Radiofrequency Ablation Group Research Articles

Long-term outcomes of radiofrequency ablation and cyanoacrylate closure for treatment of small saphenous veins

Aim: Superficial venous insufficiency is less prevalent in the lesser saphenous vein compared to the great saphenous vein. Treating the lesser saphenous vein often presents greater challenges due to its proximity to the sural nerve and anatomical variations. This study evaluates the long-term efficacy of radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) for managing small saphenous veins and discusses our treatment approach. Material and Methods: We performed a retrospective analysis involving 137 patients (64 treated with CAC and 73 with RFA) who received treatment for small saphenous vein insufficiency at our clinic between 2014 and 2019. We assessed quality of life and clinical outcomes at 6 months, and at 1, 3, and 5 years post-treatment. Results: Our findings indicated that radiofrequency ablation showed greater improvements compared to cyanoacrylate embolization in terms of VCSS. However, over the 5-year follow-up period, recurrence rates were observed in 11 (17.1%) patients in the CAC group and 5 (6.8%) patients in the RFA group, with this difference being statistically significant (p=0.045). Conclusion: Radiofrequency ablation for treating venous insufficiency offers superior long-term quality of life benefits compared to cyanoacrylate closure, particularly after three years.

Cord occlusion in twin reversed arterial perfusion sequence: a retrospective study of laser photocoagulation vs radiofrequency ablation.

Twin reversed arterial perfusion (TRAP) sequence is a rare condition complicating monozygotic multiple gestations. Prenatal management via umbilical cord occlusion (UCO) of the anomalous twin has been shown to improve pump twin survival. We compared outcomes of gestations with high-risk TRAP sequence treated with mid-trimester UCO using laser photocoagulation vs radiofrequency ablation (RFA). This is a retrospective, single-center, cohort study of all patients with high-risk TRAP sequence who underwent UCO from 2006-2023. High-risk criteria were defined as follows: larger abdominal circumference of the anomalous twin, polyhydramnios, critically abnormal Doppler waveforms in the pump twin, hydrops in the pump twin, and/or monoamniotic twins. The primary outcome was 30-day survival of the pump twin. The 74 patients were divided equally between the laser and RFA groups. For the 2 groups, mean gestational age (GA) at UCO (20.5 ± 2.3 vs 20.7 ± 3.1 weeks, P=.987) and mean GA at delivery (35.2 ± 4.6 vs 34.5 ± 5.7 weeks, P=.812) were similar. The 30-day neonatal survival rate did not differ (91.9% [34/37] vs 89.2% [33/37], OR: 1.37 [0.29-6.61], P=.692). No difference in 30-day neonatal survival was identified in patients with high-risk TRAP sequence who underwent mid-trimester UCO by laser vs RFA.

Does Radiofrequency Ablation Reduce Pain and Improve Maximal Incisal Opening More Effectively Than Electrocautery in Temporomandibular Joint Arthroscopy? A Pilot Study

The study compared the effectiveness of radiofrequency and electrocautery techniques in TMJ arthroscopic surgeries by evaluating changes in pain levels and maximal incisal opening before surgery and throughout a 30-day postoperative period. This prospective, randomized controlled trial included 62 patients with bilateral TMJ disorders classified as Wilkes stages III and IV. Patients were randomly assigned to two groups: Group 1 (n=31) underwent arthroscopy with electrocautery, and Group 2 (n=31) received radiofrequency ablation. Inclusion criteria were patients with Wilkes stages III or IV TMJ disorders. Exclusion criteria included previous TMJ surgery, significant systemic disease, or contraindications to surgery. Pain levels were assessed using the McGill Pain Questionnaire, and maximal incisal opening was measured preoperatively and up to 30 days postoperatively. The sample included 62 subjects with a mean age of 33.5 years, 80.6% female. The electrocautery group showed significantly greater maximal incisal opening at 12 hours, 7 days, and 14 days post-surgery compared to the radiofrequency ablation group. Pain levels did not differ significantly between groups, though the electrocautery group reported higher pain scores on postoperative day 14. Both groups showed similar pain improvement and maximal incisal opening changes over 30 days, with a trend towards more improvement in maximal incisal opening in the radiofrequency ablation group. No significant differences in complications or overall pain improvement were observed. Electrocautery and radiofrequency did not differ in postoperative pain outcomes; however, electrocautery was more effective in improving maximal incisal opening up to postoperative day 14.

Comparative study of CT-guided radiofrequency and alcohol ablation in the treatment of primary hyperhidrosis.

