Radiofrequency Ablation Group Research Articles

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=<0.001 and 4.9 vs. 2.2 Gycm2, p=<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<0.001) but a longer fluoroscopy time (23.1±7.2 vs 16.8±6.3 min, p<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 (<0.5mV) and complex fractionated electrogram (cycle length <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<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 >55 cm2/m2 or low voltage area <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

Durability of pulmonary vein isolation with pulsed field ablation compared to radiofrequency ablation in patients with persistent atrial fibrillation: results from a prospective remapping study

Abstract Background Pulsed field ablation (PFA) is a novel technology used for pulmonary vein isolation (PVI). Durability of PVI is critical to avoid atrial fibrillation (AF) recurrence. There is little data available on durability of PVI with PFA as compared to radiofrequency ablation (RFA), and on the mechanisms of arrhythmia recurrence in patients with persistent AF. Objective To invasively assess the durability of PVI with PFA compared to RFA using mandatory remapping studies after 6 months. Methods In a prospective study we included patients with symptomatic persistent AF to undergo a first PVI by either CLOSE protocol-guided RFA or PFA. Irrespective of AF recurrence, a remapping procedure was mandated 6-8 months following the index procedure to invasively evaluate PVI durability. The outcome of AF ablation was based on clinical recurrence and 7-day Holter-ECGs 3 and 6 months after the index procedure. Arrhythmia recurrence was defined as any atrial arrhythmia episode longer than 30 seconds beyond the 3-month blanking period. Results 60 patients (82% male; median age 68 years [60 – 74], median LAVI 47 ml/m2 [38 – 51]) undergoing PVI for persistent AF (median duration: 5 months [IQR: 3 – 9.5]) were included (30 in RFA group vs. 30 in PFA group). Procedure time was longer in the RFA group (169±39 min vs. 114±33 min, p<0.001), with longer fluoroscopy time in the PFA group (7.7±6.0 min vs. 19.7±7.5 min, p<0.001). Acute PVI was achieved in all 241 veins (100%) and no procedural complications were observed in either group. A median of 7.2 months after the index procedure 49 out of 60 patients underwent the remapping study (26 in RFA and 23 in PFA group; with some remapping procedures pending at the time of abstract submission). In the RFA group 78 out of 102 (76%) pulmonary veins (PVs) showed persistent isolation, compared to 74 out of 95 (78%) PVs in the PFA group (p=0.726). 15/26 (58%) RFA and 11/23 (48%) PFA group patients presented complete isolation of all PVs (p=0.594). Recurrence of arrhythmia was observed in 6/26 (23%) RFA and in 7/23 (30%) PFA group patients (p=0.542). Recurrence of persistent AF, paroxysmal AF, and atrial tachycardia was similar in both groups (RFA: 6 / 0 / 0; PFA: 5 / 1 / 1; p=0.612). In the pooled cohort, arrhythmias recurred irrespective of PV isolation status, in 7/26 (27%) patients with complete PVI vs. 6/23 (26%) patients with reconnected PVs (p=0.947). Similarly, the proportion of durably isolated PVs was not different in patients with (7/13; 54%) and without arrhythmia recurrence (19/36; 53%; p=0.947). Conclusions In patients with persistent AF undergoing mandated remapping procedure, we found comparable rates of durable PVI with RFA and PFA, both on a per-patient and a per-vein level. PVI with PFA was faster than RFA but required longer fluoroscopy time. Recurrence of AF was independent of durable PV isolation, underlining the need for additional ablation targets in a subset of patients with persistent AF.

Role of BMI on radiation dose in patients undergoing pulmonary vein isolation by pulsed field, cryoballoon and high-power-short-duration radiofrequency ablation

