The gastric branch of the vagus nerve is required for hypothalamic pituitary axis stress habituation in male Sprague Dawley rats.

Re-Ablation of Atrial Fibrillation Targeting Electrogram Dispersion in Patients with Isolated Veins: The RESTART Trial.

Fluorescein-guided surgical ablation of Spinal Dural Arteriovenous Fistula (SDAVF) is a safe and effective add-on to ensure surgical closure

Artificial-Intelligence Electrocardiography and Computed Tomography Mapping to Guide Surgical Ablation of Ventricular Arrhythmias

Introduction: Parkinson’s Disease (PD) and Essential Tremor (ET) are the two most prevalent movement disorders, with tremor being a core, often drug-refractory, motor feature. While traditional surgical treatments like Deep Brain Stimulation (DBS) and Radiofrequency (RF) ablation are effective, they are invasive and carry inherent risks such as hemorrhage and infection, necessitating craniotomy. This reality drives the need for less invasive therapeutic options for patients with advanced, medication-refractory symptoms and motor fluctuations. Aim: The aim of this systematic review is to assess the clinical efficacy and safety profile of Thalamotomy and Pallidotomy performed using Magnetic Resonance-Guided Focused Ultrasound (MRgFUS) technology in the treatment of Essential Tremor and Parkinson’s Disease. Review methods: A comprehensive analysis of research papers available on PubMed and Google Scholar was conducted using keywords: Focused Ultrasound (FUS), Essential Tremor (ET), Parkinson's Disease (PD), Thalamotomy, Pallidotomy, MRgFUS. Conclusion: MRgFUS-guided thalamotomy (VIM) and pallidotomy (GPi) constitute a breakthrough, non-invasive alternative to traditional surgical ablations. The technology demonstrates high and durable efficacy, achieving a 47% reduction in ET tremor and a 39,1% reduction in PD motor symptoms (UPDRS III), comparable to invasive standards. Crucially, MRgFUS offers a favorable safety profile by eliminating the risk of surgical bleeding and infection while providing real-time lesion monitoring. However, a key limitation remains the requirement for an adequate Skull Density Ratio (SDR), excluding some clinically eligible patients. Further long-term, prospective studies are required to fully establish its role.

Commentary on "Thoracoscopic surgical ablation for atrial fibrillation patients with functional regurgitation: the treatment strategy prioritizing atrial fibrillation".

ObjectivesMinimally invasive surgical ablation for atrial fibrillation is an alternative to catheter ablation. Achieving a lasting sinus rhythm in long-standing persistent atrial fibrillation is challenging, and long-term data after surgery are limited. In 2016, we published a randomized trial comparing totally endoscopic box lesion ablation of the left atrium (case) to medical therapy (control) during 1 year in patients with long-standing persistent atrial fibrillation. This study presents data from a follow-up of our previous cohort to investigate the rhythm outcome long-term.MethodsThis was an observational follow-up study. Most recent heart rhythm, time from totally endoscopic ablation to first relapse in atrial fibrillation, re-ablation, stroke, medication, left ventricular ejection fraction, and mortality were gathered from medical records and analysed with descriptive statistics and survival analysis.ResultsAt the end of the randomized trial, 80% of the cases had sinus rhythm without antiarrhythmic drugs. During a mean follow-up of 9 years, 43% of cases and 74% of controls had undergone additional ablation procedures (P = .009). At the last follow-up, 21% of cases and 5% of controls were in SR. After totally endoscopic ablation, the mean time from surgery to first relapse in atrial fibrillation was 23 months (14-31 [95% CI] P < .001).ConclusionsIn this population of patients with long-standing persistent atrial fibrillation, totally endoscopic box lesion ablation of the left atrium had short-term efficacy in restoring sinus rhythm. Long-term efficacy could not be demonstrated, with a high proportion of relapse in atrial fibrillation beyond 1 year post ablation.