This study compared the efficacy and complications of percutaneous radiofrequency ablation with anhydrous alcohol ablation of sympathetic nerves in treating hyperhidrosis of the head and palms. A retrospective analysis was conducted on 54 patients with primary hyperhidrosis in our department from June 2018 to June 2021, divided into a radiofrequency ablation group (30 cases) and an anhydrous alcohol ablation group (24 cases). Treatment outcomes were compared by analyzing the number of CT scans, effectiveness, and complications. In the radiofrequency group, symptoms of bilateral hyperhidrosis significantly improved in 24 patients, with an 80% postoperative satisfaction rate. In the alcohol ablation group, symptoms significantly improved in 19 patients postoperatively, with a 79.2% satisfaction rate. There was no statistically significant difference in effectiveness or complications between the two groups (all P > 0.05). The number of CT scans in the radiofrequency group was 4.60 ± 0.56 and 6.08 ± 0.28 in the alcohol group, showing a statistically significant difference (P < 0.05). This study concluded that both percutaneous radiofrequency ablation and alcohol ablation are effective methods for hyperhidrosis treatment, with similar effectiveness and complication rates, but the radiofrequency ablation group required fewer CT scans.

Strategic timing- early and delayed catheter ablation in atrial fibrillation

Abstract Background Atrial fibrillation (AF) is the most common sustained arrhythmia. AF catheter ablation (CA) is superior to antiarrhythmic drug (AAD) therapy in maintaining sinus rhythm. However, not much is known regarding the optimal timing of the ablation. Purpose This review aims to examine the evidence supporting both early and delayed ablation approaches, as well as explore their respective disadvantages. Methods We performed an electronic search in databases such as PubMed, ScienceDirect, Springer, Wiley Online Library, focusing on studies published from 2013 until 2022 and including both observational studies and randomized controlled trials (RCTs). Left atrial diameter and ejection fraction (EF) were assessed. The limit between early and delayed ablation was set to be 3 years, considering delayed CA studies with a diagnosis-to-ablation-time (DAT) of 3 years or more, and early CA studies with a DAT of less than 3 years. Included studies were selected according to our eligibility criteria: observational studies or RCTs that included patients with symptomatic paroxysmal or persistent AF that underwent ablation using either radiofrequency or cryoballoon approach or both approaches, studies that reported DAT, studies that included a follow-up period, studies that evaluated AF recurrence or AF burden. Studies that included a surgical ablation, a hybrid ablation approach, or ablation for arrhythmias other than AF were excluded. Results Ten studies were selected out of 1387 identified records. After a follow-up period of 1 year, the early ablation subgroup had a lower mean AF recurrence rate (31.1%) compared to that of the delayed ablation subgroup (37.7%) ( p&amp;lt;0.0004). The median AF recurrence rate in radiofrequency ablation group was (47.8%) in comparison to the AF recurrence rate in cryoablation group which was (27.4%) (p&amp;lt;0.0001). In studies that included paroxysmal AF patients exclusively, the AF recurrence rate was directly proportional to the DAT(R=0.95). Conclusion Our results demonstrate that DAT correlates with recurrence rate at 1 year following AF CA, the shorter the DAT the better the outcome especially in paroxysmal AF population.Prisma study selection flow diagramCorrelation between DAT-AF recurrence

Haemolysis and acute tubular injury after pulsed field ablation compared to radiofrequency: An observational study

Abstract Background Pulsed field ablation (PFA) represents a novel promising non-thermal alternative in non-pharmacological treatment of atrial fibrillation (AF). However, infrequent cases of acute renal failure secondary to intravascular haemolysis after a PFA procedure have been described. Objective To investigate the impact of ablation technology (PFA vs. radiofrequency ablation (RFA)) on the level of plasma cell-free haemoglobin (CFH) and the concentration of serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of tubular injury. Methods This was a prospective observational trial. In a consecutive cohort of patients who underwent AF ablation (PFA of RFA), blood samples were drawn just before the procedure (Sample 1: CFH and NGAL), immediately after the procedure (Sample 2: CFH) and one day after the procedure (Sample 3: CFH and NGAL). Plasma CHF level and serum NGAL concentration were analysed using the ELISA technique. Results Among 70 patients enrolled (mean age 64.3 ± 10.3 years, 61 % male), 23 underwent RFA and 47 PFA (22 pulmonary vein isolation (PVI) only and 25 PVI with other additive lesions). Baseline serum creatinine levels of both groups were comparable (91.7 ± 22.1 µmol/L vs. 88.8 ± 22.1 µmol/L P = 0.44). In the PFA cohort, a significant peak of CFH concentration was observed just after the procedure with a subsequent decrease within 12 hours (Sample 1 vs. Sample 2: 93.4 ± 65.1 µg/mL vs. 2394.9 ± 1966.1 µg/mL P &amp;lt; 0.001, Sample 1 vs. Sample 3: 93.4 ± 65.1 µg/mL vs. 97.2 ± 68.5 µg/mL P = 0.75). No significant differences were observed in the RFA cohort. Compared to baseline, neither the PFA nor the RFA group showed a significant difference in NGAL levels (PFA 98.6 ± 31.7 ng/mL vs. 98.5 ± 38.1 ng/mL P = 0.78, RFA 108.3 ± 33.8 ng/mL vs. 116.3 ± 32.2 ng/mL P = 0.49). Conclusions Compared to RFA, PFA leads to significant peri-procedural haemolysis. However, no differences in the concentration of the tubular injury marker NGAL were observed on the first day after the procedure.