Abstract Background Different ablation modalities for pulmonary vein isolation (PVI) have been established. Since recent data from a randomized trial showed non-inferiority for pulse field ablation (PFA) vs. cryoballoon (CBA) or radiofrequency ablation (RFA) it seems reasonable to evaluate procedural parameters of these modalities in specific subgroups. Purpose The aim of this study was to evaluate radiation dose and procedural parameters in patients with body mass index (BMI) >26 kg/m² vs. ≤26 kg/m² undergoing PVI with different modalities. Methods Data of n=409 patients (140 PFA, 125 CBA, 144 RFA) having undergone PVI in three German centers for either paroxysmal or persistent atrial fibrillation were analysed. The primary endpoint was total radiation dose (Dose Area Product, DAP). Patients were analyzed with respect to BMI> vs. ≤26 kg/m² in PFA, CBA and RFA (with high-power short duration applications) groups, respectively. Secondary endpoints were radiation time and procedure time. Results The study included predominantly male patients (63.1%) with a mean age of 67.8±10.5 years. Cardiovascular risk factors were comparable within the groups, while the overall CHA2DS2-VASc-score was higher in CBA patients, which was largely influenced by a higher proportion of women in the CBA group. BMI was well balanced between the modalities (PFA: 28.7±5.6 kg/m² vs CBA: 28.5±6.0 kg/m² vs HPSD-RFA: 28.3±4.8 kg/m², p=0.78) as well as the proportion of patients with extreme obesity (BMI >30 kg/m²). The overall DAP was the lowest in the PFA group (370.2±274.6 µGym2) followed by HPSD-RFA (471.4±385.3 µGym2) and the highest in the CBA (1260.9±1053.5 µGym2) group. The radiation time was longest in the CBA group (16.6±17.0min) while being comparatively lower in PFA and HPSD-RFA groups (9.4±6.8 vs. 9.4±5.8 min). Procedure time was the shortest in the PFA group (79.6±30.5min), while being longest in the HPSD-RFA group (111.9±55.3 min). When stratifying patients according to BMI> 26 kg/m², there was a significant increase in DAP in all modalities, with the lowest mean increase in DAP in the PFA group (Δ143.84 µGym2), followed by HPSD-RFA (Δ329.54 µGym2) and the highest increase in the CBA group (Δ691.17 µGym2) (Figure 1). No difference was observed in radiation or procedure time when stratifying patients to BMI. (Figure 2) Conclusion Our study analyzing differences of radiation exposure according to elevated BMI among various PVI techniques shows that while there is a significant increase of DAP in patients with BMI >26 kg/m² in all modalities, the lowest increase is registered in the PFA collective. These results suggest that PVI performed with PFA, if available, or HPSD-RFA should be the energy sources of choice in obese patients with respect to radiation exposure.

THerapy Efficacy in Short or long-coupled idiopathic ventricular fibrillation: an International Survey (THESIS)

Abstract Background A recent review of 86 patients with short or long-coupled premature ventricular complex (SLC-PVC) initiating idiopathic ventricular fibrillation (IVF) found high success rate in arrhythmia control with quinidine (QND) (83%) or radiofrequency ablation (RFA) (70.8%). Purpose To compare the efficacy of QND vs. RFA therapy in a large patient cohort with SLC-IVF. Methods THESIS included 287 patients with SLC-IVF screened from 58 centers and 1 multicenter group in 22 countries across 4 continents. The study cohort included 146 (50.9%) males, aged 39+14 years at the time of IVF documentation. Therapy groups were defined according to the first therapy given. Therapy success was defined as no VF recurrence. Results Patients presented after aborted cardiac arrest, ICD shocks, syncope, aborted cardiac arrest + arrhythmic storm, arrhythmic storm, palpitations, seizures or were asymptomatic in 121 (42%), 51(18%), 42(14.6%), 27 (9.4%), 23 (8%), 8 (2.8%), 6 (2.1%) and 9 (3.1%), respectively. Fifty-three patients (18.5%) had a prior history of syncope. Eleven (3.8%) patients required ECMO support. Mean shortest and longest coupling interval which triggered VF in the same patient were 304.9+82ms and 341.2+94.1ms, respectively. VF initiation with "long" coupled PVC (coupling interval >350ms) was observed in 41 (18.1%) patients, and VF initiation with both short and long coupled PVC was documented in 30 (13.2%) others. RFA was performed in 112 patients and QND was given to 68 patients. Patients were followed during a mean follow-up of 84.8+64.5 months. Therapy success was achieved in the RFA or QND group in 69 (62.2%) and 49 (71%) patients, respectively (p=0.29). The RV Purkinje was the main targeted ablation site in 46 (47.4%) patients. Treatment success varied according to the site of origin (SOO) of the PVC which triggered VF. Therapy success was higher with QND when PVC SOO based on ECG, was the RV inflow tract (81.3% vs. 57.7%, p=0.048) or when the SOO was not available (67.9% vs 36.4%, p=0.064), and when the coupling interval/QT ratio was <1 (75.5% vs. 57.5%, p=0.03), Figures 1,2. A higher success rate with ablation compared with QND was seen with LV- SOO compared with RV-SOO (82.1% vs 60.3%, p=0.019). Similarly, successful ablation was achieved in 83.3% (n=24) vs. 55.9% (n=68) patients with LV and RV-SOO respectively; p=0.004. One patient expired of sudden cardiac death due to misdiagnosis, while wearing a subcutaneous -ICD, without any drug or ablation therapy. Conclusions SLC-IVF strikes males and females equally. SLC-PVCs triggering the arrhythmia mainly arise from the RV Purkinje system. QND and RFA have similar efficacy in arrhythmia control. Quinidine has a higher treatment success rate in patients with PVC-SOO in the RV inflow area and in those with coupling interval/QT<1.Figure 1Treatment success by SOOFigure 2Treatment success by CI/QT