This review investigates that atrial fibrillation (AFIB) is affecting a large and increasing number of patients. The underlying pathophysiological process is not yet fully understood. Minimal invasive surgical ablation offered to some patients has a high success rate, long durability, and minimal risk. In patients with concomitant heart surgery, the benefit also has a prognostic effect and is recommended in cardiac surgery guidelines. Referral to a thoracic surgical centre should be considered for patients with symptomatic AF not responding to conventional therapy.

Impacts of atrial fibrillation and surgical ablation on rheumatic and degenerative mitral surgeries.

Primary tumor surgery in patients with de novo stage IV breast cancer: Is there an optimal subgroup for locoregional therapy?

Background:Concomitant surgical ablation (SA) is recommended at the time of cardiac surgery in patients with AF but it remains widely underperformed. We sought to report on the safety and long-term efficacy of concomitant SA and the associated incidence of stroke and survival.Methods:A retrospective observational study was performed on patients with AF undergoing cardiac surgery between April 2011 and March 2022 with grouping based on whether or not they received concomitant SA. Thirty-day complications and long-term atrial tachyarrhythmia recurrence, stroke and mortality were compared between groups after propensity score matching.Results:A total of 1,205 patients were included; two groups were obtained after matching (n=326 each). Post-operative length of stay was slightly longer in matched patients receiving concomitant SA (median 10 versus 9 days; p=0.048) but length of stay on intensive care and complication rates were similar in both groups. Freedom from atrial tachyarrhythmia in the SA group was 74% at 1 year and 58% at 3 years compared with 10% and 8%, respectively, for the no-SA group. Ten-year survival was increased for matched patients in the SA group compared with patients in the no-SA group (adjusted HR 0.61; 95% CI [0.45–0.82]; p=0.001) but the incidence of ischaemic stroke was similar (subdistribution HR 1.11; 95% CI [0.53–2.30]; p=0.790).Conclusion:In patients with AF undergoing cardiac surgery, concomitant SA was associated with improved long-term survival without increasing complications. Concomitant SA was not associated with an independent reduction in the long-term incidence of ischaemic stroke.

Surgical microwave ablation of 3035 liver tumors in 1416 patients: a retrospective analysis of 16 years of experience.

Background: Chronic venous illness is one of the major developing illnessesacross the world. Varicose vein leads to major negative consequences,including missed work, pain, discomfort, and a deterioration in quality of life. Methods: Varicose veins affect people’s quality of life and range in incidencefrom 10% to 30% worldwide Varicose vein treatment options are taken basedon a number of factors, including patient preferences, postoperative risk, cost,and the degree of the venous insufficiency.). Varicose vein patients who areasymptomatic are initially treated conservatively with medications,compression therapy, and lifestyle changes. Patients who are symptomatic,on the other hand, are advised to look at surgical options such asradiofrequency ablation(RFA), endovenous laser ablation (EVLA), high ligationand stripping (HL/S) of the incompetent great saphenous vein (GSV), Cureconservatrice et Hemodynamique de Insufficience veineuse en Ambulatoire(CHIVA) , mechanochemical ablation (MOCA) , cyanoacrylate embolization(CAE),etc. Results: Each treatment is effective in the treatment of each type and eachstage of varicose veins and has its pros and cons. This article analysis thevaricose vein treatments and discusses the safety, efficacy and success rate ofeach treatments.

The paper presents the case of a 47-year-old perimenopausal woman who presented with metrorrhagia occuring after a 2-month period of amenorrhea. The patient was investigated through anamnesis, clinical examination, transvaginal ultrasound, endometrial biopsy and blood tests. The ultrasound showed blood inside the uterine cavity, a 7.5 mm thick endometrium and 2 follicles in the structure of the left ovary, the right one being absent due to surgical ablation. After 16 days of continuous metrorrhagia, uterine curettage was performed. Histopathological examination revealed endometrial hyperplasia without atypia and uterine leiomyoma fragments

The need for diagnostic, staging, and treatment surgical procedures in the context of pulmonary oncologic pathology and robotic surgery involves specialized airway management, specifically with the requirement of one-lung ventilation. This case report presents successfull use of preoperative flexible fiberoptic bronchoscopy in a patient with a history of recurrent laryngeal papillomatosis with multiple surgical ablation procedures, with a preoperative diagnosis of non-keratinizing large cell carcinoma of the right upper lobe scheduled for frozen section biopsy by mediastinoscopy and the subsequent performance of robotically assisted right upper lobectomy.