Comparison of laparoscopic hepatectomy and radiofrequency ablation for small hepatocellular carcinoma patients: a SEER population-based propensity score matching study.

This study was designed to compare the efficacy of laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) in terms of their therapeutic effect on small hepatocellular carcinoma (SHCC). The SEER database was employed to integrate SHCC patients who had received treatment with either LH (n = 1132) or RFA (n = 797). The LH group (n = 623) and the RFA group (n = 623) were matched with 1:1 propensity score matching (PSM) in order to reduce the possibility of selection bias. The Kaplan-Meier method and Cox proportional hazards regression method were employed to ascertain the prognostic factors associated with overall survival (OS) and disease-specific survival (DSS). Both before and after PSM, the 1, 3 and 5-years OS and DSS were significantly higher in the LH groups compared to the RFA group. Besides, for SHCC with tumor size ≤ 2cm (n = 418), even P values not reaching statistical significance, the survival curves were compatible with a superiority of LH over RFA for OS and DSS in overall (P = 0.054 and P = 0.077), primary SHCC (P = 0.110 and P = 0.058) and recurrent SHCC (P = 0.068 and P = 1.000) cohorts. In contrast, for SHCC with tumor size between 2 and 3 cm (n = 828), LH group always had a better OS and DSS in the all cohorts (all P < 0.05). In addition, higher AFP level, poor differentiation grade, recurrent tumor and treatment type were independent prognostic factors for OS, while poor differentiation grade, larger tumor size and treatment type were the independent prognostic factors for DSS (all P < 0.05). LH was associated with better OS and DSS than RFA in SHCC patients. Even in tumor size ≤ 2cm, LH still should be the first choice as its long-term survival benefits.

Retrospective Analysis of Radiofrequency Ablation in Patients with Small Solitary Hepatocellular Carcinoma: Survival Outcomes and Development of a Machine Learning Prognostic Model.

The effectiveness of radiofrequency ablation (RFA) in improving long-term survival outcomes for patients with a solitary hepatocellular carcinoma (HCC) measuring 5 cm or less remains uncertain. This study was designed to elucidate the impact of RFA therapy on the survival outcomes of these patients and to construct a prognostic model for patients following RFA. This study was performed using the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2017, focusing on patients diagnosed with a solitary HCC lesion ≤5 cm in size. We compared the overall survival (OS) and cancer-specific survival (CSS) rates of these patients with those of patients who received hepatectomy, radiotherapy, or chemotherapy or who were part of a blank control group. To enhance the reliability of our findings, we employed stabilized inverse probability treatment weighting (sIPTW) and stratified analyses. Additionally, we conducted a Cox regression analysis to identify prognostic factors. XGBoost models were developed to predict 1-, 3-, and 5-year CSS. The XGBoost models were evaluated via receiver operating characteristic (ROC) curves, calibration plots, decision curve analysis (DCA) curves and so on. Regardless of whether the data were unadjusted or adjusted for the use of sIPTWs, the 5-year OS (46.7%) and CSS (58.9%) rates were greater in the RFA group than in the radiotherapy (27.1%/35.8%), chemotherapy (32.9%/43.7%), and blank control (18.6%/30.7%) groups, but these rates were lower than those in the hepatectomy group (69.4%/78.9%). Stratified analysis based on age and cirrhosis status revealed that RFA and hepatectomy yielded similar OS and CSS outcomes for patients with cirrhosis aged over 65 years. Age, race, marital status, grade, cirrhosis status, tumor size, and AFP level were selected to construct the XGBoost models based on the training cohort. The areas under the curve (AUCs) for 1, 3, and 5 years in the validation cohort were 0.88, 0.81, and 0.79, respectively. Calibration plots further demonstrated the consistency between the predicted and actual values in both the training and validation cohorts. RFA can improve the survival of patients diagnosed with a solitary HCC lesion ≤5 cm. In certain clinical scenarios, RFA achieves survival outcomes comparable to those of hepatectomy. The XGBoost models developed in this study performed admirably in predicting the CSS of patients with solitary HCC tumors smaller than 5 cm following RFA.

Efficacy and safety of B-ultrasound-guided radiofrequency ablation in the treatment of primary liver cancer: Systematic review and meta-analysis.

