Radiofrequency Ablation Research Articles

Long-term outcomes after endoscopic eradication therapy for dysplastic and T1a adenocarcinoma related Barrett's esophagus: higher rate of late dysplastic recurrence with radio-frequency ablation monotherapy.

There is conflicting literature describing the durability of complete remission of intestinal metaplasia (CRIM) after endoscopic eradication therapy (EET) for Barrett's esophagus (BE). We aim to assess the timeline, predictors and long-term outcomes of recurrence. Data on 365 patients who underwent EET for dysplastic BE were collected prospectively between 2008 and 2022 at a Barrett's referral unit. Kaplan-Meier method and Epanechnikov-kernel density estimate were used to determine the cumulative incidence of recurrence following CRIM and the rate of recurrence over time. A logistic regression analysis was fitted to identify factors associated with recurrence. 216 patients achieved CRIM and were then followed for a median (IQR) 5.8 years (2.9, 7.2). Intestinal metaplasia (IM) recurred in 57 patients (26.4%) and dysplasia in 18 patients (8.3%). The time to recurrence peaked at 1.8 years. The cumulative recurrence risk within 2 years was 23.1% with an additional 29.2% risk over the next 10 years. Increased risks of any BE recurrence (Odds ratio (OR) 3.0; p=0.009), dysplastic (Relative risk ratio (RRR) 5.53; p=0.001) and late (≥2 years) recurrences (RRR 3.24; p=0.01) were associated with radio-frequency ablation (RFA) monotherapy, whereas combination endoscopic mucosal resection (EMR) and RFA was associated with a decreased risk of dysplastic recurrence (RRR 0.27; p=0.02). The risk of recurrence is highest within the first 2 years post-CRIM, but remains significant long term. The risk of IM, dysplasia and late recurrence is higher when RFA was the sole modality used to achieve CRIM, raising the possibility that RFA provides a less durable response. These findings may impact treatment and surveillance decisions.

Comparison of radiofrequency ablation, microwave ablation and high-intensity focused ultrasound for hepatocellular carcinoma: a retrospective study.

The recommended first-line treatment for respectable hepatocellular carcinoma (HCC) is surgical resection, but local ablation has gained popularity as a safe alternative. This study aims to compare the effectiveness of radiofrequency ablation (RFA), microwave ablation (MWA) and high-intensity focused ultrasound (HIFU) as first-line treatments for HCC. In this single-centre retrospective study, 352 patients receiving RFA, MWA, or HIFU as first-line treatment for HCC were included. Pre- and post-treatment tumour sizes and overall and disease-free survival rates were analysed to compare the three local ablation modalities. Propensity-score matching was used to reduce the bias due to differences in pre-treatment liver function. Patients receiving HIFU had significantly higher pre-treatment MELD score and Child-Pugh grade. The complete response rates of HIFU patients were significantly lower than those of RFA and MWA groups (p<0.001) despite propensity-score matching. However, the three groups had similar disease-free survival (p=0.216) and comparable one-year survival (p=0.173). HIFU serves as a last resort rescue therapy for patients with poor pre-treatment liver function who are not eligible for other local ablative means. Despite the low complete response rate, the overall survival and disease-free survival rates of patients having HIFU were comparable to those having RFA or MWA.

Bisphosphonate-mineralized nano-IFNγ suppresses residual tumor growth caused by incomplete radiofrequency ablation through metabolically remodeling tumor-associated macrophages.

