Radiofrequency Ablation Research Articles

Polyoxometalate-based injectable coacervate inhibits HCC metastasis after incomplete radiofrequency ablation via scavenging ROS

BackgroundIncomplete radiofrequency ablation (iRFA) stimulates residual hepatocellular carcinoma (HCC) metastasis, leading to a poor prognosis for patients. Therefore, it is imperative to develop an effective therapeutic strategy to prevent iRFA-induced HCC metastasis.ResultsOur study revealed that iRFA induced an abnormal increase in ROS levels within residual HCC, which enhanced tumor cell invasiveness and promoted macrophage M2 polarization, ultimately facilitating HCC metastasis. Molybdenum-based polyoxometalate (POM) is an excellent ROS-scavenging nanocluster, but its size is too small to be easily cleared by the kidneys, limiting its effectiveness in scavenging iRFA-induced ROS. To overcome this limitation, we synthesized an injectable POM-loaded coacervate delivery system named POM@Coa, which can sustainably scavenge iRFA-induced ROS by slowly releasing POM. POM@Coa markedly reduced HCC invasiveness, reversed macrophage polarization from M2 to M1, and promoted the infiltration and activation of CD8+ T cells, ultimately inhibiting HCC metastasis. Importantly, POM@Coa showed superior therapeutic efficacy to free POM in the absence of systemic toxicity.ConclusionsPOM@Coa exhibits the potential to decrease HCC invasiveness and activate anti-tumor immunity, opening up new avenues for the safe and effective treatment and prevention of HCC metastasis when combined with RFA.

Pudendal Neuralgia: A Review of the Current Literature.

This paper aims to review pudendal neuralgia pathophysiology, risk factors, diagnosis, and treatment options. Conservative and pharmacologic options are first line treatments for the treatment of pudendal neuralgia. Interventional treatment such as, pudendal nerve blocks can be tried if first line treatments feel to provide adequate analgesia. If pudendal nerve blocks provide sufficient relief but have a short duration, decompressive surgery may be considered. Neuromodulation is also a viable option. Emerging techniques such as pulsed radiofrequency ablation, cryotherapy, lipofilling, and repetitive transcranial magnetic stimulation are promising; however, more studies are needed to evaluate safety and effectiveness. Current study data is generally poor, and unstandardized. Further research is needed to identify the optimal treatment approach and evaluate the effects of pudendal neuralgia on mental health and quality of life.

Radiofrequency Ablation of Low-Risk Papillary Thyroid Microcarcinoma: A Retrospective Cohort Study Including Patients with More than 10 Years of Follow-up.

Background: The longest reported follow-up for thermal ablation of papillary thyroid microcarcinoma (PTMC) is 5 years. We evaluated the long-term efficacy and safety of radiofrequency ablation (RFA) in patients with low-risk PTMC with clinical follow-up of more than 10 years. Methods: In this retrospective cohort study, we included patients with low-risk PTMC who had more than 10 years of follow-up after ultrasound (US)-guided RFA (performed between May 2008 and December 2013). Sixty-five consecutive patients with 71 low-risk PTMCs who were unsuitable for surgery or declined surgery were included. Before RFA, all patients underwent US and thyroid computerized tomography. Repeat RFA for staged ablation was performed when the first RFA did not secure sufficient safety margins because of the tumor closely abutting the recurrent laryngeal nerve. Follow-up US imaging was performed at 1 week, 3 months, 6 months, every 6 months until 2 years, and then annually afterward. Primary outcomes were the respective cumulative rates of disease progression (defined by local tumor progression, lymph node, or distant metastasis), newly developed thyroid cancer, and conversion surgery. Secondary outcomes were serial volume reduction rate (VRR), complete disappearance rate of ablated PTMC, and adverse events associated with procedures. Results: Of 65 patients included in the study, 60 had unifocal and 5 had multifocal PTMCs. The mean number of RFA sessions per tumor was 1.2, and the median follow-up duration was 151 months (interquartile ranges, 131-157). Twenty percent (13/65) of patients required repeat RFA. There were no cases of disease progression. Five patients (5/65, 7.7%) developed a new papillary thyroid cancer (four treated with RFA and one with lobectomy). At 24 months, the mean VRR was 100%, and this was maintained throughout the final follow-up. The complete tumor disappearance rates after one or more RFA treatments were 40.8% (29/71), 74.6% (53/71), and 100% (71/71) at 6, 12, and 24 months, respectively. One major (subclinical hypothyroidism) and three minor adverse events occurred. Conclusions: In our experience, RFA of low-risk PTMC is effective and safe. During more than 10 years of follow-up, we observed no incident local tumor progression nor metastases, but 7.7% of patients developed a new papillary thyroid cancer.

