Ethanol Ablation Research Articles

Trans catheter edge to edge repair for mitral regurgitation and left ventricular outflow obstruction in hypertrophic cardiomyopathy

Abstract Background Based on previous reports, mitral valve transcatheter edge to edge repair (TEER) may be considered in patients with severe mitral regurgitation (MR) and left ventricular obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) that are high risk for surgery. Objective We aimed to evaluate the feasibility, and immediate and short-term outcomes of mitral TEER in symptomatic patients with severe MR and HOCM. Methods Five patients (age 75±6, 3 men) with severe MR and HOCM with high surgical risk, and anatomy not suitable for septal ethanol ablation, who remained symptomatic despite maximally tolerated drug therapy were selected for TEER using the MitrClip system. Result The procedure was performed successfully on all 5 patients. Devices were deployed at the A2-P2 scallops of the mitral valve. MR severity declined from severe to mild in all patients, left ventricular outflow (LVOT) maximal gradient decreased from 140±46 to 8±5 mmHg after TEER, and was 41±32 mmHg at 4±2 month follow- up, Clinically, all patients reported improvement of their symptoms to Class I-II NYHA functional Class. Conclusion TEER may be a beneficial procedure for severely symptomatic patients with severe MR and obstructive HOCM on maximal tolerated medical therapy, who are not amenable to surgery because of excessive risk, old age, and frailty.Pre and Post procedure EchoPre and Post Cath

Effect of Ultrasound-Guided Ethanol Ablation in Management of Benign Cystic Thyroid Nodules

Effect of Ultrasound-Guided Ethanol Ablation in Management of Benign Cystic Thyroid Nodules

Anatomical Treatment Strategies for Persistent Atrial Fibrillation with Ethanol Infusion within the Vein of Marshall—Current Challenges and Future Directions

Currently, pulmonary vein isolation (PVI) is the gold standard in catheter ablation for atrial fibrillation (AF). However, PVI alone may be insufficient in the management of persistent AF, and complementary methods are being explored. One such method takes an anatomical approach—improving both its success rate and lesion durability may lead to improved treatment outcomes. An additional approach complementary to the anatomical one is also attracting attention, one that focuses on epicardial conduction. This involves ethanol ablation of the vein of Marshall (VOM) and can be very effective in blocking epicardial conduction related to Marshall structure; it is becoming incorporated into standard treatment. However, the pitfall of this “Marshall-PLAN”, a method that combines an anatomical approach with ethanol infusion within the VOM (Et-VOM), is that Et-VOM and other line creations are not always successfully completed. This has led to cases of AF and/or atrial tachycardia (AT) recurrence even after completing this lesion set. Investigating effective adjunctive methods will enable us to complete the lesion set with the aim to lower the rates of recurrence of AF and/or AT in the future.

S4013 Sugar Shortage: A Case of Insulinoma Managed by EUS-Guided Ethanol Ablation

S4013 Sugar Shortage: A Case of Insulinoma Managed by EUS-Guided Ethanol Ablation

Feasibility of Ethanol Ablation of the Vein of Marshall in Patients with Coronary Sinus Leads

Feasibility of Ethanol Ablation of the Vein of Marshall in Patients with Coronary Sinus Leads

A novel treatment:EUS-guided ethanol ablation for primary hyperparathyroidism ineligible by percutaneous access(with video)

A novel treatment:EUS-guided ethanol ablation for primary hyperparathyroidism ineligible by percutaneous access(with video)

The Efficacy of Renal Denervation in Treating Resistant Hypertension: A Systematic Review.

Resistant hypertension is blood pressure (BP) that is persistently above target in spite of the maximally tolerated usage of at least three anti-hypertensives simultaneously. The sympathetic nervous system is instrumental in blood pressure (BP) regulation. Renal (sympathetic) denervation involves using ablative energy to disrupt the sympathetic nerves in renal arteries. This systematic review examines the efficacy of this treatment modality. Abiding by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we conducted an extensive literature search in five databases, Cochrane Library, Google Scholar, PubMed, PubMed Central (PMC), and ScienceDirect, to retrieve studies that are free, open access, and published in English done within the past four years. Nineteen articles passed critical appraisal. These articles were randomized controlled trials (RCT), a case report, a cross-sectional study, a cohort study, and previous reviews. Renal denervation (RDN) was generally superior to sham control in patients with resistant hypertension for reducing various systolic blood pressure (SBP) measures, including 24-hour ambulatory, daytime, and nighttime SBP. The efficacy was highest in patients whose baseline SBP was higher. BP reduction was sustained for years post-procedure. The procedure had a good safety profile with no severe complications. Future studies should compare the efficacy of different types of renal denervation, such as ethanol ablation versus radiofrequency ablation, and renal denervation against other procedure-based treatment modalities,such as carotid baroreceptor stimulation and transcranial direct current stimulation.