Primary liver cancer is one of the most lethal malignancies in the world. Traditional treatment methods have limitations in terms of efficacy and safety. Radiofrequency ablation (RFA) guided by B-ultrasound, as a minimally invasive treatment, has attracted increasing attention in the treatment of primary liver cancer in recent years. To study the efficacy and safety of RFA were compared with those of traditional surgery (TS) for treating small liver cancer. At least 2 people were required to search domestic and foreign public databases, including foreign databases such as EMBASE, PubMed and the Cochrane Library, and Chinese databases such as the China National Knowledge Infrastructure database, China Biomedical Literature database, Wanfang database and VIP database. Controlled trials of RFA vs conventional surgery for small liver cancer were retrieved from January 2008 to January 2023. They were screened and evaluated according to the quality evaluation criteria in the Cochrane Handbook of Systematic Reviews. The meta-analysis was performed using RevMan 5.3 software. A total of 10 studies were included in this study, including 1503 patients in the RFA group and 1657 patients in the surgery group. The results of the meta-analysis showed that there was no significant difference in 1-year overall survival between the two groups (P > 0.05), while the 3-year and 5-year overall survival rates and 1-year, 3-year and 5-year tumor-free survival rates in the surgery group were greater than those in the RFA group (P < 0.05). In terms of complications, the incidence of complications in the RFA group was lower than that in the surgery group (P < 0.05). In terms of long-term survival, TS is better than RFA for small liver cancer patients. However, RFA has fewer complications and is safer.

Cost-effectiveness of radiofrequency ablation versus percutaneous ethanol injection for early hepatocellular carcinoma in a resource-poor setting: a randomized trial.

This study assessed the cost-effectiveness of radiofrequency ablation compared with percutaneous ethanol injection in patients with early hepatocellular carcinoma in relation to the objective response rate and costs related to the procedure. This was a prospective single-center randomized trial. The primary outcome was cost-effectiveness. Secondary outcomes were the complete response rate according to the modified response evaluation criteria in solid tumors 60 days after randomization and the complication rate within 180 60 days. Fifty patients were placed into the following groups: percutaneous ethanol injection (n=23) and radiofrequency ablation (n=27). Fifty-four nodules were randomized (mean follow-up: 205.37 days). The estimated mean hospital cost was US$ 1854.11 and US$ 2770.96 for the Radiofrequency Ablation and Percutaneous Ethanol Injection Groups, respectively. The incremental cost-effectiveness ratio was US$ -2674.59, which is advantageous for radiofrequency ablation. After 60 d, 28 of 29 nodules in the Radiofrequency Ablation Group achieved complete response versus 12 of 22 in the Percutaneous Ethanol Injection Group (RD, 42.01 [95%CI= 20.55-63.24]; p<0.001). Only four early complications were observed among patients treated by percutaneous ethanol injection (p<0.05). Late complications occurred in two and one patient(s) in the Radiofrequency Ablation and Percutaneous Ethanol Injection Groups (p>0.05), respectively. Radiofrequency ablation was more cost-effective and achieved higher complete response and lower complication rates than the Percutaneous Ethanol Injection Group within this cohort. NCT06450613.

Radiofrequency ablation therapy for knee osteoarthritis: a systematic review and meta-analysis.

The objective of the study is to systematically analyze the safety and efficacy of radiofrequency ablation (RFA) therapy for the treatment of patients with knee osteoarthritis (KOA) and to assess the methodological quality of the published studies. By searching the PubMed, Embase, and CENTRAL databases, we retrieved and collected relevant randomized controlled trials (RCTs) published up to June 26, 2023. We included 13 RCTs, involving a total of 865 patients. Compared with the control group, the RFA group had significantly reduced pain scores at 1-2 weeks, 4 weeks, 12 weeks, and 24 weeks post-treatment, with standardized mean differences of -1.24 (95% confidence interval [CI]: -1.99--0.49; p = 0.001; I2 = 91%), -0.76 (95% CI: -1.27--0.26; p = 0.003; I2 = 76%), -1.70 (95% CI: -2.56--0.83; p = 0.0001; I2 = 94%), and -2.26 (95% CI: -3.49--1.04; p = 0.0003; I2 = 95%). RFA, as an adjunctive treatment modality, demonstrates potential in the treatment of patients with KOA. This method may become a primary treatment strategy for these patients.

Open surgical excision vs. endoscopic radiofrequency ablation in managing congenital pyriform sinus fistula-a comprehensive analysis of 166 cases.

Congenital pyriform sinus fistula (CPSF) is uncommon congenital abnormality, and the optimal definitive treatment has not yet been established. The aim of the present study was to comparatively evaluate patients with CPSF regarding the indications and outcomes of treatment with open surgical excision (OSE) vs. endoscopic Radiofrequency Ablation (RA), and the advantages of both therapeutic procedures were also analyzed. An observational, longitudinal, retrospective, analytical and comparative study was conducted on 166 consecutive pediatric patients with CPSF treated at Shanghai Children's Hospital between December 2018 and September 2023. In this study, there were 79 males and 87 females. The median age at operation was 4.8 years (8 days to 15 years). OSE and Endoscopic RA were respectively performed in 48 and 118 children. The gastric tube retention time after RA was longer (3 days vs. 14 days) than after OSE. Patients with a history of incision and drainage (I&D) tended to choose OSE (75.0% vs. 39.0%, P < 0.01). There were no significant differences in postoperative complications and recurrence rates between these two groups (P > 0.05), but the hospitalization duration was shorter for RA group compared to OSE group [2 (2-3) vs. 4 (3-5), P < 0.01]. Both OSE and RA are recognized as first-line treatment options for CPSF, which show no significant differences in prognosis, except hospitalization duration and the gastric tube retention time. Nevertheless, the indications for OSE and RA differ, which are influenced by factors such as the inflammatory stage, specific typing, previous treatments, and the surgeon's expertise. The selection of surgical approach should be carefully determined based on individual circumstances.