Effectiveness of the Cooled Radiofrequency Ablation of Genicular Nerves in Patients with Chronic Knee Pain Due to Osteoarthritis: A Double-Blind, Randomized, Controlled Study

Background: Increasing evidence supporting the clinical effectiveness of cooled radiofrequency ablation (RFA) therapy for genicular nerves in patients with chronic knee osteoarthritis (OA) exists. However, no study has been conducted to eliminate the potential influence of a placebo effect associated with this procedure. Therefore, we evaluated the efficacy of cooled RFA compared with a sham procedure in patients with painful knees due to OA. Methods: In this double-blind, randomized, controlled study, participants were randomly assigned to receive cooled RFA of the knee (cooled RFA group, n = 20) or a sham procedure (sham group, n = 20). The primary outcome was the proportion of successful responders at the three-month follow-up. The secondary outcomes were successful responders at one and six months; pain intensity of the knee; functional status; medication; and satisfaction at one, three, and six months after the procedures. Results: For the primary outcome, the successful responder rate was significantly higher in the cooled RFA group (76.5%) than in the sham group (33.3%) (p = 0.018). For the secondary outcome, more successful responders were observed in the cooled RFA group than in the sham group at one and six months after the procedure (p = 0.041 and 0.007, respectively). The decreased knee pain intensity was maintained throughout the six-month follow-up period in the cooled RFA group. No differences were observed in functional status, medication change, or satisfaction in both groups. Conclusions: The cooled RFA of genicular nerves offers significant pain relief and surpasses the effects attributable to a placebo.

Proton Beam Radiotherapy as a Curative Alternative to Radiofrequency Ablation for Newly Diagnosed Hepatocellular Carcinoma.

This study aimed to compare the oncological outcomes of proton beam radiotherapy (PBT) with those of radiofrequency ablation (RFA) for newly diagnosed hepatocellular carcinoma (HCC). This study included 323 patients who underwent PBT (n=40) or RFA (n=283) as a curative treatment for previously untreated HCC between October 2016 and June 2021. The primary endpoints were local progression and toxicity. The median follow-up was 3.4 years (range=1.1-5.7 years). In terms of portal vein tumor thrombosis, tumor size, alpha-fetoprotein, and prothrombin-induced by vitamin K absence-II, the PBT group had significantly more severe tumor burdens than those of the RFA group (p<0.0001, p<0.0001, p=0.0004, and p<0.0001, respectively). No significant difference was observed in cumulative local progression rate (10.4% in PBT vs. 7.8% in RFA at 3-years, p=0.895). Grade 3 or higher toxicity was reported in only one patient (0.4%) after RFA. Multivariable analysis demonstrated that treatment modality was not a significant prognostic factor for local progression (hazard ratio=1.05; 95% confidence interval=0.32-3.48; p=0.934). PBT demonstrated comparable local control with acceptable toxicity to RFA in newly diagnosed HCC. Therefore, PBT may be a valid alternative.

Effectiveness and Safety of Radiofrequency Ablation versus Liver Resection in the Treatment of Early-stage Hepatocellular Carcinoma: A Systematic Review and Meta-analysis.