Rationale: Radiofrequency ablation (RFA), as a minimally invasive surgery strategy based on local thermal-killing effect, is widely used in the clinical treatment of multiple solid tumors. Nevertheless, RFA cannot achieve the complete elimination of tumor lesions with larger burden or proximity to blood vessels. Incomplete RFA (iRFA) has even been validated to promote residual tumor growth due to the suppressive tumor immune microenvironment (TIME). Therefore, exploring strategies to remodel TIME is a key issue for the development of RFA therapy. Methods: The negative effect of iRFA on colorectal cancer therapy was firstly investigated. Then a zoledronate-mineralized nanoparticle loaded with IFNγ (Nano-IFNγ/Zole) was designed and its tumor suppressive efficacy was evaluated. Finally, the metabolic reprogramming mechanism of Nano-IFNγ/Zole on tumor-associated macrophages (TAMs) was studied in detail. Results: We found iRFA dynamically altered TIME and promoted TAM differentiation from M1 to M2. Nano-IFNγ/Zole was fabricated to metabolically remodel TAMs. IFNγ in Nano-IFNγ/Zole concentrated in the ablation site to play a long-term remodeling role. Acting on mevalonate pathway, Nano-IFNγ/Zole was discovered to reduce lysosomal acidification and activate transcription factor TFEB by inhibiting isoprene modification of the Rab protein family. These mechanisms, in conjunction with IFNγ-activated JAK/STAT1 signaling, accelerated the reprogramming of TAMs from M2 to M1, and suppressed tumor recurrence after iRFA. Conclusions: This study elaborates the synergistic mechanism of zoledronate and IFNγ in Nano-IFNγ/Zole to reshape suppressive TIME caused by iRFA by remodeling TAMs, and highlights the important value of metabolically induced cellular reprogramming. Since both zoledronate and IFNγ have already been approved in clinics, this integrative nano-drug delivery system establishes an effective strategy with great translational promise to overcome the poor prognosis after clinically incomplete RFA.

Transarterial Chemoembolization Plus Radiofrequency Ablation and Iodine-125 Seed Implantation for Hepatocellular Carcinoma in High-Risk Locations: A Propensity Score-Matched Analysis.

The effect of transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA) (TACE-RFA) for hepatocellular carcinoma (HCC) in high-risk locations is not satisfactory. The aim of this study was to compare the clinical outcomes of TACE-RFA plus iodine-125 (125I) seed implantation (TACE-RFA-125I) therapy with those of TACE-RFA for unresectable HCC (≤5 cm) in high-risk locations. From January 2010 to June 2023, the clinical data of 126 patients with unresectable HCC (≤5 cm) in high-risk locations who received TACE-RFA-125I or TACE-RFA treatment were retrospectively analyzed. The clinical outcomes between the two groups were compared after propensity score matching (PSM) analysis. Forty-six pairs of patients were matched. The local progression-free survival rates at 1-, 2-, 3-, 4-, and 5-years were 100%, 82.4%, 74.8%, 63.5%, and 54% in the TACE-RFA-125I group, which were significantly higher than 91.3%, 69.4%, 50.7%, 29.4%, and 26.7% in the TACE-RFA group, respectively (p = 0.004). The median progression-free survival in the TACE-RFA-125I group was significantly longer than that in the TACE-RFA group (p = 0.002). The overall survival rates at 1-, 2-, 3-, 4-, and 5-years were 100%, 93.4%, 80.7%, 74.9%, and 64.7% in the TACE-RFA-125I group, which were significantly higher than 97.8%, 78%, 68.6%, 51.1%, and 45.3% in the TACE-RFA group, respectively (p = 0.011). There was no occurrence of major complications or procedure-related deaths in the two groups. Compared with the TACE-RFA treatment, TACE-RFA-125I should be a more effective treatment strategy for patients with unresectable HCC (≤5 cm) in high-risk locations.

Efficacy of microwave ablation for intrahepatic cholangiocarcinoma: a systematic review and meta-analysis.

Data on overall survival (OS) and progression-free survival (PFS) after microwave ablation (MWA) for intrahepatic cholangiocarcinoma (ICC) are scarce. We conducted a systematic review of the safety and efficacy of MWA for ICC. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for studies reporting the outcomes of MWA for ICC. Meta-analyses of the pooled OS, PFS, technical success, technical efficacy, and complication rates were conducted. Pooled hazard ratios (HRs) of common variables were calculated to identify the factors associated with OS. The analysis encompassed 168 entries, among which 8 observational studies comprising 423 patients were deemed eligible. The pooled results were as follows: The median OS was 22.0 months [95% confidence interval (CI): 15.1-28.9], with the 1-, 3-, and 5-year OS rates being 83.7% (95% CI: 75.8-91.6%), 51.0% (95% CI: 41.1-60.9%), and 33.3% (95% CI: 14.1-52.4%), respectively. The median PFS was 12.5 months (95% CI: 8.3-16.7), and the 1-year PFS rate was 61.2% (95% CI: 36.5-85.9%). The technical success, technical efficacy, and major complication rates were 100% (95% CI: 99.5-100%), 99% (95% CI: 92.1-100%), and 2.8% (95% CI: 1.1-5.2%), respectively. A cancer antigen 19-9 (CA 19-9) level >37 U/mL was associated with a shorter OS (HR =1.4; 95% CI: 1.2-1.7; P=0.001). MWA is a safe and effective alternative to chemotherapy, radiotherapy, and radiofrequency ablation (RFA) treatments, especially for patients with a CA 19-9 level ≤37 U/mL, and potentially has advantages over RFA. However, further studies are required to validate these findings.