Ultrasound-guided percutaneous radiofrequency ablation versus surgery for solitary T1N0M0 papillary thyroid carcinoma in the danger triangle.

To compare the safety and efficiency of ultrasound-guided percutaneous radiofrequency ablation (RFA) and surgical resection (SR) for thyroid papillary carcinoma (PTC) in the danger triangle area. The clinical data of 298 patients who underwent either percutaneous RFA or SR for PTC in the thyroid danger triangle at our hospital between January 2018 and April 2020 were retrospectively analyzed. Propensity score matching is employed to regulate for confounding factors. All patients undergoing ablation were treated using a strategy that combined sufficient paratracheal fluid isolation with a low-power, short electrode. Disease progression was analyzed in patients with T1N0M0 PTC (T1a and T1b) employed in Kaplan‒Meier curves. Treatment parameters and the rates of local recurrence, distant metastasis, and complications are recorded and compared. Of 182 eligible patients who were included, 91 were in the RFA (age 44.84 ± 13.19; 71 females; 77 T1a) and 91 were in the SR (age 47.36 ± 11.05; 68 females; 69 T1a). The average treatment time, length of hospital stays, blood loss volume, and scar length are substantially less in the RFA than in the SR. Major complications as well as postoperative permanent recurrent laryngeal nerve injury and postoperative transient parathyroid dysfunction occurred only in the SR, with a substantial distinction between the two groups (p < 0.05). There is no substantial distinction in the disease progression between RFA and SR treatment of T1N0M0 PTC. RFA is as effective as surgery for PTC in the danger triangle area in the short term, with faster recovery and fewer complications. Radiofrequency ablation has a clinical efficacy comparable to surgery in the treatment of papillary thyroid carcinoma in the danger triangle area in the short term with the advantages of faster recovery and fewer complications when compared with surgery. Use of radiofrequency ablation (RFA) in the thyroid danger triangle is still controversial. RFA and surgery groups showed no difference in disease progressions, and no major complications occurred with RFA. Radiofrequency ablation offers a new option for papillary thyroid carcinoma patients in the danger triangle.

Stereotactic body radiotherapy is an alternative to radiofrequency ablation for single HCC ≤5.0 cm

Background & AimsRadiation therapy has been refined with the increasing evidence of stereotactic body radiation therapy (SBRT) in treating hepatocellular carcinoma (HCC). In this study, we aimed to evaluate whether SBRT could serve as an alternative to radiofrequency ablation (RFA) for small HCC with a single lesion ≤ 5.0 cm. MethodsPatients with a single HCC lesion ≤ 5.0 cm who received RFA or SBRT were included. Cumulative local/distant recurrence rate (CLRR/CDRR), progression-free survival (PFS), overall survival (OS), adverse events (AEs) and subsequent treatments after recurrence were analyzed. ResultsA total of 288 patients received RFA (166) or SBRT (122) were enrolled. The baseline characteristics between the two groups were comparable. The CLRR in the SBRT group was significantly lower than that in the RFA group (HR = 0.30, 95%CI = 0.16 – 0.57, P < 0.001), especially for patients with tumors > 2.0 cm (HR = 0.20, 95% CI = 0.08 – 0.50, P < 0.001) or adjacent to major vessels (HR = 0.29, 95% CI = 0.13 – 0.66, P < 0.001). CDRR, PFS and OS showed no significant differences between the two groups (all P > 0.050). AEs were mild and easily reversible. However, more patients in the SBRT group suffered from Child-Pugh score and TB increase. More treatment options after recurrence or progression might be available for patients in the RFA group compared to those in the SBRT group (P < 0.001). ConclusionsBoth RFA and SBRT were effective and safe for HCC with a single lesion ≤ 5.0 cm. SBRT could be an alternative treatment to RFA, especially for tumors > 2.0 cm or adjacent to major vessels. Impact and implicationsStereotactic body radiation therapy (SBRT) may be used as an alternative therapy to thermal ablation for patients with BCLC stage A hepatocellular carcinoma (HCC) who are not candidates for surgical resection, including those with tumors > 3 cm and those with 1 to 3 tumors. This study focused on HCC patients with specific tumor burden, a single lesion ≤ 5.0 cm, demonstrating that SBRT could be an effective and safe alternative to radiofrequency ablation (RFA), especially for those with tumors > 2.0 cm or adjacent to major vessels. The findings of this study provided robust empirical evidence supporting for the utilization of SBRT in treating small HCC, while also establishing a solid foundation for future prospective clinical investigations.