Vein of Marshall ethanol infusion for recurrent atrial fibrillation in patients with durably isolated pulmonary veins.

Vein of Marshall (VoM) ethanol ablation has a proven benefit in patients with persistent atrial fibrillation (AF) undergoing index procedure; however, its role in repeat ablation is unknown. We sought to evaluate the benefit of empiric VoM ethanol ablation in addition to posterior wall isolation (PWI) during the repeat procedure in patients with durable pulmonary vein (PV) isolation from prior ablation. Twenty-three patients (age 67.1 + / - 7.4, 74% males) who received empiric VoM ethanol infusion in addition to PWI were matched for age, gender, ejection fraction, and left atrial size with forty-six patients receiving empiric PWI alone. All patients in the study group underwent additional ablation on mitral isthmus to complete the lateral mitral isthmus line. Additional ablation was based on program and trigger stimulation. Primary outcome was freedom from AF after a blanking period of 3months by qualification of symptoms, EKG, wearable, or implantable monitor or device. The study group had a higher average BMI (35.07 + / - 8.98 vs. 30.85 + / - 5.65, p = 0.033) and rate of persistent AF (83.0% vs. 54.3%, p = 0.029) versus the control. The 1-year AF-free survival for the study and control groups was 20 (86.96%) and 28 (60.1%) patients (p = 0.027). Cox proportional hazard regression analysis showed a significant reduction in AF recurrence in the study group (HR 0.25, 95% CI 0.073-0.843, p = 0.026). Among patients undergoing repeat catheter ablation for recurrent AF with durably isolated PVs, the addition of VoM ethanol infusion increased the likelihood of remaining free from AF at 12months.

Light‐activatable minimally invasive ethyl cellulose ethanol ablation: Biodistribution and potential applications

Light‐activatable minimally invasive ethyl cellulose ethanol ablation: Biodistribution and potential applications

Posterior wall isolation with pulsed field ablation or radiofrequency ablation with vein of marshall ethanol ablation for the treatment of atrial fibrillation

Abstract Background In patients undergoing repeat catheter ablation for atrial fibrillation (AF) two ablation strategies beyond pulmonary vein isolation (PVI) have recently gained increased interest: posterior wall isolation (PWI) using pulsed field ablation (PFA) and Vein of Marshall (VoM) ethanol ablation combined with radiofrequency energy ablation (RFA). However, a direct comparison is lacking. Purpose To compare prospectively enrolled patients undergoing repeat catheter ablation for persistent AF using PVI and PWI with PFA (PFA group) vs. PVI and VoM ethanol ablation using RFA (VoM group) regarding procedural characteristics, safety, myocardial injury and outcomes. Methods Patients undergoing redo PFA-PVI with PWI and VoM ethanol ablation with RFA were included. Isolation and bidirectional block were checked using a multipolar mapping catheter. High-sensitivity cardiac troponin T (hs-cTnT) was measured after 24h of ablation. Results A total of 84 patients were included (age 69 [interquartile range (IQR) 63-75] years; ejection fraction 56% [IQR 48-60%]; left atrial size 42 [IQR 37-47] mm), baseline characteristics did not differ significantly between groups. Of these, 54 patients (64%) were in the PFA group and 30 (36%) in the VoM group. The procedure duration (65 [IQR 56-73] minutes vs 116 [IQR 103-142] minutes; p < .001) and fluoroscopic times (11 [IQR 8–14] minutes vs 14 [IQR 12-19] minutes; p < .001) were significantly shorter for the PFA group than for the VoM group. No major complications were observed except for a probable allergic reaction in the VoM group and a transient AV-block in the PFA group. High-sensitivity cardiac troponin levels post ablation were similar between the PFA group and the VoM group with 886 [IQR 627–1260] ng/L and 793 [IQR 543-1199] ng/L, p=0.28, respectively. During follow-up (median duration 230 [IQR 117-370] days), AF recurrence was observed in 15% in the PFA group and in 40% in the VOM group (p ≤ 0.01). Conclusion In patients undergoing repeat catheter ablation for AF, PVI and PWI using PFA is associated with shorter procedure and fluoroscopic times, similar high-sensitivity cardiac troponin levels and a reduced recurrence rate compared to PVI using RFA with additional VoM ethanol ablation.Central Illustration