US-Guided Thermal Ablation for Secondary Hyperparathyroidism: A Prospective Multicenter Study.

Background Interest in microwave ablation (MWA) and radiofrequency ablation (RFA) use for treating secondary hyperparathyroidism (SHPT) is rising; however, ablation outcomes in patients with SHPT are not well characterized. Purpose To assess the response of parathyroid hormone (PTH), calcium, phosphorus, and alkaline phosphatase (ALP) levels to US-guided parathyroid MWA and RFA and the safety of these treatments in participants with SHPT. Materials and Methods This prospective multicenter cohort study, conducted from September 2017 to March 2022, included participants with SHPT. The primary end point was the proportion of participants achieving the target PTH level (≤585 pg/mL). The secondary end points included PTH, calcium, phosphorus, and ALP levels before ablation and time points for follow-up assessments after ablation (2 hours, 1 day, 1 month, 3 months, and 6 months, and then every 6 months) and complications and technical success rates. Mixed-effects logistic regression models were used to identify factors associated with treatment failure. Results A total of 215 participants (median age, 53 years [IQR, 43-60 years]; 109 [50.7%] male participants) were evaluated, and 183 (85.1%) achieved target PTH levels. Compared with baseline levels, there was an 85.9%, 6.3%, 15.3%, and 37.4% reduction in PTH, calcium, phosphorus, and ALP levels at 24 months after ablation, respectively. For major complications, one (0.5%) participant experienced persistent hoarseness, and severe hypocalcemia (<1.87 mmol/L) was present in 74 (34.4%) participants. After adjustments, predictors associated with treatment failure included the preablation PTH level (adjusted odds ratio [OR], 3.78; 95% CI: 1.19, 12.04; P = .03), maximum tumor volume (adjusted OR, 5.02; 95% CI: 1.74, 14.53; P = .003), and number of glands ablated (adjusted OR, 0.32; 95% CI: 0.11, 0.98; P = .046). The prediction model showed good discrimination ability in the development and validation cohorts (area under the receiver operating characteristic curve, 0.78 [95% CI: 0.66, 0.90] and 0.73 [95% CI: 0.55, 0.91], respectively). Conclusion US-guided thermal ablation techniques were effective and safe treatments in participants with SHPT because they effectively reduced PTH, calcium, phosphorus, and ALP levels. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Gemmete in this issue.

Sequential CMR imaging in a nonischemic cardiomyopathy patient with an ICD before and after radio-frequency ablation

Sequential CMR imaging in a nonischemic cardiomyopathy patient with an ICD before and after radio-frequency ablation

Retrospective evaluation of a novel ultrasound-based imaging analysis software for predicting radiofrequency ablation areas.

This study aimed to introduce and evaluate a novel software-based system, BioTrace, designed for real-time monitoring of thermal ablation tissue damage during image-guided radiofrequency ablation for hepatocellular carcinoma (HCC). BioTrace utilizes a proprietary algorithm to analyze the temporo-spatial behavior of thermal gas bubble activity during ablation, as seen in conventional B-mode ultrasound imaging. Its predictive accuracy was assessed by comparing the ablation zones it predicted with those annotated by radiologists using contrast-enhanced computed tomography (CECT) 24 hours post-treatment, considered the gold standard. The study included 20 liver tumors. The median tumor measurement along the major axis was 1.2 cm. The median Dice coefficient, Sensitivity, and Precision between BioTrace and CECT were 0.90, 0.91, and 0.91, respectively. The intraclass correlation showed excellent agreement in volume size between BioTrace and CECT findings (0.98). BioTrace effectively generates an ablation damage prediction map based on real-time ultrasound imaging, accurately predicting the ablation zone as confirmed by 24-hour post-procedural CECT. This system has the potential to enhance the safety and efficacy of ablation procedures in clinical settings.

Radiofrequency Ablation for Recurrent Thyroid Cancers: 2025 Korean Society of Thyroid Radiology Guideline.