Radiofrequency ablation compared to surgery for thyroid nodules: A case for office based treatment.

We aim to evaluate the safety and effectiveness of radiofrequency ablation (RFA) for benign thyroid nodules by ENT surgeons and to compare it to conventional hemithyroidectomy in the public healthcare, operating theater contained setting. 50 patients who underwent a single session of RFA for symptomatic benign thyroid nodules in Prince of Wales Hospital and Tseung Kwan O Hospital in Hong Kong from 2020 to 2022 were evaluated. Objective outcomes including nodule volume, volume reduction rate (VRR) and complications were recorded. Subjective response in the form of a 0-10 point scale for patient symptoms including obstructive, cosmetic, pain and satisfaction scores were collected. Significant reduction in mean VRR was found at 3, 6 and 12 months post treatment, accompanied by a significant reduction in the mean obstructive and cosmetic symptom scores. Comparing with conventional hemithyroidectomy, the RFA group had a significantly shorter mean procedure time and lower rate of complications. Estimated cost to patient for RFA was found to be less than half of that of hemithyroidectomy. RFA is a safe and effective treatment modality for benign thyroid nodules by ENT surgeons with advantages of being a scarless local anesthetic procedure with shorter procedure time, lower complication rate and lower cost to patient compared to hemithyroidectomy. In Hong Kong, where most of the population is treated in the public sector, there are limited resources, often with high caseload burden and long operation waiting times. Therefore, RFA is an office-based treatment that serves as a valuable alternative to hemithyroidectomy for benign nodules, especially in lower resource settings. 3.

Combined image-guided radiofrequency and iodine-125 seeds implantation in the treatment of recurrent hepatocellular carcinoma after hepatectomy

BackgroundCurrently, there is no consensus on the treatment of recurrent hepatocellular carcinoma (HCC) after hepatectomy. It is necessary to assess the efficacy and safety of radiofrequency ablation (RFA) combined with iodine-125 seeds implantation (RFA-125I) in the treatment of recurrent HCC.MethodsThis study retrospectively analyzed the clinical data of patients with postoperative recurrence of HCC receiving RFA-125I or RFA treatment from January 2013 to January 2023. Both RFA and 125I seeds implantation were performed under dual guidance of ultrasound and CT. Overall survival (OS), progression-free survival (PFS), recurrence, and complications were compared between the two groups.ResultsA total of 210 patients with recurrent HCC were enrolled in this study, including 125 patients in the RFA-125I group and 85 patients in the RFA group. The RFA-125I group showed a significantly better survival benefit than RFA group (median OS: 37 months vs. 16 months, P < 0.001; median PFS: 15 months vs. 10 months, P = 0.001). The uni- and multivariate analysis showed that RFA-125I was a protective factor for OS and PFS. There were no procedure-related deaths and no grade 3 or higher adverse events in both groups.ConclusionsRFA combined with 125I seeds implantation under dual guidance of ultrasound and CT is effective and safe for the treatment of HCC patients with recurrence after hepatectomy.

Cryoballoon versus radiofrequency catheter ablation: 3-year follow-up data from the prolonged Norwegian randomized study of persistent atrial fibrillation (NO-PERSAF study)

Abstract Background Pulmonary vein isolation (PVI) is still regarded as a cornerstone for treatment of persistent atrial fibrillation (AF). Both radiofrequency ablation (RFA) and cryoballoon ablation (CBA) are frequently employed to achieve PVI. Similar results of both techniques have been reported during short follow-up, but clinical outcomes for long-term follow-up from randomized trials are still missing. Purpose This study aimed to evaluate the effectiveness of PVI performed with CBA compared with RFA in patients with persistent AF over 3 years. Methods For the NO-PERSAF study, 101 patients (63.2±8.6 years old, 80 male, 21 female), with persistent AF (77 persistent AF, 24 long-standing persistent AF) referred to PVI were randomized (1:1) to CBA or RFA and followed for 12 months. All patients participating in the NO-PERSAF study were invited to an extended outpatient evaluation with 12-lead ECG and 7-day Holter. The primary endpoint was any documented recurrent atrial tachyarrhythmia (ATA) lasting longer than 30 s during 3 years after the index ablation procedure (following a 3-month blanking period). The ATA-free survival curves were estimated by Kaplan-Meier method and analyzed by log-rank test. Results One patient crossed over from CBA to RFA group because of equipment problem during index ablation procedure. 99 of the original 101 patients responded (1 died of non-cardiovascular diseases, 1 lost). Freedom from ATA was achieved in 51 (50.5%) of the 101 patients, 28 (54.9%) out of 51 patients in the CBA group and 23 (46.0%) out of 50 patients in the RFA group (Figure 1). No difference of ATA recurrence was found between the two groups (p=0.327). There was significantly (p=0.031) less atrial flutter in the CBA group (7.8%; 4 atypical) compared with the RFA group (22%; 10 atypical, 1 typical). 28 patients received repeat ablations with RFA during the follow-up period, 15 in the CBA group and 13 in the RFA group (1 twice). Freedom from ATA after multiple ablations was achieved in 74 (73.3%) of the 101 patients, 40 (78.4%) out of the 51 patients in the CBA group and 34 (68.0%) out of the 50 patients in the RFA group. No difference of ATA recurrence was found between the two groups (p=0.178, Figure 2) after multiple ablations with RFA for AF and atrial flutter. Noticeably, 2 patients in the CBA group and none in the RFA group received atrioventricular nodal ablation after permanent pacemaker implantation. Conclusions Compared to RFA, PVI performed with CBA showed similar outcome of freedom from ATA over a long-term follow-up of 3 years. However, the incidence of atrial flutter was significantly lower in the CBA group.Figure 1Figure 2