Acute hemodynamic effects of the Marshall-Plan ablation on left and right atrial pressure: does 'respecting atrial physiology' prevent stiff left atria? A retrospective single- center analysis

Abstract Introduction Stiff left atrium (STILA)-syndrome is a relevant concern after extensive ablation in the left atrium (LA) e.g. in persistent atrial fibrillation (AF). STILA often causes disabling heart failure symptoms worse than the initial arrhythmia symptoms. Therefore preventing adverse ablation-induced hemodynamic effects is of utmost concern. Methods This single-center study retrospectively analyzed data from 89 consecutive patients who underwent biatrial ablation for AF following the Marshall-Plan between February 2022 and November 2023. The procedures included ablation of the CTI and PVI where necessary followed by ablation of a LA roof line and ablation of the lateral mitral isthmus after previously performed ethanol ablation of the vein of Marshall. This lesion set is considered to maintain physiological activation of the LA. This study evaluates acute hemodynamic changes following the Marshall-Plan. Invasive hemodynamic measurements of mean left and right atrial pressure, as well as A- and V-waves were performed in all patients before and after the ablation. We assessed the acute changes of atrial hemodynamics in these procedures. Continuous data are given as mean ± standard deviation, categorical data are expressed as number and percentages. Differences between groups were determined by Student’s t-test, chisquare-test, and Fisher’s exact test using SPSS software. A p-value of <0.05 was deemed significant. Results The patients' mean age was 70.1 ± 7.5 years and 39.0% were female. Mean BMI was 28.9 ± 5.2 kg/m². Procedures were performed under general anesthesia (with a PEEP of 5.5cmH2O (2-10 cmH2O)) and took 181 minutes on average. Left atrial mean pressure averaged at 15.7mmHg before the procedure. The overall average change of left atrial mean pressure was +1,8mmHg. The average change in left atrial A- and V-Wave amounted to -1.9mmHg and -0.9mmHg respectively. The pre-procedural average right atrial mean pressure was 12.1mmHg. Right atrial mean pressure inclined by +1.6mmHg. The average change in right atrial A- and V-Wave was +0.6mmHg and +1.1mmHg respectively. The i.v. administered volume averaged 1900 ± 285ml. 3.3% of patients showed an increase of mean LA-pressure >9mmHg. Those patients tended to be older (74.3years), were all male (100%) and had a higher BMI (31.5 kg/m²) as well as higher amount of i.v. administered volume (2333ml) and a longer procedure (213min). Discussion Complex and extensive biatrial ablation following the Marshall-Plan does not lead to acute significant increases in left or right atrial pressures. The administered i.v. volume might explain the slight increases observed. In our observation, the rate of significant increases in LA-pressure is low. This suggests that disrupting the (left) atrial activation pattern might play a role in the development of diastolic dysfunction and thereby STILA-syndrome. Respecting atrial physiology may be beneficial for preventing adverse hemodyamic changes after ablation.

Acute impact of vein of marshall ethanol infusion combined with anatomical ablation validated by pacing in redo ablation of persistent atrial fibrillation