Radiofrequency ablation (RFA) is a minimally invasive treatment modality used as an alternative to surgery in patients with benign thyroid nodules, recurrent thyroid cancers (RTCs), and primary thyroid microcarcinomas. The Korean Society of Thyroid Radiology (KSThR) initially developed recommendations for the optimal use of RFA for thyroid tumors in 2009 and revised them in 2012 and 2017. As new meaningful evidence has accumulated since 2017 and in response to a growing global interest in the use of RFA for treating malignant thyroid lesions, the task force committee members of the KSThR decided to update the guidelines on the use of RFA for the management of RTCs based on a comprehensive analysis of current literature and expert consensus.

Efficacy and Safety of Conventional and Cooled Radiofrequency Ablation in Patients with Advanced Knee Osteoarthritis: A Prospective, Randomized, Double-blind Study

Background: In knee osteoarthritis (KOA), cooled radiofrequency ablation (C-RFA) and conventional radiofrequency ablation (Conv-RFA) are seldom compared directly, and long-term outcome is unclear. Aim: The aim is to compare the efficacy and safety of C-RFA and Conv-RFA in patients with Kellgren and Lawrence grade ≥3. Settings and Design: This prospective, randomized, double-blind study was performed over 30 months (October 2020 to March 2023) with 12 months follow-up in the Department of Pain Medicine. Materials and Methods: The study included 30 patients each in C-RFA and Conv-RFA groups. The outcomes were assessed at baseline, 3, 6, and 12 months and included pain relief (Visual Analogue Scale [VAS] score), rescue analgesic use, functional improvement (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores), and adverse events. Results: At 12 months, both C-RFA and Conv-RFA groups had a significant reduction in VAS score and analgesic use as well as an improvement in WOMAC score (P &lt; 0.0001). In the C-RFA group, VAS score and analgesic use decreased, while WOMAC score improved significantly at 3, 6, and 12 months compared to baseline (P &lt; 0.0001). At corresponding intervals, similar changes were observed in the Conv-RFA group at all the intervals, except no significant reduction in VAS score at 12 months (P = 0.900). The groups had comparable VAS and WOMAC scores at baseline, 3, and 6 months; however, at 12 months, the VAS score decreased significantly and the WOMAC score improved significantly in C-RFA groups (P &lt; 0.0001). Conclusions: C-RFA provided significantly greater and prolonged pain relief and functional improvement in patients with KL grade III–IV KOA, and thus is superior to Conv-RFA.

Comparison of P-wave parameter changes after radiofrequency ablation and cryoballoon ablation for paroxysmal atrial fibrillation: An observational cohort study.

Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) can be performed using one-shot cryoballoon ablation (cryo) or point-by-point radiofrequency ablation (RF). This study compares the changes in P-wave parameters between both ablation methods. This single-centre retrospective study included contact force RF and second-generation cryo for PAF between 2018 and 2019. Procedure success was defined by freedom of ECG-documented AF at 12months. Digital 12‑leads ECGs with 1-50 hertz bandpass filters were monitored directly during the procedure. Corrected P-wave duration (PWDc), P-wave voltage (PWV), P-wave dispersion (PWDisp), and P-wave terminal force in V1 (PTFV1) were measured and compared between RF and cryo. Additional ablations outside pulmonary veins were excluded. The final analysis included 226 patients, and the freedom of AF rate was similar at the 12-month follow-up between RF and cryo (76% vs 74%, P=0.12). PWDc and PWV increased and decreased, respectively in both arms. PTFV1 decreased in RF (-3.3mm.s to -4.6mm.s, P<0.001) and cryo (-3.4mm.s to -5.3mm.s,P=0.002). There were similar changes after RF and cryo in PWDc (F11, 1032=0.80, P=0.85), PWV (F11, 1032=0.19,P=0.06), and PWDisp (F11, 1032=0.16,P=0.34) and PTFV1 (P=0.39). Increased PWDc was correlated with failure of RF (hazard ratio [2.3], 95% confidence interval [CI]: 1.4-5.9, p=0.01) and cryo (HR: 2.1, 95% CI (1.3-4.6), p=0.02). Results were similar when patients on antiarrhythmic drugs were excluded. RF and cryo caused similar freedom of AF rate at 12months in PAF and similar P-wave parameter changes.