To systematically evaluate the efficacy and safety of radiofrequency ablation and liver resection in the therapeutic management of early-stage hepatocellular carcinoma. We conducted a comprehensive search of domestic and foreign databases including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang to retrieve literature on radiofrequency ablation and liver resection for the treatment of early hepatocellular carcinoma. The retrieved literature underwent thorough screening, and relevant data were extracted. Following the evaluation of the literature's quality, Meta-analysis was performed using RevMan 5.4 software. In this study, a total of 11 documents were selected, comprising 1334 patients with hepatocellular carcinoma. Meta-analysis results indicated that there was no statistically significant difference in the 1-year overall survival rate [Relative risk (RR) = 1.01, 95% confidence intervals (CI) (0.98; 1.04)] and the 3-year overall survival rate [RR = 0.95, 95% CI (0.90; 1.01)] between the radiofrequency ablation and liver resection groups (p > 0.05). Similarly, there was no statistically significant difference in the 1-year disease-free survival rate [RR = 0.94, 95% CI (0.87; 1.01)] between the two groups. However, the 3-year disease-free survival rate [RR = 0.84, 95% CI (0.74; 0.96)] of patients in the radiofrequency ablation group was significantly lower than that in the hepatectomy group (p < 0.05). Notably, the incidence of complications [RR = 0.42, 95% CI (0.33; 0.55)] was significantly lower in the radiofrequency ablation group compared to the hepatectomy group. Conversely, the local recurrence rate [RR = 1.45, 95% CI (1.22; 1.73)] was significantly higher in the radiofrequency ablation group compared to the hepatectomy group (p < 0.05). During the treatment of hepatocellular carcinoma, hepatectomy demonstrates superior clinical efficacy compared to radiofrequency ablation, particularly in its ability to control tumor recurrence. However, radiofrequency ablation presents with fewer complications and a higher level of safety. These findings can serve as a valuable foundation for clinicians when selecting the most suitable treatment approaches for liver cancer.

Radiofrequency ablation versus microwave ablation for hepatocellular carcinoma with cirrhosis: a propensity score analysis.

Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most frequently used percutaneous ablation techniques for the treatment of liver cancer. The aim of our study was to identify the ablation method that had a better long-term prognosis for patients with cirrhotic hepatocellular carcinoma (HCC). This retrospective study consisted of HCC patients with cirrhosis who underwent RFA and MWA between January 2014 to December 2021 at Beijing You'an Hospital. Patients were divided into two groups according to the therapeutic approaches: the RFA group and the MWA group. The prognosis was compared before and after 1:1 propensity score matching (PSM). A total of 800 HCC patients with cirrhosis who received interventional treatment from January 2014 to December 2021 were prospectively enrolled. After PSM, there were 268 patients in each of the RFA and MWA groups. The statistically significant differences in recurrence-free survival (RFS) and overall survival (OS) between RFA and MWA groups can be observed, both before and after PSM. Besides, 1-, 3-year RFS, and 5-year OS rates were higher in those the RFA group than in the MWA group. Age, tumor size, gamma glutamyl transferase (GGT), and hepatitis B surface antigen (HBsAg) were independent risk factors for RFS. Child-Pugh, lymphocyte (Lym), GGT, and treatment modality were independent risk factors for OS. For patients with HCC associated with cirrhosis, RFA can provide a better prognosis than MWA, with lower recurrence and mortality rate.

Efficacy and safety of radiofrequency ablation versus surgical sympathectomy in palmar hyperhidrosis

Radiofrequency ablation (RFA) comparative efficacy of treatments using video-assisted thoracoscopic sympathectomy (VATS) in the long term remains uncertain in patients with palmar hyperhidrosis (PHH). This study aimed to compare the efficacy and safety of RFA and VATS in patients with PHH. We recruited patients aged ≥ 14 years with diagnosed PHH from 14 centres in China. The treatment options of RFA or VATS were assigned to two cohort in patients with PHH. The primary outcome was the efficacy at 1-year. A total of 807 patients were enrolled. After propensity score matching, the rate of complete remission was lower in RFA group than VATS group (95% CI 0.21–0.57; p < 0.001). However, the rates of palmar dryness (95% CI 0.38–0.92; p = 0.020), postoperative pain (95% CI 0.13–0.33; p < 0.001), and surgery-related complications (95% CI 0.19–0.85; p = 0.020) were lower in RFA group than in VATS group, but skin temperature rise was more common in RFA group (95% CI 1.84–3.58; p < 0.001). RFA had a lower success rate than VATS for the complete remission of PHH. However, the symptom burden and cost are lower in patients undergoing RFA compared to those undergoing VATS.Trial Registration: ChiCTR2000039576, URL: http://www.chictr.org.cn/index.aspx.