Abstract Background Catheter ablation with radiofrequency in persistent atrial fibrillation (PeAF) has limited success and a significant proportion of patients requires redo ablation. Several trials showed that addition of vein of Marshall ethanol infusion (Vom-EI) to catheter ablation, compared with catheter ablation alone, increases the possibilities of remaining free of AF. No data are available about the effect on VoM-EI in Pe-AF patients that undergo a redo ablation. Purpose We evaluated acute impact on lesion formation post-VoM-EI and the mitral line block validation after a methodical approach including VoM-EI and check of pulmonary vein isolation (PVI), roof-line, mitral line (ML) and cavo-tricuspid isthmus line in a population of PeAF patients undergone redo ablation. We aimed also the results of a short follow-up. Methods Consecutive patients undergoing redo ablation for PeAF were enrolled. All patients underwent check of PVI, left atrium (LA) roofline and cavotricuspid isthmus line and, if necessary, ablation was completed. In all patients, after a detailed electroanatomical map of the LA (filter at 0.05-0.5 mV if the patient was in sinus rhythm or 0.05-0.3 mV in the case of AF), we proceeded with the VoM-ETHO. LA map was thus repeated to assess the extension of the newly-formed low voltage area (LVA). According to the newly-formed LVAs, the validation of mitral line was obtained by the evidence of bidirectional block. In presence of conduction through the mitral line also after endocardial revision, we proceeded to mapping and ablating in the CS epicardial gaps in the "anchored wall" or in the "free-wall"of the great cardiac vein (GCV). Results Twenty consecutive patients (64±8 years and 65% male) undergone redo ablation for AF with VoM-EI were included in this study. All patients underwent PVI in the previous procedure but only in 11 roof line has been performed. In twenty patients (52%) reconnection of PV was observed (12/20 in right superior pulmonary vein). In 4/11 roof line was not complete. The medium value of basal LA-LVAs was 3.38土5.27 cmq and the newly-formed LVAs after the VoM-EI procedure was 9.21土5.63 cmq. All patients achieved bidirectional block validated across ML: in 8/20 after epicardial gaps ablations into the anchored wall of GCV and in 6/20 after epicardial gaps ablation in the free wall of GCV. The ML procedural time was 18.82土12.79 minutes. The number of radiofrequency irrigation was 20.11土10.56. No major complications occurred. Five patients had VOM dissection without consequences. During a short follow-up period (6土5 months), only one patient had AF recurrences after the blanking period of one month. Conclusions VoM ethanol ablation added to PVI and linear lesions in the context of a methodical and anatomical approach during redo ablation of PeAF patients seems to have promising results and to be safe. Longer follow-up is needed to understand the role of this technique in redo ablation.

Coronary venous ethanol ablation of refractory left ventricular summit arrhythmias: comparison with radiofrequency ablation

Abstract Background Radiofrequency (RF) ablation of ventricular premature beats (VPBs) and ventricular tachycardia (VT) arising from the left ventricular (LV) summit is challenging and may fail due to anatomical inaccessibility of the substrate. Coronary Venous Ethanol Ablation (CVEA) has been suggested as a bailout strategy following failed RF ablation of LV Summit Arrhythmias (LVSA). Comparison with RF ablation strategies are lacking. Purpose To compare CVEA with RF ablation for the treatment of LVSA. Methods Between January and November 2023, 20 patients were treated with CVEA for LVSA. Results were compared to 36 patients that underwent RF ablation for LVSA (Panel A). Endo- and/or epicardial RF ablation was performed based on local signal precocity and pace-mapping. Coronary venogram-guided mapping of coronary sinus side-branches was performed using an angioplasty wire connected to our EP-recording system using a crocodile clamp. The target veins were specifically selected based on early presystolic potentials and confirmed by matching VPB pace-maps. For the treatment, angioplasty balloon(s) measuring 2-2.5×6-8 mm were employed to administer ethanol into the target branch of the coronary sinus. Data are reported as mean ± standard deviation, unless otherwise indicated. P-values are two-tailed. Results (Panel B): Patient characteristics were similar for both groups, except for the number of prior failed ablation procedures (75% males; mean age: 63 ± 13 y; 31 with structural heart disease; mean LVEF 39 ± 9%; VPB burden 25 ± 12%; Number of (NS)VT 72 ± 151; 65% redo in case of CVEA, 28% for RF). Mean pace-match was 97 ± 1% (99.8% max.) for CVEA versus 93 ± 8% (97% max.) for RF ablation (P = 0.002). Earliest presystolic signal was -70 ms (-49 ± 12) for CVEA versus -50 ms (-31 ± 12) for RF (P = 0.0002). Acute success, defined as elimination of VPB/VT was 95% versus 83% for CVEA and RF ablation respectively. VPB burden at Holter was 1 ± 3% 6-8 weeks after CVEA versus 8 ± 10% following RF ablation (P = 0.024). In patients with VT, number of (NS)VT decreased by 90% after CVEA (P = 0.014), while this was not significant for RF ablation. After a median follow-up of 8 months (IQR 2-10), 15% of CVEA patients showed residual non-LV summit ventricular arrhythmia as compared to 39% showing recurrence of LV summit VPB or VT following RF ablation. No patients died. One patient developed tamponade following RF ablation and one patient received PCI in the CVEA group. Conclusion Retrograde coronary venous ethanol ablation is an effective ablation strategy for the treatment of LV summit arrhythmias, also compared to conventional RF ablation.

