Safety Of RFA Research Articles

Current opinion: optimize radiofrequency ablation through electrophysiological principles, modeling, and clinical recommendations.

This article aims to empower the interventional pain physician to utilize RFA effectively by explaining the technical and electrophysiological features of monopolar, bipolar, and internally cooled RFA. Scientific data are used to provide advice on the effective, well tolerated, and rational application of these techniques. Moreover, physicians need to know how to analyze and generalize ex-vivo and in-vivo models to the clinical setting to optimize clinical outcomes. Recent studies suggest that there are many ways to enhance the technical effectiveness of interventional pain medicine RFA through adjustments in the equipment selection and settings and the local tissue conditions specific to the targeted anatomical area. These modifications could assist in improving clinical and safety outcomes. To optimize both the efficacy and safety of RFA, physicians must understand, conceptualize, interpret, and clinically translate the basic science of RFA. This knowledge is crucial for optimizing equipment selection and settings based on target location to enhance clinical outcomes and limit technical failures.

Local palliative therapies for unresectable malignant biliary obstruction: radiofrequency ablation combined with stent or biliary stent alone? An updated meta-analysis of nineteen trials.

Recently, there has been a burgeoning interest in radiofrequency ablation combined with stent (RFA + Stent) for unresectable malignant biliary obstruction (MBO). This study aimed to perform a meta-analysis to evaluate the efficacy and safety of RFA + Stent compared with biliary stent alone. We searched PubMed, Cochrane Library, Embase, and Web of Science databases from their inception dates to June 20, 2021, for studies that compared RFA + Stent and stent alone for unresectable MBO. The main outcomes were survival, patency, and adverse effects. All meta-analyses were calculated using the random-effects model. A total of 19 studies involving 1946 patients were included in this study. Compared with stent alone, RFA + Stent was significantly associated with better overall survival (HR 0.55; 95% CI 0.48, 0.63; P < 0.00001), longer mean survival time (SMD 2.20; 95% CI 1.17, 3.22; P < 0.0001), longer mean stent patency time (SMD 1.37; 95% CI 0.47, 2.26; P = 0.003), higher stent patency at 6months (OR 2.82; 95% CI 1.54, 5.18; P = 0.0008). The two interventions had similar incidence of postoperative abdominal pain (OR 1.29; 95% CI 0.94, 1.78; P = 0.11), mild bleeding (OR 1.28; 95% CI 0.65, 2.54; P = 0.48), cholangitis (OR 1.09; 95% CI 0.76, 1.55; P = 0.65), pancreatitis (OR 1.39; 95% CI 0.82, 2.38; P = 0.22). Furthermore, the serum bilirubin levels and stricture diameter after operations were significantly alleviated than before operations, but the degree of alleviation between the two groups were not significantly different (all P > 0.05). Although the alleviation of serum bilirubin and stricture diameter did not differ between the two interventions, RFA + Stent can significantly improve the survival and stent patency with comparable procedure-related adverse events than stent alone. Thus, RFA + Stent should be recommended as an attractive alternative to biliary stent alone for patients with unresectable MBO.

Efficacy and Safety of Radiofrequency Ablation for the Treatment of Autonomously Functioning Thyroid Nodules: A Long-Term Prospective Study.