Background/Objectives: Surgical ablation for atrial fibrillation (AF) during cardiac surgery decreases perioperative morbidity and mortality and improves long-term patient outcomes. Because of these benefits, it has been designated a Class I surgical society recommendation. As surgical ablation techniques have evolved, so too have ablation tools such as radiofrequency and cryothermal devices. In this study, we evaluated real-world evidence (RWE) of concomitant surgical ablation featuring an epicardial left atrial encircling lesion created by a novel bipolar radiofrequency clamp. Methods: Thirteen centers in the observational Tracking Results of Ablation to Combat AF (TRAC-AF) Registry (NCT05111015) contributed data used in this analysis. Included patients had AF and received the epicardial encircling lesion during cardiac surgery. Additional ablation and follow-up were per institutional standard of care. Freedom from AF/atrial tachycardia (AT)/atrial flutter (AFL) and survival were evaluated using the Kaplan-Meier method. Safety was evaluated within 30 days of the procedure. Results: Among 327 patients, 70% were male with a median age of 69 years. Sixty-nine percent had paroxysmal AF. Median left atrial diameter was 4.1 cm, and CHA2DS2-VASc score was 3. Isolated coronary artery bypass graft and aortic valve surgery were performed in 51% and 11% of patients, respectively. One- and two-year survival rates were 95.3% (95% CI, 91.7-97.3%) and 88.1% (95% CI, 81.5-92.5%). Through 12- and 24-months freedom from AF/AT/AFL was 87.4% (95% CI, 81.3-91.6%) and 79.9% (95% CI 72.0-85.8%). Mortality within 30 days of the index procedure was 1.5%. No serious adverse events were related to the epicardial cardiac ablation procedure or device. Conclusions: RWE from the TRAC-AF Registry demonstrates surgical ablation including an epicardial left atrial encircling lesion made by a novel bipolar RF clamp was safe and resulted in favorable long-term rhythm outcomes.

Despite significant advancements in cancer immunotherapy, survival outcomes remain poor in patients with pancreatic ductal adenocarcinoma. In this early phase II clinical trial, we evaluated the combined effects of immunotherapy with dual immune checkpoint inhibitors durvalumab and tremelimumab, local tumor ablation with microwave energy, and gemcitabine on progression-free survival in twelve patients with non-metastatic unresectable locally advanced pancreatic adenocarcinoma. Single-cell transcriptomics and T cell receptor profiling were used to characterize the tumor microenvironment and peripheral blood immune cell repertoire. Here we show that from these twelve patients (median progression-free survival = 8.9 months, 95% confidence interval 3.2-18.4), eight patients received the combination therapy (median progression-free survival of 11.2 months, 95% confidence interval 4.0-18.4). One of these eight patients experiences grade 5 toxicity. Using single-cell transcriptomics and T cell receptor profiling, we characterize the tumor microenvironment and peripheral blood immune cell repertoire of six patients, of which three patients contain paired samples before and after the start of immunotherapy. We find substantial overlap in T cell receptors and CD8-Temra cells in the tumor microenvironment and in peripheral blood. Integration of the single-cell dataset with an independent bulk transcriptome cohort reveals that a high CD8-Temra gene signature is associated with improved overall survival. While there are interesting trends, T cell receptor-related metrics do not show statistically significant correlations with progression-free survival in this dataset. These findings suggest that CD8-Temra cells may serve as potential biomarkers and therapeutic targets for immunotherapy efficacy in pancreatic ductal adenocarcinoma, pending validation in larger cohorts. We hypothesize that local tumor ablation may enhance tumor immunogenicity and systemic anti-tumor responses, supporting their integration into future treatment strategies. Future studies with larger cohorts are needed to validate these findings and optimize treatment protocols for wider clinical applicability.