Metachronous Liver Metastasis during Long-term Follow-up after Endoscopic Submucosal Dissection of a Small Rectal Neuroendocrine Neoplasm

A 67-year-old woman underwent a screening colonoscopy, which revealed a 7-mm rectal subepithelial lesion. Endoscopic submucosal dissection (ESD) confirmed a grade 1 rectal neuroendocrine neoplasm (NEN), and no further treatment was administered. One year after ESD, she was diagnosed with lung cancer, which recurred 4 years later and required chemotherapy. Nine years after ESD, multiple liver metastases from the rectal NEN were found, which were well controlled with radiofrequency ablation. The patient died 13 years after ESD due to the progression of lung cancer. This case highlights the need for long-term follow-up in patients with small rectal NENs treated with endoscopic resection.

Needle tract seeding of thyroid cancer after biopsy of distant metastasis: a retrospective cohort.

Imaging-guided percutaneous core needle biopsy is currently the most common technique for the investigation of potentially malignant bone lesions. It allows precise needle placement and better visual guidance, leading to improved diagnostic accuracy. Needle tract seeding (NTS) is a rare complication of biopsies in general, and its true incidence remains unknown. This study aimed to assess the risk of NTS in patients with thyroid cancer who underwent bone biopsy. For our cohort, we extracted data from the electronic medical record at the Mayo Clinic in Rochester (Minnesota, USA). Inclusion criteria included patients with a history of thyroid cancer who underwent biopsy for bone metastasis between 1/1/2014 and 10/1/2023. We identified a cohort of 20 patients that fit our inclusion criteria. Of these 20 patients, 2 patients developed NTS after CT-guided bone biopsy. Cases of seeding had a larger tumor size, a more aggressive histopathological presentation, a significantly shorter duration between cancer diagnosis and bone metastasis, and underwent more tumor manipulation procedures, such as biopsy and radiofrequency ablation, in contrast to those without seeding. In conclusion, our study identified NTS to have an incidence of 10% after biopsies of bone metastasis related to thyroid carcinoma. These are likely the result of an interplay of risk factors, including tumor biology, penetrated tissues and procedural technical details. Further studies with larger sample sizes are needed to confirm our findings and identify strategies to mitigate NTS.

LncRNA-056298 Regulates GAP43 and Promotes Cardiac Intrinsic Autonomic Nerve Remodelling in a Canine Model of Atrial Fibrillation Induction after Ganglionated Plexus Ablation.

Cardiac intrinsic autonomic nerve remodelling has been reported to play an important role in the recurrence of atrial fibrillation after radiofrequency ablation, which significantly affects the long-term efficacy of this procedure. lncRNAs have been shown to interact in the pathological processes underlying heart diseases. However, the roles and mechanisms of lncRNAs in cardiac intrinsic autonomic nerve remodelling during atrial fibrillation reduction after ganglionated plexus ablation remain unknown. The aim of this study was to investigate the mechanism by which lncRNA- 056298 modulates GAP43 to affect cardiac intrinsic autonomic nerve remodelling and facilitate the induction of atrial fibrillation after ganglionated plexus ablation. A canine model of right atrial ganglionated plexus ablation was established. The atrial electrophysiological characteristics and neural markers were detected before and after 6 months of ganglionated plexus ablation. High-throughput sequencing was used to screen differentially expressed lncRNAs in target atrial tissues, and lncRNA- 056298 was selected to further explore its effects and mechanisms on cardiac intrinsic autonomic nerve remodelling. The induction rate of atrial fibrillation increased in dogs after ganglionated plexus ablation. Overexpression of lncRNA-056298 by lentivirus can shorten the atrial effective refractory period and increase the induction of atrial fibrillation. lncRNA- 056298 promoted cardiac intrinsic autonomic nerve remodelling via endogenous competition with cfa-miR-185 to induce transcription of its target gene GAP43, thereby affecting the induction of atrial fibrillation. lncRNA-056298 regulates GAP43 by sponging miR-185, which affects cardiac intrinsic autonomic nerve remodelling and mediates atrial fibrillation induction after ganglionated plexus ablation.