P-36 YOUNG WOMAN WITH AMNESIA

Abstract Introduction Insulinomas are rare neuroendocrine neoplasms (NENs), usually located in the pancreas. Traditionally, the only curative treatment is surgical. However, for single solitary NENs radiofrequency ablation (RFA) is a treatment option. In this case report, we describe the first patient with insulinoma who was treated with RFA in Finland. Clinical Case The patient is a 23-year-old, previously healthy woman. In April 2022, the patient’s neighbor had noticed that the patient had not been seen during the morning. The neighbor made an emergency call. A paramedic measured the blood glucose, which was low 1.2 mmol/l, glucose infusion was started, and the patient was taken to the emergency department of a local hospital. In the hospital, patient told that after December 2021 she had experienced amnesia episodes a total of six times. The symptoms were initially considered as transient amnesia. The amnesia episodes had typically been seen throughout the morning, and there were days she had no recall of the previous 8 hours. In the emergency department, a suspicion of insulinoma was raised, and the patient was sent to the endocrinology department for further examination. On the following day, after a couple of hours fasting, a remarkably decreased glucose level was detected: plasma glucose was only 2.7 mmol/l, insulin 21 mU/l and C-peptide 1.2 mmol/l. The diagnosis of insulinoma was made based on symptoms and laboratory findings. However, in the MRI of the upper abdomen, no abnormality was found in the pancreas or stomach. Due to her severe hypoglycemia symptoms, diazoxide medication 50 mg was given three times daily. After that, hypoglycemias alleviated, and the patient was able to go home to wait for further examinations. In June 2022, the whole-body positron emission tomography – computer tomography (PET/CT) imaging was made with [68Ga]-DOTANOC tracer. However, there was no abnormality found in pancreas, nor signs of any ectopic NENs. After that, the whole body [18F]-fluorodopa-PET/CT was made, but still, no insulinoma was found. In July 2022, the endoscopic ultrasound (EUS) examination finally revealed a 13 x 8 mm sized tumor in processus uncinatus in pancreas. The tumor was confirmed as a grade I insulinoma based on the biopsy. Due to the difficult location, pancreoticoduodenectomy and a non-surgical method, EUS-RFA, remained the treatment options. Since the tumor was small, RFA was performed. After the RFA, she has been symptom free, and her glucose levels have been in normal range. Six months later, plasma glucose level (fasting) was 4.9 mmol/l while insulin was 7 mU/l. Conclusion The treatment of pancreatic insulinoma is often surgical. However, in selected patients, curative EUS-RFA can be a good treatment option in patient with small (≤ 2 cm) localized insulinomas. It seems a safe and effective option, and compared to pancreaticoduodenectomy or enucleation, the risk of complications is clearly smaller.Figure 1endoscopic ultrasound examination

Ultrasound-guided radiofrequency ablation for isthmus papillary thyroid microcarcinoma: a prospective 2years of follow-up study.