New radiofrequency ablation procedure for selective reduction in complicated monochorionic twin or triplet pregnancy using multistep, incremental expansion technique.

Radiofrequency ablation (RFA) is the preferred approach for selective reduction in complex monochorionic (MC) multiple pregnancies owing to the ease of operation and minimal invasiveness. To optimize the RFA technique and reduce the risk of adverse pregnancy outcome resulting from the heat-sink effect of RFA therapy, we used an innovative RFA method, in which an electrode needle was expanded incrementally and stepwise. This study aimed to assess the efficacy and safety profile of this novel multistep incremental expansion RFA method for selective fetal reduction in MC twin and triplet pregnancies. This was a single-center retrospective cohort study of all MC multiple pregnancies undergoing RFA between March 2016 and October 2022 at our center. The multistep RFA technique involved the use of an expandable needle, which was gradually expanded during the RFA procedure until cessation of umbilical cord blood flow was achieved. The needle used for the single-step RFA method was fully extended from the start of treatment. In total, 132 MC multiple pregnancies underwent selective reduction using RFA, including 50 cases undergoing multistep RFA and 82 cases undergoing single-step RFA. The overall survival rates were not significantly different between the multistep and single-step RFA groups (81.1% vs 72.3%; P = 0.234). Similarly, the rates of preterm prelabor rupture of the membranes within 2 weeks after RFA, procedure-related complications, spontaneous preterm delivery and pathological findings on cranial ultrasound, as well as gestational age at delivery and birth weight, did not differ between the two groups. However, there was a trend towards a prolonged procedure-to-delivery interval following multistep RFA compared with single-step RFA (median, 109 vs 99 days; P = 0.377). Moreover, the fetal loss rate within 2 weeks after RFA in the multistep RFA group was significantly lower than that in the single-step RFA group (10.0% vs 24.4%; P = 0.041). The median ablation time was shorter (5.3 vs 7.8 min; P < 0.001) and the median ablation energy was lower (10.2 vs 18.0 kJ; P < 0.001) in multistep compared with single-step RFA. There were no significant differences in neonatal outcomes following multistep vs single-step RFA. Overall survival rates were similar between the two RFA methods. However, the multistep RFA technique was associated with a lower risk of fetal loss within 2 weeks after RFA. The multistep RFA technique required significantly less ablation energy and a shorter ablation time compared with single-step RFA in selective fetal reduction of MC twin and triplet pregnancies. Additionally, there was a trend towards a prolonged procedure-to-delivery interval with the multistep RFA technique. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Pulsed-field vs cryoballoon vs radiofrequency ablation: Outcomes after pulmonary vein isolation in patients with persistent atrial fibrillation

BackgroundPulsed-field ablation (PFA) has shown promising data in terms of safety and procedural efficiency for pulmonary vein isolation (PVI), with similar long-term outcomes compared to radiofrequency ablation (RFA) and cryoballoon ablation (CBA) in patients with paroxysmal atrial fibrillation (AF). ObjectiveThe purpose of this study was to compare the procedural and long-term outcomes in patients with persistent AF undergoing PVI using PFA, CBA, or RFA. MethodsConsecutive patients with persistent AF undergoing first PVI with PFA, CBA, or RFA were included. Patients underwent 7-day Holter electrocardiography at 3, 6, and 12 months postablation. The primary outcome was recurrence of any atrial arrhythmia after a 90-day blanking period. Safety outcomes included the composite of in-hospital major adverse events. ResultsA total of 533 patients with persistent AF underwent PVI using PFA (n = 214), CBA (n = 190), or RFA (n = 129). Procedures with PFA guided by fluoroscopy were shorter than those with CBA (median 60 minutes; interquartile range [IQR] 53–80 minutes vs 84 minutes; IQR 68–101 minutes; P ≤ .001), and procedures with PFA in combination with 3-dimensional electroanatomic mapping were shorter than those with RFA (median 101 minutes; IQR 85–126 minutes vs 171 minutes; IQR 141–204 minutes; P < .001). Acute safety events occurred in 2.3%, 2.6%, and 0.8% in the PFA, CBA, and RFA groups, respectively (P = .545). The 1-year confounder-adjusted estimate for freedom from atrial arrhythmias was 62.1% for CBA, 55.3% for PFA, and 48.3% for RFA (CBA vs PFA: P = .79; CBA vs RFA: P = .009; PFA vs RFA: P = .010). ConclusionIn patients with persistent AF undergoing first PVI, 1-year confounder-adjusted outcomes are better with PFA and CBA than with RFA.