Analysis of trends in radiofrequency ablation in a tertiary care center practice.

Radiofrequency ablation (RFA) for thyroid nodules has recently been introduced into the United States healthcare system landscape. Little is known about the process of incorporating this procedure into existing clinical practice. A retrospective chart review of a single institution was conducted to examine referral patterns and decision-making after the introduction of RFA into an endocrine surgery-focused practice. Patient demographics and thyroid-specific data were recorded. Two reviewers abstracted and coded reasons for the noncompletion of RFA. Two-sample t tests were used to compare groups; linear regression was used to assess trends and practice patterns. Chart review identified 451 patients referred for consideration of RFA from January 2020 to December 2022. Only 255 (56.5%) went on to receive the treatment. There was no significant difference in nodule volume between treated and nontreated groups (18.5 vs. 14.9 cm3, p = 0.07). Concern for malignancy on genetic testing, size (too large/too small), recommendation for Ethanol ablation, and multinodular disease without target nodules were the most common reasons for physician deferral. Of patients who declined to proceed, 46% opted to undergo surgical excision. Linear regression showed that referral numbers significantly increased with time; however, the proportion of patients receiving treatment decreased yearly, primarily because of higher rates of physician deferral. This study reflects the complex decision-making in offering minimally invasive thyroid nodule ablation. Despite a greater number of referrals over time, physician criteria became increasingly selective. Optimal candidacy in RFA is an evolving determination requiring patient and physician input to guide ideal practice patterns.

Development of a 3D in vitro human-sized model of cervical dysplasia to evaluate the delivery of ethyl cellulose-ethanol injection

Introduction: Cervical cancer, the second leading cause of cancer-related death for women worldwide, remains a preventable yet persistent disease that disproportionately affects women in low and middle-income countries (LMICs). While existing therapies for treating cervical dysplasia are effective, they are often inaccessible in LMICs. Ethanol ablation is an alternative low-cost, accessible therapy that we previously enhanced into ethyl cellulose (EC)-ethanol gel formulation to improve efficacy.Methods: To evaluate the efficacy of EC-ethanol, in this study, we developed a 3D in vitro model of cervical dysplasia featuring a central lesion of cervical cancer cells surrounded by fibroblasts and keratinocytes. Using a GelMA hydrogel formulation (8.7% w/v), we successfully built a 3D model that captured the architectural complexity of cervical dysplasia. We evaluated changes in cell coverage and cell viability. Then, we compared the viscoelastic properties of the GelMA hydrogels to human cervical tissue and using micro-CT imaging, we assessed EC-ethanol injection deposition in the hydrogel, revealing retention of virtually the entire injected volume near the injection site. Finally, we measured changes in cell viability and cell coverage after the EC-ethanol injection.Results: The developed 3D in vitro model successfully replicated the architectural complexity of cervical dysplasia, demonstrating high cell viability and capturing cell responses effectively. The GelMA hydrogel formulation (8.7% w/v) exhibited viscoelastic properties akin to human cervical tissue. Micro-CT imaging revealed efficient deposition of EC-ethanol within the hydrogel, with retention of the injected volume near the injection site. Furthermore, the EC-ethanol injection significantly reduced cervical cancer cell viability and cell coverage while preserving healthy cells within the model.Conclusion: Our findings indicate that our 3D in vitro model mirrored the architecture of cervical dysplasia and demonstrated the potential of EC-ethanol for localized treatment of cervical dysplasia.

