guided MWA (n = 20,24%), RFA (n = 57,69%) or CA (n = 6,7%). There was no significant difference in baseline patient or tumor demographics among the three groups. MWA is associated with significantly decreased ablation time (P = 0.001), procedural time (P = 0.001) and sedation dosage (P = 0.001), when compared to RFA and CA groups. All three ablative modalities resulted in similar rates of complications, residual disease and local recurrence (P = 0.07, P = 0.27, P = 0.10, respectively). CT-guided MWA, RFA and CA resulted in comparable perioperative complications and treatment outcomes for anatomically complex RCC. The choice of ablative modality does not appear to impact local recurrence and survival outcomes for complex renal tumors.

Abstract No. 24 External validation of the renal ablation-specific P-RAC scoring system to predict procedure complexity or complications from percutaneous renal ablation

The percutaneous renal ablation complexity (P-RAC) score is a renal ablation-specific scoring system reported to predict the complexity of a percutaneous renal ablation (PA), including number of probe insertions, procedure duration, and requirement of adjunctive techniques such as hydrodissection. Yet, it has not yet been tested against an external population of patients or in modalities other than microwave ablation (MWA). The purpose of this study is to validate the ability of the P-RAC score to predict the complexity of PA in an external population that underwent either MWA or cryoablation (CA).

"Modern approaches for antiandrogen-resistant prostate cancer therapy

Prostate cancer represents the leading malignant tumor in men over 50 years of age with 400,000 new cases being diagnosed yearly in Europe. Even if the incidence rate is higher than the mortality rate, still there is an increasing trend when speaking of its mortality. The increasing incidence of the metabolic syndrome, the unhealthy lifestyle, the high lipid and Calcium intake, the high spread of infections with Human Papilloma Virus, Human Herpes Virus, the excess of androgen consumption and the longer life expectancy, are few of the main causes of prostate cancer increasing incidence. The new systemic therapies such as immunotherapy with Checkpoint Inhibitors or Poly, ADP-Ribose Polymerase inhibitors and local experimental procedures addressing tumor destruction, such as High- Intensity Focused Ultrasound, the Cryo and Focal Laser Ablation, provide good outcomes and become new promising tools for prostate cancer therapy. Physicians consider these methods worth using; the efficacy of some specific categories of patients being arguments for their use in the current protocols even though solid data regarding the improvement of global mortality rates are not yet published. The current article focuses on the newest systemic and local experimental treatment tools highlighting their benefits, especially for hormone-resistant prostate cancer.

Percutaneous cryoablation for advanced and refractory extra-abdominal desmoid tumors

To assess efficacy and safety of percutaneous cryoablation (CA) for advanced and refractory extra-abdominal desmoid tumors. This retrospective study reviewed 30 consecutive patients with symptomatic desmoid tumors evolving after "wait and watch" periods, and despite medical treatment, treated by CA between 2007 and 2019. Progression free survival (PFS), objective response rate, pain reduction (decreased of visual analogic scale pain (VAS)[Formula: see text] 3 or disappearance of pain), total volume lesion (TVL) and complications were documented. Kaplan Meier method was used to outline PFS. Paired sample t test was used to compare volume of tumors before treatment and at 1 and 3year. With a median follow-up of 18.5months (range 6-93months, interquartile range (IQR): 12-55), the PFS was 85.1% at 1year and 77.3% at 3years. Objective response was obtained for 80% of patients with a complete response for 43% patients. Pain reduction was obtained for 96.7% (95% confidence interval (95% CI): 90.3, 100) of patients. Median volume of desmoid tumor before treatment was 124.1cm3 (range 2-1727cm3, IQR: 54-338cm3). Median change of TLV after ablation was 66.6% (95% CI: 37.2, 72.3; p = 0.002) at 1year and 76.4% (95% CI: 59.1, 89.8; p = 0.002) at 3year. Adverse events rate was 36.6%, the most common was edema and temporary increase of pain in the days following CA. Four patients experienced a major complication (13.3%): 2 skin necrosis, 1 infection and 1 brachial plexopathy. CA is an effective treatment for advanced and refractory extra-abdominal desmoid tumor, that induces durable responses.