Efficacy of radiofrequency ablation vs. transcatheter arterial embolization for hepatic hemangiomas.

The objective of this study was to evaluate the safety and effectiveness of radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) in the treatment of large hepatic hemangiomas (LHH) (5-9.9 cm in diameter). This study retrospectively collected data from 82 patients with LHH treated at Chaoyang Central Hospital. The study analyzed the differences in postoperative efficacy, operative time, blood routine, liver and kidney function on the first day after surgery, postoperative hospitalization time and postoperative complications. There were statistically significant differences in indicators such as white blood cell count, alanine aminotransferase, aspartate aminotransferase and total bilirubin on the first day after surgery between the RFA group (39 cases) and the TACE group (43 cases) (P < 0.001). Compared to RFA, LHH patients treated with TACE had a general complication rate of 39.5% (vs. 43.6%; P = 0.7), a procedure-related complication rate of 30.2% (vs. 59.0%; P = 0.009), an effective rate at 6-12 months postoperatively of 55.8% (vs. 82.1%; P = 0.01), an operating-time of 41.2 ± 14.9 min (vs. 100.8 ± 35.5 min; P < 0.001) and hospitalization costs of 17052.7 ± 1364.8 yuan (vs. 30952.1 ± 4327.6 yuan; P < 0.001). This study indicates that the efficacy of RFA in treating LHH is significantly superior to TACE. Microwave ablation and RFA appear to be safe treatments for LHH. The TACE group exhibited shorter operating-time, lower hospitalization costs and lower demands on cardiopulmonary function.

Clinical features of patients with hepatocellular carcinoma treated with radiofrequency ablation therapy: developing a simple score to determine the need for immune-adjuvant therapy.

Unresectable recurrence after curative treatments for hepatocellular carcinoma (HCC) is a life-limited event. Although the IMbrave050 trial (IM050) showed a favorable reduction in recurrence with adjuvant immune-combination chemotherapy, inclusion criteria of the radiofrequency ablation (RFA) group were lower risk than that of the resection group. This study aimed to elucidate the clinical features of patients treated with RFA, which really need adjuvant-chemotherapy. From 2000 to 2022, 528 patients with Child-Pugh A and HCC within the Milan criteria (MC), who met the IM050 criteria for RFA and undergone resection or RFA, were enrolled (71years, HCV:HBV:HBV/HCV:alcohol:others = 337:44:5:53:89, multi-tumor = 138, RFA:resection = 309:219). Unresectable recurrence was defined as beyond the MC. Risk factors for recurrence beyond the MC were retrospectively evaluated. Multivariate Cox-hazard analysis showed HCV-positive (HR 1.49), AFP-L3 > 10% (HR 1.75), and DCP > 100mAU/mL (HR1.80) as significant prognostic factors for recurrence beyond the MC (each P < 0.05). Summing of positive factors (1 point for each) was used for scoring (AD-ON score), which showed increased positive rates for micro-hepatic vein invasion (score 0:1:2:3 = 0%:1.1%:6.6%:15.8%), micro-portal vein invasion (0:1:2:3 = 2.0%:12.1%:14.1%:31.6%), and poor differentiation (0:1:2:3 = 6.0%:6.7%:15.3%:15.8%) in the resection group associated with a greater score (each P < 0.01). In patients treated with RFA, those with greater AD-ON scores showed shorter time to recurrence beyond the MC, recurrence-free time, and overall survival (score 0:1:2:3 = no-estimation:97:66:23months, 35:27:20:12months, and 91:82:67:52months, respectively, each P < 0.05). HCC patients treated by RFA and with a high AD-ON score (≧2) should be considered for aggressive adjuvant-chemotherapy to prolong the period of recurrence beyond the MC.

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.

Laparoscopic liver resection is superior to radiofrequency ablation for small hepatocellular carcinoma: a systematic review and meta-analysis of propensity score-matched studies.