Ethanol Ablation of Ranulas and Risk Factor Analysis for Recurrence

Ethanol ablation (EA) was shown to be safe and effective for treating ranula, but few studies have assessed long-term outcomes and recurrence of ranula after EA. To evaluate the long-term outcomes and the risk factors for recurrence and receipt of subsequent surgery in patients who underwent treatment with EA for ranula. This case-series study was conducted at a single tertiary hospital and assessed patients who were treated with EA between July 2009 and March 2021. Among 70 consecutive patients, those with follow-up loss or who were followed up for less than 24 months were excluded. EA for ranula. The primary outcome was recurrence at last follow-up after single or multiple EA sessions. Secondary outcomes included receipt of subsequent surgery and the recurrence-free survival (RFS) rate after initial EA. Factors possibly associated with outcomes included patient age and sex; ranula site, type, diameter, volume, and echogenicity; the presentation-to-EA interval; parapharyngeal space extension; and sublingual gland herniation. Risk factors were identified on logistic regression analyses. Two-year RFS rates were analyzed for the initial cohort using the Kaplan-Meier method and compared by log-rank tests. A total of 57 patients (mean [SD] age, 26.4 [12.1] years; 24 female individuals [42%]) who were followed up for a median of 57 months (range, 24-167 months) were included. The recurrence rate was 33% (n = 19), and 11 (19%) underwent subsequent surgery. Among patients with recurrence, 86% (31 of 36) experienced first recurrence within 12 months after initial EA. A presentation-to-EA interval of 12 months or longer was associated with an increased risk of recurrence (adjusted odds ratio [OR], 3.74; 95% CI, 1.01-13.82). No risk factors were significantly associated with subsequent surgery (highest OR in parapharyngeal space extension: adjusted OR, 4.96; 95% CI, 0.94-26.35). Among the initial cohort of 70 patients, 2-year RFS was lower in a maximum diameter of ranula of 5 cm or greater than less than 5 cm (24% [95% CI, 7%-41%] vs 50% [95% CI, 34%-66%]; difference, 26% [95% CI, -4% to 56%]; log-rank test, P = .02). This case-series study found that the recurrence rate of ranula after EA was 33%. A presentation-to-EA interval of 12 months or longer may be a risk factor for recurrence, suggesting that early intervention with EA might minimize recurrence. Most first recurrences occurred within 12 months after EA, with a maximum diameter of ranula of 5 cm or greater being a possible risk factor.

A Solvent Exchange Induced Robust Wet Adhesive Hydrogels to Treat Solid Tumor Through Synchronous Ethanol Ablation and Chemotherapy.

The treatment of tumors in developing countries, especially those with poor medical conditions, remains a significant challenge. Herein, a novel solvent-exchange strategy to prepare adhesive hydrogels for the concurrent treatment of tumors through synchronous ethanol ablation and local chemotherapy is reported. First, a poly (gallic acid-lipoic acid) (PGL) ethanol gel is prepared that can undergo solvent exchange with water to form a hydrogel in situ. PGL ethanol gel deposited on the wet tissue can form a hydrogel in situ to effectively repel interfacial water and establish a tight contact between the hydrogel and tissue. Additionally, the functional groups between the hydrogels and tissues can form covalent and non-covalent bonds, resulting in robust adhesion. Furthermore, this PGL ethanol gel demonstrates exceptional capacity to effectively load antitumor drugs, allowing for controlled and sustained release of the drugs locally and sustainably both in vitro and in vivo. In addition, the PGL ethanol gel can combine ethanol ablation and local chemotherapy to enhance the antitumor efficacy in vitro and in vivo. The PGL ethanol gel-derived hydrogel shows robust wet bioadhesion, drug loading, sustained release, good biocompatibility and biodegradability, easy preparation and usage, and cost-effectiveness, which make it a promising bioadhesive for diverse biomedical applications.

Comparison of efficacy and safety of different minimally invasive therapies for thyroid nodules: A network meta-analysis.