Role of radiologists in the diagnosis and management of adrenal disorders

This study aimed to focus on the role of radiologists in the diagnosis and management of adrenal lesions, particularly primary aldosteronism (PA) and secondary hypertension. As hypertension affects more than one-third of the population in Japan, identifying secondary causes such as PA and adrenal lesions is crucial. Establishing a radiological differential diagnosis of adrenal lesions using advanced imaging techniques, such as computed tomography and magnetic resonance imaging, is crucial. Knowledge of the imaging findings of various benign and malignant adrenal lesions, such as adrenocortical adenomas, cortisol-producing lesions, pheochromocytomas, adrenocortical carcinoma, malignant lymphoma, and metastatic tumors, is necessary. Adrenal venous sampling (AVS) plays a crucial role in accurately localizing aldosterone hypersecretion in PA, especially when imaging fails to provide a clear diagnosis. This paper details the technical aspects of AVS, emphasizing catheterization techniques, anatomical considerations, and the importance of preprocedural imaging for successful sampling. Furthermore, we explore segmental adrenal venous sampling (SAVS), a more refined technique that samples specific adrenal tributary veins, offering enhanced diagnostic accuracy, particularly for microadenomas or challenging cases that may be missed with conventional AVS. The methodology for performing SAVS, along with the interpretation criteria for successful sampling and lateralization, is also outlined. Furthermore, radiologists have initiated treatments for unilateral PA, such as radiofrequency ablation, and play an integral role in the management of adrenal lesions. Collaborative approaches across clinical departments are required to enhance patient management in medical care involving the adrenal gland.

Pulsed Field Ablation in the Elderly via a Pentaspline Multielectrode Catheter: Safety, Efficacy, and Comparison with Cryoballoon and Radiofrequency Devices.

Catheter ablation is an effective treatment for atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a novel energy modality, which relies on high-voltage electric fields to achieve cardiac tissue ablation. Data on its efficacy in the elderly are scarce. To evaluate the procedural details and clinical outcomes of PFA in patients > 75 years old. Consecutive AF patients > 75 years old undergoing PFA via the FarapulseTM system were enrolled at 6 high-volume centers. Procedural details and clinical outcomes were compared with those of patients undergoing second-generation cryoballoon (CBA) and radiofrequency (RFA) ablation. Among 983 patients, 221 underwent PFA, 216 CBA, and 546 RFA. Procedure times were shorter with PFA (72 ± 30 minutes) compared to CBA (77 ± 27 minutes) and RFA (99 ± 23 minutes) (p<0.001). Extra-PV ablation was performed in 74.2% PFA, 9.7% CBA, and 42.1% RFA (p<0.001). The major complication rate was 1.01% (n=10) and was not significantly different among groups (1 PFA, 2 CBA, and 7 RFA; p=0.578). Minor complications were observed in 1.4 % PFA, 5.1 % CBA, and 3.5 % RFA (p=0.093). The 1-year atrial tachyarrhythmia freedom in the propensity matched population was 77.2 % with PFA, 80.8 % with CBA, and 74.9 % with RFA) (p=0.52). PFA was a safe and effective option for elderly patients, offering the advantage of enabling extra-PV ablation without the concern of thermal injury risk.

Cardiac selectivity in pulsed field ablation.

This review examines the selective cardiac injury induced by pulsed electric fields during atrial fibrillation ablation. It consolidates findings from both preclinical and clinical studies on cardiac selectivity and explores the potential mechanisms behind this selectivity. Preclinical studies indicate that pulsed electric fields cause significantly more myocardial injury compared with other tissues. Clinical studies have similarly shown that complication rates for pulsed field ablation are notably lower than those for radiofrequency and cryoballoon ablation. Pulsed field ablation demonstrates a notable selectivity for myocardial injury, likely because of the unique functional and metabolic characteristics of cardiomyocytes. This review delves into the underlying principles of cardiac selectivity and proposes future directions for improving this selectivity. It is important to note that while pulsed field ablation shows promise, its cardiac selectivity is not absolute, as some complications still occur, necessitating further research.

Evaluating the Effectiveness, Safety, and Satisfaction Rates of Phenol 90%, Trichloroacetic Acid 100%, and Radiofrequency in Lateral Matricectomy for the Treatment of Ingrown Toenails: A Triple-Arm Clinical Trial.