The approach in small hepatocellular carcinoma (HCC) is controversial, no prospective randomized trials to compare ablative or surgical approaches. We compared the surgical and oncological outcomes after laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) in small HCC patients based on matched cohort studies that performed propensity score matching (PSM). We systemically searched the PubMed, Cochrane Library, Embase, Web of Science, and the Chinese BioMedical Literature (CBM) databases. All published propensity score-matched studies that compared LH and RFA for small HCC were included in this study. Eight studies with a total of 1273 small HCC cases were included. The results of the meta-analysis revealed that there was no significant difference in the 1- year overall survival (OS) rate between the two groups, whereas the LH group had significantly higher 3- year overall survival rate (RR = 1.14, 95% CI 1.08-1.20, p < 0.00001) as well as 1- and 3-year disease-free survival (DFS) rates (RR = 1.31, 95% CI 1.22-1.42, p < 0.00001; RR = 1.66, 95% CI 1.46-1.90, p < 0.00001) than the RFA group. Meanwhile, the local recurrence rate and intrahepatic distant recurrence rate were significantly lower in the LH group than in the RFA group (RR = 0.29, 95% CI 0.20-0.42, p < 0.00001; RR = 0.67, 95% CI 0.49-0.92, p = 0.01). In comparison with the LH group, the RFA group had a lower incidence of overall and major postoperative complications (RR = 1.81, 95% CI 1.47-2.24, p < 0.00001; RR = 2.76, 95% CI 1.48-5.12, p = 0.001), but there was no significant difference in postoperative mortality between the two groups. In addition, further comparison of single postoperative complications showed that the incidence of ascites was lower in the RFA group than in the LH group (RR = 3.62, 95% CI 1.64-7.96, p = 0.001), whereas there was no significant difference in the incidence of postoperative bleeding, abdominal infection and bile leakage between the two groups (RR = 3.50, 95% CI 0.74-16.61, p = 0.11; RR = 5.00, 95% CI 0.59-42.23, p = 0.14; RR = 4.00, 95% CI 0.45-35.23, p = 0.21). Besides, the hospital stay was shorter in the RFA group than in the LH group (MD = 4.29, 95% CI 2.06-6.53, p = 0.0002). Our meta-analysis demonstrated that in comparison with RFA in the treatment of small HCC, LH provided superior long-term OS and DFS together with lower rates of local and intrahepatic distant recurrence after surgery. However, RFA was associated with better short-term outcomes.

Radiofrequency ablation versus stripping of great saphenous vein in the management of varicose veins

Background: Varicose veins are defined as dilated, tortuous subdermal veins &gt;3 mm in diameter. It is a common entity affecting an estimated 10% of population. Aims and Objectives: The aim was to compare the efficacy of radiofrequency ablation (RFA) with great saphenous vein (GSV) stripping in patients with lower limb varicose veins in terms of disappearance of visible varicosities. Materials and Methods: It was a prospective randomized controlled study, conducted in a tertiary care medical college with the study population consisting of patients suffering from varicose veins. Totally 30 patients were enrolled and divided into 2 groups of 15 patients each. Group A underwent RFA while Group B underwent stripping of GSV with flush ligation of saphenofemoral junction. Results: The mean duration of the procedure in Group A was 53.67±6.6 min while in Group B it was 101.4±11.85 min which was statistically significant (P&lt;0.0001). The mean duration of return to routine activities and work was 2.2±0.41 days in Group A and 3.07±1.16 days in Group B which was statistically significant (P=0.024). Post-operative analgesic requirement was similar in both groups (P=0.224). Complete remission was observed in all patients at 12 months visit and there was no recurrence identified even after a follow-up period of 4 years. Conclusion: RFA was found to be as effective as stripping of GSV in terms of obliteration of veins. The duration of procedure was found to be much less in RFA. Furthermore, cosmetic results, ulcer healing and patient satisfaction rate was better in RFA group. Patient return to normal activity was significantly earlier in RFA group.

Radiofrequency Combined with Intratumoral Immunotherapy: Preclinical Results and Safety in Metastatic Colorectal Carcinoma.