To explore the safety and clinical efficacy of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) located in the isthmus. This prospective study enrolled patients with single isthmus PTMC admitted to General Surgery Department of 983rd Hospital of Joint Logistic Support Force of PLA from 2017 to 2022. After ablation, the ultrasound and contrast-enhanced ultrasound (CEUS) were performed to follow up the outcomes at 1, 3, 6, 12, 18, and 24 months. The volume reduction rates (VRR), disappearance rates (DR), incidence of complications, recurrence, and lymph node metastasis were recorded. A total of 135 patients were enrolled in this study, including 26 men and 109 women. The average age was 41.07±13.60 years old. The average diameter of PTMC was 0.68 ±0.17cm. After ablation, the DRs at 1, 3, 6, 12, 18 months, and 24 months were 0.0% (0/135), 10.4% (14/135), 52.6% (71/135), 81.5% (110/135), 100% (135/135), and 100% (135/135), and the VRRs at 1, 3, 6, 12, 18 months, and 24 months were 66.18±12.57%, 82.42±12.01%, 93.33±8.70%, 98.58±3.71%, 100.00±0.00%, 100.00±0.00%. Two patients suffered recurrence of PTMC in the thyroid at 6 and 12 months after ablation, and one patient suffered cervical lymph node metastases at 18 months after ablation. No patient had serious complications, including death, hemorrhage, or thermal injury to peripheral organs. RFA was a safe and effective treatment for isthmus PTMC, which may add new choices to the treatment strategy for patients.

Microwave ablation for liver metastases from colorectal cancer: A comprehensive review of clinical efficacy and safety.

Microwave ablation (MWA) is emerging as a highly effective treatment for colorectal liver metastases (CRLMs). This review explores the advantages of MWA compared to other ablative techniques such as radiofrequency ablation and cryoablation and highlights its clinical efficacy, safety, and technical considerations. MWA offers significant benefits, including higher intratumoral temperatures, larger ablation zones, and reduced susceptibility to the heat-sink effect, which make it particularly suitable for tumors near large blood vessels. This review details the patient selection criteria, procedural approaches, and the use of advanced imaging techniques to improve the precision and effectiveness of MWA. Clinical outcomes indicate that MWA achieves high rates of complete tumor ablation and long-term survival with a favorable safety profile. This review is significant because it provides updated insights into the expanding role of MWA in treating unresectable CRLM and its potential as an alternative to surgical resection for resectable tumors. By summarizing recent studies and clinical trials, this review highlights the comparative effectiveness, safety, and integration with systemic therapies of MWA. In conclusion, MWA is a promising treatment option for CRLM and offers outcomes comparable to or better than those of other ablative techniques. Future research should focus on optimizing technical parameters, integrating MWA with systemic therapies, and conducting large-scale randomized controlled trials to establish standardized treatment protocols. Advancing our understanding of MWA will enhance its application and improve long-term survival and quality of life for patients with CRLM.

Concurrent Micra Leadless Pacemaker Implantation and AVN Ablation: Computer Modeling of Novel Risk Mitigation Strategy.

Concurrent Micra leadless pacemaker (Medtronic, Minneapolis, Minnesota) implantation and atrioventricular node (AVN) ablation has been shown to be feasible and safe in patients with symptomatic, drug-refractory atrial fibrillation (AF). However, major complications within the 30 days after concurrent Micra implantation and AVN ablation have been reported. We evaluated the efficacy and safety of the concurrent procedure at our institution. We conducted a single-center, retrospective case series of patients who underwent concurrent Micra implantation and radiofrequency (RF) AVN ablation from January 2019 to May 2023. A simulated computer model was created to characterize the interaction between the dissipated power at the Micra cathodal electrode as a function of the distance between the RF ablation catheter and the location of the return electrode. Fifteen patients were included. Most were elderly, White, female, and had persistent AF. One had transient, acute loss of ventricular capture that resulted in asystole and required emergent pacing from the ablation catheter. A proposed strategy of moving the RF return electrode to a cranial position from a caudal position was shown by computer modeling to direct more RF current away from the Micra and lower the dissipated power at the Micra cathodal electrode. Concurrent Micra implantation and AVN ablation is feasible and safe and has high procedural success. An acute rise in pacing threshold can occur from RF energy, resulting in asystole. Computer modeling showed that placing the RF return electrode in the cranial position resulted in lower dissipated power at the Micra cathodal electrode.