Comparison of pulsed field ablation and thermal ablation for repeat procedures after failed prior thermal ablation for atrial fibrillation

Abstract Background Procedural efficiency and long-term clinical outcome after a first pulmonary vein isolation (PVI) for atrial fibrillation (AF) with pulsed-field ablation (PFA) has recently been reported to be non-inferior compared to radiofrequency ablation (RFA) and cryoballoon ablation (CBA). Studies comparing PFA and RFA for a first redo procedure in patients with failed prior thermal PVI are lacking. Purpose We sought to compare procedural efficiency and 1-year success rate (i.e maintenance of sinus rhythm) between PFA and RFA in patients undergoing a first redo procedure due to recurrence of atrial tachyarrhythmias after a prior thermal PVI. Methods Patients with recurrences after a 90-day blanking period following an index PVI with either RFA or CBA referred for a first redo ablation were enrolled. All redo procedures were done using a 3D electro-anatomical mapping to identify PV reconnections and guide repeat PVI by either PFA or RFA. In cases of incomplete or ostial isolation, the PFA group was treated using the standard 8-applications per vein while the CLOSE protocol was used for segmental PVI completion in the RFA group. Extra-PV lesion sets were added at the discretion of the treating physician. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after reablation. Recurring arrhythmias were categorized as persistent AF, paroxysmal AF, or atrial flutter. Secondary endpoints were periprocedural complications, total ablation time, radiation time and exposure. Results A total of 220 patients (median age 67 [IQR 58-74] years, 64% male, 64% persistent AF) were enrolled and equally treated with PFA or RFA (110 in both groups). There were no statistically significant differences in the clinical characteristics at baseline. Procedure time was shorter in the PFA group (95 vs. 122 minutes, p=0.001) whereas radiation time and dose were higher in the PFA group (17.0 vs. 6.4 minutes, p=&amp;lt;0.001 and 4.9 vs. 2.2 Gycm2, p=&amp;lt;0.001). Additional posterior wall ablation (PFA) or roof line (RFA) was performed predominantly in the PFA group (61 patients, 55.5 %) and in 5 patients (4.5 %) in the RFA group (p=0.001). Major complications occurred in 3 patients in the PFA group and in 1 patient in the RFA group (see Picture 2). Freedom from arrhythmia in Kaplan-Meier analysis 12 months after the reablation was 61% (CI 50-74%) in the PFA group and 59% (CI 49-71%; log-rank test p=0.81). No differences in outcomes were observed in the pooled group between paroxysmal AF (60%, CI: 50-72%) and persistent AF (61%, CI: 51-73%, p=0.64). Recurrence of organized atrial tachycardia was more common in the PFA group (p=0.018) Conclusion In patients undergoing a first redo procedure after a first round of thermal PVI and with recurrence of atrial tachyarrhythmia, PFA for reablation resulted in shorter procedure times compared to RFA despite more frequent posterior wall ablation. Long-term arrhythmia-free survival after the redo procedure was similar in both groups.Kaplan-Meier analysis of redo proceduresProcedure and outcome data

Comparison of pulsed field and radiofrequency ablation for non-paroxysmal atrial fibrillation: a propensity score-matched analysis