Radiofrequency ablation (RFA) of cancer induces an anti-tumor immunity, which is insufficient to prevent recurrences. In mice, RFA-intratumoral immunotherapy by granulocyte-macrophage colony-stimulating factor (GM-CSF) and Bacillus Calmette-Guerin resulted in complete metastases regression. Infectious risk in human needs replacement of live vaccines. Intratumoral purified protein derivatives (PPD) have never been tested in digestive cancers, and the safety of intratumoral immunotherapy after RFA has not yet been validated in human models. We investigated the therapeutic efficacy of combined radiofrequency ablation (RFA) and intratumoral immunotherapy (ITI) using an immune-muco-adherent thermogel (IMT) in a mouse model of metastatic colorectal cancer (CRC) and the safety of this approach in a pig model. Intratumoral stability of the immunogel was assessed using magnetic resonance imaging (MRI) and bioluminescent imaging. Seventy-four CT26 tumor-bearing female BALB/c mice were treated with RFA either alone or in combination with intratumoral IMT. Regression of distant metastasis and survival were monitored for 60 days. Six pigs that received liver radiofrequency and intralesional IMT injections were followed for 15 days. Experimental gel embolisms were treated using an intravascular approach. Pertinent rheology of IMT was confirmed in tumors, by the signal stability during 3 days in MRI and 7 days in bioluminescence imaging. In mice, the abscopal effect of RFA-intratumoral immunotherapy resulted in regression of distant lesions completed at day 16 vs. a volume of 350 ± 99.3 mm3 in the RFA group at day 25 and a 10-fold survival rate at 60 days. In pigs, injection of immunogel in the liver RFA area was safe after volume adjustment without clinical, hematological, and liver biology disorder. Flow cytometry showed an early increase in CD3 TCRγδ+T cells at D7 (p < 0.05) and a late decrease in CD29+-CD8 T cells at D15 (p < 0.05), reflecting the inflammation status changes. Systemic GM-CSF release was not detectable. Experimental caval and pulmonary thermogel embolisms were treated by percutaneous catheterism and cold serum infusion. RFA-intratumoral immunotherapy as efficient and safe mini-invasive interventional oncology is able to improve ablative treatment of colorectal liver metastases.

Comparison of Radiofrequency Ablation and Cyanoacrylate Closure for Large-Diameter Great Saphenous Vein Insufficiency

ObjectiveTo compare radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) for large-diameter great saphenous vein insufficiency (GSV) between diameters of 12 and 16 mm. Material-MethodsThis study is a single-centre retrospective study. Subjects who underwent endovenous treatment with RFA (Group A) or CAC (Group B) for GSV insufficiency between June 2015 and June 2021 who were followed up for at least 2 years were included in the study. Subjects who had a 12 to 16 mm target vessel diameter and subjects with grade 3 and grade 4 reflux were included. Subjects’ demographic data (age, sex), body mass indices (BMI), clinical, aetiological, anatomic, pathophysiologic (CEAP) classification, GSV diameter, reflux grade, target vessel length, preoperative venous clinical severity score (VCSS), procedural time, postoperative 1st-day pain scores, postoperative 14th-day patient satisfaction scale and postoperative complications were noted. In follow-up, subjects were evaluated with duplex ultrasonography and VCSS at 1, 6, 12 and 24 months. ResultsIn total, 142 subjects were included (n=71 for both groups). The mean GSV diameter was 13,21±1,00 for Group A and 13,51±0,97 for Group B. The groups did not differ in terms of age, sex, BMI, CEAP classification, GSV diameter, reflux grade, target GSV length, preoperative VCSS, complications, postoperative 24-hour pain status or postoperative 14-day patient satisfaction scale (p>0.05 for all comparisons). The procedure time was significantly shorter in Group B (34,68±4,22 min for Group A vs. 22,59±4,5 min for Group B, p=0,001). In the 1-month and 6-month Duplex ultrasonography of the subjects, partial closure and patency rates in Group B were significantly higher than those in Group A (p=0.003 and p=0.025, respectively). At the 12- and 24-month evaluation, closure rates did not show a statistically significant difference between the groups (p=0.056 and p=0.090, respectively). Preoperative and 1-month VCSS measurements did not show a statistically significant difference between groups (p>0.05 for all comparisons). The 6- and 12-month 24-month VCSS measurements of Group A were significantly higher than those in Group B. (p=0.043, p=0.009 and p=0.002, respectively). ConclusionBoth RFA and CAC were found to be effective in the treatment of large-diameter GSV incompetency. The complication rates were similar between the two techniques. CAC had a shorter procedure time. Although the closure rates in the early postoperative period were better in the RFA group, long-term follow-up demonstrated similar patency rates. The functional results in the long-term follow-up were better in the RFA group.