A Comparison of the Efficacy and Safety of US-, CT-, and MR-Guided Radiofrequency and Microwave Ablation for HCC: A Systematic Review and Network Meta-Analysis

Objectives: The aim of this study was to compare the efficacy and safety of thermal ablation, focusing on radiofrequency ablation (RFA) and microwave ablation (MWA), for hepatocellular carcinoma (HCC) using US-, CT-, and MR-guidance. Methods: PubMed, EMBASE, Cochrane Library, and Web of Science were searched for studies comparing US, CT, and MR guidance in thermal ablation for HCC. Observational studies and randomized controlled trials (RCTs) were included. Overall survival (OS), local tumor recurrence (LTR), primary technique effectiveness (PTE), and major complications were assessed with network meta-analysis. Results: One RCT and 13 retrospective cohort studies reporting on 2349 patients were included. For OS at 3 years, compared to CT, US had hazard ratios (HRs) of 0.98 (95%CI: 0.77–1.26), and MR had HRs of 1.60 (95%CI: 0.51–5.00); For OS at 5 years, US had HRs of 0.80 (95%CI: 0.64–1.01), and MR had HRs of 1.23 (95%CI: 0.52–2.95) compared to CT. LTR rates, PTE, and major complications did not show statistical significance among the three guidance modalities (LTR: RR = 0.29 (95%CI: 0.08–1.14), p = 0.97 MR vs. CT; RR = 0.25 (95%CI: 0.06–1.02), p = 0.97 MR vs. US; PTE: RR = 1.06 (95%CI: 0.96–1.17), p = 0.90 MR vs. CT; RR = 1.08 (95%CI: 0.98–1.20), p = 0.90 MR vs. US. Major complications: RR = 0.27 (95%CI: 0.13–0.59), p = 0.94 MR vs. CT; RR = 0.41 (95%CI: 0.10–1.74), p = 0.94 MR vs. US). Conclusions: CT-, US-, and MR-guided RFA and MWA are equally effective and safe for HCC patients.

Apple Vision Pro-guided Laparoscopic Radio Frequency Ablation for Liver Tumors: The Pioneer Experience.

Background: This study evaluates the feasibility of Apple Vision Pro goggles as an augmented reality (AR) surgical navigation tool for laparoscopic-assisted ultrasound-guided radiofrequency ablation (RFA) of liver tumors. Traditional RFA is effective but challenging due to the integration of multiple imaging modalities.Purpose: The primary aim of this research is to assess how Vision Pro goggles can enhance the surgical navigation process during RFA, improving tumor localization and the overall effectiveness of the procedure.Research Design: A feasibility study design was used to analyze the implementation of AR technologies in surgical navigation, focusing specifically on their application in laparoscopic surgeries.Study Sample: Participants included patients undergoing laparoscopic-assisted ultrasound-guided RFA, with pre-operative imaging workups involving CT and MRI scans followed by intraoperative laparoscopic sonography.Data Collection and/or Analysis: Data were collected through observations during surgical procedures using the Vision Pro goggles, which displayed various imaging inputs (MRI, 3D reconstruction, and laparoscopic sonography) in the surgeon's field of view. Image manipulation was assessed based on accuracy and effectiveness of tumor ablation.Results: The goggles enhanced tumor localization accuracy and facilitated real-time image manipulation, resulting in effective tumor ablation. Initial results show promising outcomes in the precision and efficiency of the RFA procedure.Conclusions: While the initial results are promising, larger studies are necessary to validate the technology's efficacy and safety. Future research should compare outcomes with traditional methods and explore its applicability to other surgeries, aiming to refine the system further. The Vision Pro goggles potentially represent a significant advancement in surgical technology by improving RFA precision and efficiency.

Rationale and Design of the InsightPFA Trial: A Prospective, Multicenter, Randomized Controlled Trial of the Irreversible Electroporation-Based Pulsed Field Ablation Versus Radiofrequency Ablation in Chinese Patients With Symptomatic Paroxysmal Atrial Fibrillation.