Abstract Background Ablation of non-paroxysmal atrial fibrillation (AF) is challenging and often requires left atrial substrate ablation. While the pentaspline, multi-electrode pulsed-field ablation (PFA) catheter is approved for pulmonary vein isolation (PVI), its role in procedures involving substrate ablation for nonparoxysmal forms of AF remains unknown. Purpose We conducted a retrospective study to assess the safety and long-term outcomes of PFA for non-paroxysmal AF. Methods Procedural and follow-up data were retrospectively collected for all patients undergoing a first-time ablation for non-paroxysmal AF across two centers, between November 2021 and December 2022. Patients undergoing PFA consisting of PVI, isolation of the posterior wall (PWI) and ablation of the mitral isthmus (MI) with the pentaspline multi-electrode PFA catheter, were compared with patients undergoing radiofrequency ablation (RFA) involving PVI, a roof line or PWI, alcohol ablation of the vein of Marshal (VOM) and MI ablation. Patients were matched using propensity scores to minimize potential confounders. The primary endpoint was arrhythmia (AF/atrial flutter/atrial tachycardia) recurrence after a 90-day blanking period. Results The baseline characteristics of the 116 matched patients are detailed in Table 1. PVI was successful in all patients. In the PFA group, PWI was additionally performed in all patients and MI ablation in 83% of cases, resulting in acute success rates of 97% and 96%, respectively. In the RFA group lesions beyond PVI included: a roof line (90%), PWI (10%), VOM alcohol ablation (93%) and MI ablation with ablation in the coronary sinus (CS) if needed (97%). Procedural block across the roof and the MI was achieved in 96% and 95%, respectively and complete PWI in 83% of cases. The PFA group had a shorter total procedure (84.2±22.3 vs 117.3±24.8 min, p&amp;lt;0.001) but a longer fluoroscopy time (23.1±7.2 vs 16.8±6.3 min, p&amp;lt;0.001). The difference in radiation dose, however, was not statistically significant (57.7±74.1 Gy.cm2 in the PFA vs 49.8±53.6 Gy.cm2 in the RFA group, p=0.24). The overall periprocedural complication rates were similar in both groups (8.6% PFA vs 12.1% RFA, p=0.76), with no cardiac tamponades or deaths. Group-specific complications included 1 coronary spasm in the PFA group and 1 CS dissection in the RFA group. During a median follow-up of 447 days (IQR: 364-552), 1 stroke occurred in each group and 1 sudden cardiac death in the RFA group, 13 months post-procedure. Both groups had similar rates of recurrences (32.8% PFA vs 25.9% RFA, p=0.54). Arrhythmia-free survival probability at 16 months was estimated at 67.2% for PFA and 77.6% for RFA by Kaplan-Meier analysis (p=0.16, Figure 1). Conclusions In this propensity-matched cohort of patients with non-paroxysmal AF, PFA and RFA demonstrated similar complication rates and arrhythmia-free survival at follow-up. The procedure duration, however, was significantly shorter with PFA.Figure 1

Different predictors of AF recurrence after pulmonary vein isolation with cryoballoon and radiofrequency ablation: insights from clinical and electroanatomical mapping data of the NO-PERSAF study

Abstract Background Pulmonary vein isolation (PVI) with cryobaloon ablation (CBA) and radiofrequency ablation (RFA) lead to a similar outcome of freedom from atrial tachyarrhythmia (ATA) during follow-up as showed by the NO-PERSAF study. Analyses of ATA recurrence for these two techniques based on data of electroanatomical mapping (EAM) are scarce from randomized clinical trials. Purpose This study aimed to evaluate and compare clinical outcomes and EAM data recorded in the left atrium (LA) during CBA and RFA procedures in patients with persistent atrial fibrillation (AF). Methods For the NO-PERSAF study, 101 patients (mean 63.2±8.6 years, 80 male, 21 female) with persistent AF (77 persistent AF, 24 long-standing persistent AF) referred to PVI were randomized (1:1) to CBA or RFA and followed for 12 months. A prolonged 3-year follow-up was carried out. EAM was performed by a circular mapping catheter with a 3-dimensional mapping system in all patients. EAM data were recorded and analyzed off-line. The areas of the LA, posterior wall, low-voltage (&amp;lt;0.5mV) and complex fractionated electrogram (cycle length &amp;lt;120 ms) were measured and corrected by body surface area (BSA). EAM data from 90 patients were qualified for further analysis and the others (5 in CBA and 6 in RFA) excluded because of disqualification or technical failure of recording. Correlation between clinical results of 3-year follow-up and the EAM data were analyzed using univariate cox regression. Results After 3-year follow-up, freedom from ATA was achieved in 51 (50.5%) of the 101 patients, 28 (54.9%) out of 51 patients in the CBA group and 23 (46.0%) out of 50 patients in the RFA group and no difference was found (p=0.327). RFA compared with CBA resulted in larger ablation lesions in the LA (23.9% vs. 21.3%; p=0.037) and particularly in the posterior wall (44.2% vs 31.8%; p&amp;lt;0.001). Compared between the patients with and without recurrence, there was no difference with respect to age, gender, AF history, body mass index, heart disease and CHA2DS2-vasc score. For EAM data, the area of the LA and low voltage were significantly higher in ATA recurrent patients in CBA group, but not in RFA group (Table 1). Univariate cox regression analyses suggested that 3-year follow-up outcomes were associated with the size of the LA and the amount of low voltage corrected by BSA. The criteria of the LA area &amp;gt;55 cm2/m2 or low voltage area &amp;lt;19 cm2/m2 could predict ATA recurrence after CBA, but not after RFA procedure (Figure 1). Conclusions The size of the LA and the amount of low voltage corrected by BSA was associated with the outcomes of PVI during follow-up and could be employed as predictors of ATA recurrence for CBA, but not for RFA procedure.Table 1Figure 1K-M curves after CBA and RFA