ObjectiveThis study aims to evaluate the efficacy and safety of RFA in the AFTN treatment after 2 years of follow-up and to find the factors related to treatment responses through TSH level and VRR.Materials and MethodsThis long-term prospective study was conducted from September 2017 to April 2021 on 17 AFTNs treated with RFA. Clinical evaluations, thyroid function tests, thyroid scintigraphy, and ultrasonography examinations were performed at 1 month, 3 months, 6 months, and 24 months after ablation. The primary endpoint was the success rate of RFA in restoring the euthyroidism stage after 24 months of follow-ups; secondary outcomes were VRR and improvements of US parameters, clinical examinations, and complications. The Spearman rank correlation test was used to determine related factors with treatment response variables.ResultsAt the 24 months after the procedure, symptom score, cosmetic score, vascularity grade, and nodule volume significantly decreased. The VRR reduced approximately 42.77%, 63.13%, 78.3%, and 95.65% after 1 month, 3 months, 6 months, and 24 months follow-up. All 17 patients were restored euthyroid state without taking ATDs. No major complications were collected. The last TSH level was significantly correlated with the age of patients (Spearman rho = −0.637, p = 0.008). The VRR was significantly correlated with age of patients (Spearman rho = 0.566, p = 0.018) and initial TSH (Spearman rho = 0.485, p = 0.048).ConclusionRFA was demonstrated as a safe and effective option for AFTN treatment in long-term follow-up. It can be used as an alternative treatment with encouraging results.

Benefits of catheter ablation of typical cavotricuspid isthmus-dependent atrial flutter using half-normal saline

Abstract Funding Acknowledgements Type of funding sources: None. Background Radiofrequency catheter ablation (RFA) of cavotricuspid isthmus–dependent atrial flutter (AFL) is a procedure with a high success rate and a low complication rate. The anatomical variation and irregularity of the isthmus, with the high local blood flow, can reduce the effectiveness of the lesion and consequently of the procedure. Recent data suggests that deeper ablation lesions can be created using open-irrigated catheters (CA) with half-normal saline (HNS). Purpose To assess the acute efficacy and safety of RFA of AFL with half-normal saline (HNS). Compare the results with CA irrigated with normal saline (NS). Methods Randomized, prospective, observational and single-center study. Consecutive patients with first AFL RFA between June 2019 and December 2020 were included. CA with HNS or NS were used, with a limit of 40 watts and 40° C. An RFA line was performed under fluoroscopic guidance or electroanatomic mapping. If necessary, the lesion was repeated until the arrhythmia was interrupted and the bidirectional block was achieved (success). Acute success, total radiofrequency time (RT), number of radiofrequency applications, and complications were analyzed. Results 38 patients with RFA of AFL were analyzed. 19 in the HNS and 19 in the NS group. There were no significant differences between the baseline characteristics of each group. (Table 1) The accute success rate was 100% with a median of 2 RFA applications in both groups. The mean RT in HNS was 7:10 vs 09:16 min in NS group; the t-test analysis did not show a significant difference (p = .2). A subanalysis was performed in those patients who required more than 2 lines of RFA; a mean of 4 in the HNS group vs 6 in the NS group (p = .4). In the HNS group, RT was significantly shorter; 8:17 vs 13:17 min in the NS group (p = .011). (Figure 1) There was a steam pop in the HNS group and no complications or steam pop in the NS group (p = .53). Conclusions RFA of AFL using HNS is an effective and safe procedure. In patients with unfavorable anatomy who required a greater number of applications, the radiofrequency time was significantly shorter using HNS. Baseline characteristicsHNS (19 p)NS(19 p)pAge56 ± 12.3 years61 ± 10.8 years.22Male16 p (84%)16 p (84%)1Heart Disease7 p (36.8%)5 p (26.3%).68Ejection Fraction57.1 ± 11%56 ± 14.3%.49Ejection Fraction &amp;lt; 50%2 p (10.5%)2 p (10.5%)1Electroanatomic mapping10 p (52.6%)8 p (42.1%).7Abstract Figure. Fugure 1

Segmentation of anatomical heart structures in Ensite Verismo software for radiofrequency ablation of arrhythmogenic tissues