Pulsed field ablation (PFA) is gaining recognition as a nonthermal, tissue-specific technique for the treatment of atrial fibrillation (AF). The preclinical evaluation of the investigated novel PFA system from Insight Medtech Co. Ltd has demonstrated feasibility, safety, and 30-day efficacy for pulmonary vein isolation (PVI) in the swine model. We are currently conducting a randomized controlled trial to compare the PFA directly with ablation-index (AI)-guided radiofrequency ablation (RFA) for PVI. The InsightPFA trial is a prospective, multicenter, randomized controlled trial to compare the effectiveness and safety of PFA versus RFA for PVI in Chinese patients with symptomatic paroxysmal AF. Two hundred and ninety-two patients diagnosed with symptomatic paroxysmal AF will be randomly assigned to either the PFA group or the RFA group in a 1:1 ratio. All subjects will undergo PVI using PFA or AI-guided RFA and be followed up to 12 months. The primary endpoint is defined as freedom from any episodes of AF/AFL/AT without Class I or III antiarrhythmic drugs during the 9-month follow-up period after a 90-day blank period. The secondary endpoints of effectiveness include acute treatment success and procedural data. The safety evaluation includes a composite of death, stroke and transient ischemic attack, procedure-related complications, device-related adverse events, and serious adverse events. A noninferiority comparison will be conducted between the novel PFA system and the existing RFA system in terms of both effectiveness and safety. This trial aims to determine whether the InsightPFA for PVI is as effective and safe as standard RFA in the treatment of symptomatic paroxysmal AF. https://www. gov/study/NCT06014996; NCT06014996.

Characteristics of In Vivo Lesion Formation With a Temperature-Controlled Diamond-Tip Radiofrequency Ablation Catheter in the Ventricle: A Preclinical Model.

Power-controlled radiofrequency ablation with irrigated-tip catheters has been the norm for ventricular ablation for almost 2 decades. New catheter technology has recently integrated more accurate tissue temperature sensing enabling temperature-controlled irrigated ablation. We aimed to investigate the in vivo ablation parameters and lesion formation characteristics in ventricular myocardium using a novel temperature-controlled radiofrequency catheter. Twenty canines were divided into 3 groups: 4 noninfarcted, acute (phase I); 8 noninfarcted, chronic (phase II); and 8 infarcted, chronic (phase III). Lesions were delivered with a temperature-controlled radiofrequency system utilizing a chemical vapor deposit diamond for efficient thermal diffusivity. In phase I, 17 ablation settings were tested (temperature set points, 50/60/70 °C; ablation duration, 15/30/60/90/120 s; and power limit, 30/50 W). Four and one of these sets of parameters were further tested in phases II and III, respectively. Lesions were assessed by ex vivo contrast-enhanced magnetic resonance imaging and gross pathology 5 weeks after ablation in phases II/III. Across all phases, 111 ablation lesions were delivered. Ablation with the power limit of 50 W, the temperature set point of 60 °C, and the duration of 60 s produced significantly larger and deeper lesions (mean, 569.2 mm3; mean maximal depth, 9.8 mm) compared with 50 W/60 °C/30 s (mean, 340.4 mm3; mean maximal depth, 8.3 mm) and 50 W/50 °C/60 s (mean, 227 mm3; mean maximal depth, 6.9 mm), with P<0.05 for all pairwise comparisons. Ablation of infarcted myocardium in phase III (50 W/60 °C/30 s) resulted in smaller impedance and bipolar electrogram amplitude changes and lesion size compared with ablation in normal myocardium with the same settings. No steam pop, myocardial perforation, or char formation was observed in any of the 111 ablations across all phases. In vivo radiofrequency ablation in a canine model with a diamond-tip temperature-controlled catheter using a temperature set point of 60 °C and a power limit of 50 W created large lesions without steam pop risk in both normal and infarcted ventricular myocardia.