This study aimed to compare efficacy and safety of minimally invasive therapies such as radiofrequency ablation (RFA), microwave ablation (MWA), ethanol ablation (EA), and laser ablation (LA) for thyroid nodules through network meta-analysis (NMA). This study searched PubMed, Web of Science, Embase, and The Cochrane Library databases to collect randomized controlled trials (RCTs) or cohort studies comparing efficacy and safety of different minimally invasive therapies for thyroid nodules. Newcastle-Ottawa Scale (NOS) was implemented to assess quality of included cohort studies, and Cochrane risk of bias assessment tool was utilized to evaluate quality of included RCTs. Eligible studies contained at least one of the following clinical outcome measures: volume reduction rate (VRR), symptom score, cosmetic score, nodule regrowth rate, and complication rate. STATA software was utilized for NMA. Sixteen eligible studies (4 RCTs, 11 retrospective cohort studies, 1 prospective cohort study) involved 4094 patients. NMA results revealed that RFA group had the highest VRR at 1 months and 12 months. There were no significant differences in symptom scores and cosmetic scores among all treatment methods, with the lowest symptom scores and cosmetic scores in RFA group. LA group had a significantly higher nodule regrowth rate than RFA and MWA groups, with the lowest in RFA group. There were no significant differences in complication rate among all treatment methods. RFA had the highest VRR for thyroid nodules, and it excelled in symptom scores, cosmetic scores, and nodule regrowth rates.

Can Ethanol Ablation Achieve Durable Control of Neck Nodal Recurrences in Adults With Stage I Papillary Thyroid Cancer?

Results of ethanol ablation (EA) for controlling neck nodal metastases (NNM) in adult patients with papillary thyroid carcinoma (APTC) beyond 6 months have rarely been reported. We now describe outcome results in controlling 71 NNM in 40 node-positive stage I APTC patients followed for 66 to 269 months. All 40 patients were managed with bilateral thyroidectomy and radioiodine therapy and followed with neck ultrasound (US) for >48 months after EA. Cumulative radioiodine doses ranged from 30 to 550 mCi; pre-EA 27 patients (67%) had 36 additional neck surgeries. Cytologic diagnosis of PTC in 71 NNM selected for EA was confirmed by US-guided biopsy. EA technique and follow-up protocol were as previously described. The 40 patients had 1 to 4 NNM; 67/71 NNM (94%) received 2 to 4 ethanol injections (total median volume 0.8 cc). All ablated 71 NNM shrank (mean volume reduction of 93%); nodal hypervascularity was eliminated. Thirty-eight NNM (54%) with initial volumes of 12-1404 mm3 (median 164) disappeared on neck sonography. Thirty-three hypovascular foci from ablated NNM (pre-EA volume range 31-636 mm3; median 147) were still identifiable with volume reductions of 45% to 97% observed (median 81%). There were no complications and no postprocedure hoarseness. Final results were considered to be ideal or near ideal in 55% and satisfactory in 45%. There was no evidence of tumor regrowth after EA. Our results demonstrate that for patients with American Joint Committee on Cancer stage I APTC, who do not wish further surgery or radioiodine, and are uncomfortable with active surveillance, EA can achieve durable control of recurrent NNM.

Differential Pacing Maneuver From the Vein of Marshall.

Bidirectional mitral isthmus (MI) block is conventionally verified by differential pacing from the coronary sinus (CS) and its sequence change. This study aimed to evaluate the ability of differential pacing from the vein of Marshall (VOM) to detect epicardial MI connections. Radiofrequency and VOM ethanol MI ablation were performed with a VOM electrode catheter inserted to the septal side of the ablation line. MI block was verified using conventional CS pacing. To perform differential VOM pacing analysis, initial pacing was delivered from a distal VOM bipole closer to the block line, and then from a proximal VOM bipole. The intervals from pacing stimulus during different VOM pacing sites to the electrogram recorded through the CS catheter on the opposite side of the line were compared. When the interval during distal VOM pacing was longer than that during proximal VOM pacing, it indicated a VOM connection block; however, if the former interval was shorter, the connection through the VOM was considered persistent. Overall, 50 patients were evaluated. According to CS pacing, MI ablation was incomplete in 9 patients, in whom the analysis indicated persistent VOM connection. Among 41 patients with complete MI block, confirmed by CS finding, in 30 (73%) patients, the interval during distal VOM pacing was longer than that during proximal VOM pacing by 11±5 ms. However, in 11 patients (27%) the former interval was revealed to be shorter than the latter by 16±8 ms, indicating residual VOM connection. Conduction time across the line was significantly shorter in 11 patients than in the other 30 (166±21 versus 197±36 ms; P<0.01). Ten successful reevaluated analyses after VOM ethanol and further radiofrequency ablation of the connection indicated VOM block achievement. Differential VOM pacing maneuver reflects the VOM conduction status. This maneuver can uncover residual epicardial connections that are missing with CS pacing.