Review of the problem. The relevance of the research is the need of a high-quality imaging of the left atrium anatomy for the effectiveness of radiofraquency ablation of arrhythmogenic tissue of the myocardium in real time. For its safety it is important to assess the attachment of the esophagus to the wall of the heart. Nowadays, methods of visualization of real anatomical structures are dynamically developed on the basis of data processing of DICOM computer and magnetic resonance imaging, including for the reconstruction of 3D anatomy of the heart. Purpose of research. The task of the research was to construct a three-dimensional model of the anatomical structures of the heart and the nearby organs (pulmonary veins, esophagus) in EnSite Verismo software environment (St.Jude Medical, USA) and to implement the technique in clinical practice in order to improve the accuracy of visualization, safety and efficacy of RFA in X-ray conditions in real time. Metodology. The research was carried out at the M.M. Amosov National Institute of Cardiovascular Surgery Ukraine NAMS of Ukraine with the use of modern specialized high-tech medical equipment and clinical materials, computer tomography images (CT) of the patient's heart N. obtained in the radiation diagnostics department and data of the electroanatomic mapping of the patient's heart in the department of treatment of arrhythmias with X-ray surgery. The approach for conducting RFA with the EnSite Verismo software was implemented using the following algorithm:Receiving and preserving CT scans of the patient in the DICOM format.Downloading gray images into the EnSite Verismo software.Construction of a 3D model of anatomical structures of the heart, pulmonary veins and esophagus by the segmentation of CT images.Export of model to the EnSite NavX system (St. Jude Medical, USA).Combination of a segmented model and electroanatomical map in the EnSite NavX system for further radiofrequency ablation.An algorithm for 3D segmentation of the left atrium, pulmonary veins and esophagus in the EnSite Verismo software is developed. It is based on the threshold method of splitting the image into an area for which a certain homogeneity criterion is fulfilled. Result and conclusions. The developed algorithm for segmentation of the left atrium, pulmonary veins and esophagus for the EnSite Verismo allows for the construction of an exact anatomy of structures. The 3D model of individual anatomy of the heart provides the information for surgeon during RFA about the features of the structure of the left atrium: the location of the pulmonary veins in order to avoid vein stenosis; the localisation of the esophagus in order to apply ablation very carefully, so as not to make the perforation of the esophagus. A 3D model, supplemented by an electro-anatomical map of the left atrium that shows, in addition to anatomy, the order of activation of heart miocardium and localization of arrhythmia, will increase the efficiency and safety of RFA.

Percutaneous radiofrequency ablation for spinal osteoid osteoma and osteoblastoma.

We sought to verify the efficacy and safety of RFA in spinal OO and osteoblastomas (OB) (Enneking Stage 2, S2). We retrospectively reviewed patients treated in our hospital. Surgical resection was indicated for Enneking Stage 3 OB. RFA indications for spinal OO and OB (S2) were no neurological deficits, complete bone cortex around the lesion on computed tomography (CT), and cerebrospinal fluid between a lesion and the spinal cord/nerve root on magnetic resonance imaging. Abundant cerebrospinal fluid (more than 1.0mm) between the lesion and nerve root/spinal cord was preferred to prevent neurological damage by heat. Otherwise, surgery was recommended. The minimum follow-up was 24months. Ten patients were treated with CT-guided percutaneous RFA, including three with OB and seven with OO. No patients had neurological deficits or scoliosis. In OO patients, the average visual analog scale (VAS) scores were 7.6/10 (range 6-10) before RFA. In OB cases, the VAS scores were 8, 7, and 9 before RFA. Nine patients had a one-stage biopsy and then RFA, and one patient had a two-stage procedure (biopsy before RFA). The average RFA time for OO was 10min (range 4-12). In the three OB cases, the RFA time was 12, 12, and 24min. The time of the whole produce was 98min (range 65-130min). All 10 patients were followed-up. The average follow-up time of OO was 46.6months (range 24-66). Six patients were free of pain, except one who suffered occasional pain with VAS 2/10. The three OB cases were free of pain at 24, 26, and 26months. CT-guided percutaneous RFA is a safe and effective treatment for spinal OO and S2 OB, especially in lesions with no neurological deficits and intact cortical bone. Cerebrospinal fluid around the lesion is an appropriate indication for percutaneous RFA.