Real-world single-center preliminary experience of radiofrequency balloon pulmonary vein ablation for atrial fibrillation.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and pulmonary vein isolation (PVI) by percutaneous transcatheter ablation is its pivotal treatment. Nowadays, several techniques using different energy sources are used, such as radiofrequency (RF), cryoablation and laser ablation. A new technology that combines the strengths of different techniques has been developed, in particular having both the speed of one-shot techniques and the selectivity and precision of point-by-point RF: the RF balloon (RFB). Recent clinical studies1-3 have demonstrated its efficacy and safety, with good results in terms of first pass isolation, procedural duration and fluoroscopy time. However, real-world data regarding RFB ablation is scarce, therefore with this study we aimed to describe the experience of our center with this technology (one of the first adopting it in our country). We prospectively enrolled in a single-center a total of 20 consecutive patients who underwent AF ablation with RFB. The primary endpoint, i.e. PVI defined as stable absence of any electrical conduction from and into the veins, was met by 18 patient (90%). Mean procedural and fluoroscopy times were 79±30.68 min and and 15.36±6.57 min, respectively, dwelling time was 30.3±8.09 min. The only complication reported was a single case mild pericardial effusion 24 h after the procedure, likely of inflammatory nature, which was treated conservatively and resolved before discharge. With this study we demonstrated that PVI with RFB appears to be an effective and safe technique in a real world setting, with many upsides and a reduced atrial dwelling time that theoretically could reduce the risk of thromboembolic complications. Further studies on larger number of patients are needed to confirm the results we obtained.

Effect of Sequential, Colocalized Radiofrequency and Pulsed Field Ablation on Cardiac Lesion Size and Histology.

Sequential application of radiofrequency with pulsed field (PF) ablation may increase lesion depth while preserving the advantages of PF. The study's aim was to determine lesion dimensions of sequential, colocalized radiofrequency and PF ablation. A preclinical study using swine (n=4) performed lesions in the right/left ventricles. Ablations were performed with a force-sensing 3.5-mm irrigated-tip ablation catheter using a generator delivering both radiofrequency and PF. PF was delivered using unipolar, biphasic pulses at a standard dose (PF index, 300) with 4-mL/min irrigation. Radiofrequency was delivered at 50 W for 10 s (15 mL/min). Lesions were created by applying colocalized radiofrequency followed by sequential application of PF on the same location, PF followed by sequential application of radiofrequency on the same location, PF alone, or radiofrequency alone. Tissue was collected after 2 hours for lesion assessment. Results are mean±SD. Forty-five lesions were analyzed. The lesion depth of radiofrequency alone was 4.9±0.8 mm. The mean lesion depth and width for PF alone were 3.5±0.6 and 5.1±1.8 mm. Lesion depths for combined applications were significantly greater versus PF alone (6.2±1.8 mm radiofrequency followed by sequential application of PF on the same location; 5.7±1.3 mm PF followed by sequential application of radiofrequency on the same location; P<0.0001 for both). Lesion widths were also significantly greater with combined therapy versus PF alone (8.6±1.8 mm radiofrequency followed by sequential application of PF on the same location; 8.9±2.1 mm PF followed by sequential application of radiofrequency on the same location; P<0.0001 for both). Histology for both combined lesions showed central thermal necrosis surrounded by a hemorrhagic and transitional PF zone. Combined, colocalized radiofrequency and PF, irrespective of order, show significantly increased lesion size compared with the same dose of PF or radiofrequency alone.

Therapeutic outcomes and safety of radiofrequency ablation for primary papillary thyroid carcinoma: A game-changing meta-analysis.