This study aimed to evaluate the effectiveness, safety, and satisfaction rates of three different lateral matricectomy methods for treating ingrown toenails: 90% phenol, 100% trichloroacetic acid (TCA), and radiofrequency (RF) ablation. Our objective was to identify which method offers superior outcomes regarding postoperative pain, healing time, aesthetic results, and complication rates. Conducted between August 2022 and June 2023, the study included 12 eligible patients divided into three groups: Group 1 underwent lateral matricectomy with 90% phenol, Group 2 with 100% TCA, and Group 3 with RF treatment. Preoperative assessments were conducted, and patients were followed up on the day after surgery and at Weeks 1, 2, and 3, as well as at Months 1, 2, 6, and 9 postoperatively (totaling nine assessments). Pain levels were measured using the Visual Analog Scale (VAS), while wound discharge and bleeding were rated on specified scales. Mean pre- and postoperative (second day) pain scores were 6.0 ± 3.3 and 0.75 ± 0.67 for Group 1, 6.25 ± 4.92 and 1.75 ± 0.58 for Group 2, and 6.25 ± 2.25 and 3.50 ± 0.50 for Group 3, with significant differences observed. RF treatment showed higher moderate postoperative pain compared to mild pain in the phenol and TCA groups. Average healing time was 22.75 ± 3.50 days (phenol), 40 ± 12.91 days (TCA), and 26.25 ± 6.70 days (RF), with phenol demonstrating faster healing, although differences were statistically insignificant. The median aesthetic outcomes favored phenol with a score of 5.0. Lateral matricectomy with 90% phenol, 100% TCA, and RF all provide unique advantages for ingrown toenail treatment. Phenol exhibited high success rates, minimal complications, faster healing, and excellent aesthetic outcomes. IRCT, IRCT20220228054152N1. Registered 03 January 2023, https://www.irct.behdasht.gov.ir/trial/65907.

The risk of malnutrition as a predictor of arrhythmia recurrence after catheter ablation in patients with paroxysmal non-valvular atrial Fibrillation and heart failure with preserved ejection fraction.

Malnutrition presents a significant challenge in managing patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF), yet its impact on AF recurrence after catheter ablation in this population remains unclear. We conducted a retrospective analysis of 204 patients with paroxysmal non-valvular AF and HFpEF who underwent radiofrequency or cryoballoon ablation. Risk of malnutrition as assessed using three screening tools: the Controlling Nutritional Status (CONUT) score, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI)]. We examined the relationship between risk of malnutrition and AF recurrence post-ablation. After a mean follow-up period of 11.2 ± 1.8 months, 43 patients (21.1%) experienced AF recurrence. Despite being classified as overweight or obese based on body mass index, many patients were at risk of malnutrition according to the CONUT score, NRI, and PNI. Adjusted analyses showed that higher CONUT scores (HR: 10.132; 95% CI: 2.545-40.336; P = 0.001), lower NRI (HR: 22.734; 95% CI: 6.399-80.776; P < 0.001), or lower PNI (HR: 9.469; 95% CI: 3.232-27.739; P < 0.001) were significantly associated with increased risk of AF recurrence. Restricted cubic spline regression revealed an inverted U-shaped relationship between the CONUT score and AF recurrence, and L-shaped relationships for both NRI and PNI with AF recurrence. Systematic nutritional assessment is crucial in patients with paroxysmal non-valvular AF and HFpEF. High CONUT scores, low NRI, or low PNI serve as independent predictors for AF recurrence. Further large-scale randomized controlled trials are required to validate these findings.

Optical coherence tomography-enabled classification of the human venoatrial junction.

Radiofrequency ablation to treat atrial fibrillation (AF) involves isolating the pulmonary vein from the left atria to prevent AF from occurring. However, creating ablation lesions within the pulmonary veins can cause adverse complications. We propose automated classification algorithms to classify optical coherence tomography (OCT) volumes of human venoatrial junctions. A dataset of comprehensive OCT volumes of 26 venoatrial junctions was used for this study. Texture, statistical, and optical features were extracted from OCT patches. Patches were classified as a left atrium or pulmonary vein using random forest (RF), logistic regression (LR), and convolutional neural networks (CNNs). The features were inputs into the RF and LR classifiers. The inputs to the CNNs included: (1)patches and (2)an ensemble of patches and patch-derived features. Utilizing a sevenfold cross-validation, the patch-only CNN balances sensitivity and specificity best, with an area under the receiver operating characteristic (AUROC) curve of across the test sets. RF is more sensitive than LR, with an AUROC curve of . Cardiac tissues can be identified in benchtop OCT images by automated analysis. Extending this analysis to data obtained in vivo is required to tune automated analysis further. Performing this classification in vivo could aid doctors in identifying substrates of interest and treating AF.