Radiofrequency ablation (RFA) is an emerging treatment option for small, low-risk papillary thyroid carcinoma (PTC). This systematic review and meta-analysis aimed to evaluate and compare the efficacy and safety profiles of RFA for primary T1a vs. T1b PTC. PubMed, Web of Science, Embase, Google Scholar, and ScienceDirect databases were searched from inception to February 14, 2024 for studies reporting outcomes of RFA for T1a vs. T1b PTC with no known nodal or distant metastasis. The primary outcomes assessed were pooled proportions of tumor disappearance, volume reduction, complications, and recurrence. Twenty studies with 6,613 RFA-treated PTC nodules were included. The median age was 44 years, and the average follow-up was 36.4 months. The mean tumor volume and diameter were 168.9 mm3 and 0.69 cm, respectively. The pooled tumor disappearance rate was 94.3 % for all tumors, with rates of 96.1 % for T1a and 76.7 % for T1b lesions (p = 0.05). The disappearance rate increased from 61.8 % at 12 months to 91.5 % at 48 months post-RFA. The overall volume reduction rate (VRR) was 99.4 % for both T1a and T1b tumors, increasing from 36.8 % at 1 month to 99.6 % at 48 months. Tumor progression occurred in only 1.33 % of the cases overall, with low recurrence rates in both T1a (1.11 %) and T1b (4.21 %) lesions. New cancer foci and lymph node metastases were rare, observed in 0.81 % and 0.20 % of cases, respectively. The overall complication rate was 1.71 %, with transient voice change (0.44 %) and neck pain (0.30 %) being the most common. RFA is a safe and effective minimally invasive treatment option for both T1a and T1b PTC, with high tumor disappearance and volume reduction rates and low complication and recurrence rates. The low progression rates in both tumor sizes suggest that RFA is a promising alternative to surgery for selected low-risk PTC patients. Prospective studies with standardized protocols are warranted to validate these findings.

Radiofrequency ablation: an effective alternate treatment of ectopic ACTH syndrome secondary to a well-differentiated lung carcinoid tumor

Radiofrequency ablation: an effective alternate treatment of ectopic ACTH syndrome secondary to a well-differentiated lung carcinoid tumor

Pulmonary vein stenosis or occlusion resulting from radiofrequency ablation of atrial fibrillation can be mistakenly diagnosed as pneumonia: a case report

Pulmonary vein stenosis or occlusion resulting from radiofrequency ablation of atrial fibrillation can be mistakenly diagnosed as pneumonia: a case report

Transhepatic venous access for catheter ablation of right and left side atrial arrhythmias in adults: challenges and outcomes.

Electrophysiologic (EP) procedures are typically performed via the femoral venous system, but in some patients, the inferior vena cava (IVC) is unavailable. The hepatic vein has emerged as a viable alternative to femoral access, providing an inferior route that accommodates large sheaths required for better catheter manipulation. Although the percutaneous transhepatic approach has been used successfully in the pediatric population, its use in adults is scarce, with a complication rate of approximately 5%. Three patients with limited venous access were referred for ablation between 2018 and 2021. The percutaneous transhepatic access approach provided good support for the EP study, electro-anatomical mapping, and effective radiofrequency ablation of right and left-side arrhythmias. No significant complications were documented, and all patients were discharged within 48 hours of the procedure. At follow-up, all patients had excellent arrhythmia control without significant adverse events. Percutaneous transhepatic access is a feasible and safe alternative to femoral venous access for EP procedures in adult patients with limited venous access.

Thyroid Dysfunction Following Thermal Ablation of Large Solid and Solid-Predominant Thyroid Nodules.

Thermal ablation (TA) is an alternative to lobectomy for thyroid nodules (TNs). While it is believed that thyroid function remains stable after TA for cystic TNs, the impact of TA on solid TNs, especially the large ones, is less explored. This study investigates changes in thyroid hormones after TA in patients with solid-predominant TNs and identifies potential risk factors for thyroid dysfunction after TA. Euthyroid patients with solid-predominant TNs (≥80% solid) were enrolled. The volume, diameter, and cytopathology of TNs were assessed before TA. TA was performed using either microwave or radiofrequency ablation. Thyroid hormone levels were measured at 1 week and 1, 3, 6, and 12 months after TA. 77 euthyroid patients with TNs were included. The euthyroid rate dropped to 70.1% at 1 week after TA but improved to over 90% by 1 month and returned to 100% by 12 months. At 1 week after TA, subclinical hyperthyroidism and hyperthyroidism were observed, with elevated T4, fT3, fT4, and TGAb levels, along with decreased TSH levels. The diameter and total volume of TNs were positively correlated with thyroid dysfunction, while TSH-baseline was negatively correlated with thyroid dysfunction 1 week after TA. A larger diameter and lower baseline TSH were identified as independent risk factors for thyroid dysfunction. TA may cause short-term thyroid dysfunction, especially in patients with large TNs. Monitoring of thyroid hormone levels is recommended from 1 week to 3 months after TA to manage potential thyroid dysfunction effectively.

Comparison of a Novel Temperature-Controlled Diamond-Tip Catheter and a Power-Controlled Gold-Tip Catheter for the Irrigated Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter

Background/Objectives: Radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) is a recommended treatment option for typical atrial flutter (AFL). While power-controlled ablation has been the current standard, a novel temperature-controlled ablation system has been introduced. We aimed to compare the procedural efficacy and one-year outcome of a temperature-controlled diamond-tip catheter with an established power-controlled gold-tip catheter. Methods: Consecutive patients undergoing ablation of CTI-dependent AFL using a power-controlled catheter or the novel temperature-controlled catheter were enrolled. Patients were followed up using a 7-day electrocardiogram after 3, 6, and 12 months. The primary endpoint was acute efficacy (procedural success, total RF, and procedure time). The secondary endpoint was the recurrence of typical AFL during follow-up. Results: In total, 38 patients undergoing temperature-controlled ablation were enrolled and compared to 283 patients undergoing power-controlled ablation. A bidirectional CTI block was achieved in 100% in the temperature-controlled group and 97.5% in the power-controlled group (p = 0.7). The total RF time (median: 192 sec (IQR 138–311) vs. 643 sec (IQR 386–1079), p &lt; 0.001) and total procedure time (median: 45 min (IQR 34–57) vs. 52 min (IQR 39–70), p = 0.01) were shorter with temperature-controlled ablation. At the one-year follow-up, there was no difference in the recurrence of typical AFL between groups. Conclusions: Utilization of temperature-controlled ablation for typical AFL increased procedural efficiency with shorter RF and procedure times compared to power-controlled ablation. The recurrence rate of typical AFL after one year was low and did not differ amongst groups.

Omnipolar mapping versus point-by-point mapping approach for catheter ablation of atrioventricular accessory pathway.

The conventional mapping approach for the atrioventricular accessory pathway (AP) involves point-by-point mapping to identify the connection sites of the AP to the atria or ventricle and accurate interpretation of local electrograms. Omnipolar mapping technology (OMT) explains how vector and wave speed are produced by using both unipolar and bipolar signals to obtain omnipolar signals, directions, and conduction velocity. The aim of this study is to verify the effectiveness of OMT for catheter ablation of AP. The study enrolled 68 patients who underwent catheter ablation of APs between January 2018 and December 2023, of which 35 (OMT group) underwent high-resolution omnipolar mapping and 33 underwent radiofrequency ablation (RF) with a conventional approach (conventional group). The background characteristics and procedural details of these groups were compared. All patients achieved acute success. Any arrhythmia recurrence was observed in one and three patients in the OMT and conventional groups, respectively (p = 0.0501). In the OMT group, AP elimination by the first RF applications (77.1% vs. 48.4%, p = 0.0143), the number of RF applications for eliminating AP (median [IQR]; 1.1 [1.0-3.0] vs. 4.4 [1.0-7.0], p = 0.0012), procedure time (median [IQR], min; 80.1 [72.2-92.7] vs. 112.0 [95.1-125.4], p < 0.01), fluoroscopy time (median [IQR], min; 12.0 [9.5-15.2] vs. 19.8 [13.6-28.1], p < 0.01), and fluoroscopy dose (median [IQR], mGy; 60.9 [45.0-83.5] vs. 129.0 [80.5-360.2], p < 0.01) were significantly lower than in the conventional group. No complications associated with mapping and ablation procedures were observed. The OMT was useful for ablating APs and reducing the number of RF applications and radiation exposure.