Abstract Background Atrial fibrillation (AF) is the most prevalent and persistent arrhythmia, with its frequency rising globally. Prevention of stroke resulting from thrombi in the left atrial appendage (LAA) is a crucial pillar in the management of AF. The hybrid convergent approach has been shown to be a safe and effective technique for treating patients with long-standing persistent AF (LSPAF) with superior efficacy to conventional catheter ablation. The LAA is also a critical substrate in the propagation of AF and an anatomical focus for thrombus formation. Epicardial LAA occlusion has several advantages: LAA ligation results in a favourable electrical and structural atrial remodelling, which decreases AF recurrence and stroke reduction. Endocardial ablation alone is not effective for all patients, and emerging evidence demonstrates improved outcomes in patients with persistent AF after a combined hybrid endocardial-epicardial ablation. One approach for LAA exclusion is the catheter-based LARIAT device, which deploys an epicardial suture to ligate the LAA. This can be performed as a standalone percutaneous procedure, but we describe a case series, where this is performed at the same time as a minimally invasive surgical epicardial ablation procedure for AF. Methods and results We describe the treatment of 18 patients (demographics in table) referred for the convergent procedure for AF. Patients were deemed to be suitable for concomitant LARIAT LAA closure following MDT discussion and favourable anatomy on cardiac CT. The procedures were performed between October 2023 - October 2024. A combined procedure was performed. LAA ligation was achieved using the LARIAT system and surgical epicardial AF ablation using the Epi-Sense unipolar vacuum-assisted linear RF-ablation catheter. The median size of LARIAT device used was 50 mm. The procedure was performed in a hybrid theatre and performed by a cardiac surgeon and cardiac electrophysiologist. Patients were then listed for the second stage of the procedure (LA mapping and endocardial catheter ablation). All procedures were concluded without any peri-procedural complications. During 30 day outcomes, there were no major adverse effects. Conclusion The combination of minimally invasive LAA ligation and epicardial ablation was demonstrated to be feasible and safe. This represents a new approach for the treatment of LSPAF in patients with persistent and long-standing persistent AF. In conclusion, the combination of minimally invasive epicardial ablation with simultaneous LARIAT closure of the LAA with staged endocardial ablation revealed to be a safe and feasible approach for the treatment of refractory AF in patients with persistent and long-standing persistent AF.

Abstract Background Endocardial catheter ablation of persistent (PsAF) and long-standing persistent atrial fibrillation (LSPsAF) is associated with suboptimal outcomes. The hybrid "Convergent" two-stage surgical ablation procedure is associated with improved long-term outcomes, but real-world evidence remains limited. Purpose We characterized the efficacy of the Convergent procedure with concomitant left atrial appendage (LAA) exclusion in achieving arrhythmia-free survival among patients with PsAF or LSPsAF. Methods Single-center retrospective study of 65 patients who underwent the Convergent procedure from 2021-2023 for PsAF (n=36) or LSPsAF (n=29). The primary endpoint was one-year freedom from any documented atrial tachyarrhythmia (AT) &amp;gt;30 seconds after a 90-day blanking period. Results Mean age was 67.5 ± 10.3 years, there was a male predominance (78.5%), mean BMI of 29.2 ± 5.0 kg/m2, and mean LA volume index was 42.4 ± 14.9 ml/m2. LAA clipping was performed in 98.5% of patients, and the Ligament of Marshall was divided in 67.7% of patients. In the cohort, 24.5% had prior AF catheter ablation, and mean number of failed antiarrhythmic drugs (AADs) was 0.60 ± 0.7. Overall freedom from any AT at one year was 77.7%, without AADs in 89.4% of patients. We found no significant difference in the primary endpoint for patients with PsAF vs LSPsAF (76.9% vs 78.9%, log-rank p = 0.96). There was a 3.1% post-procedural complication rate. Conclusion The Convergent ablation procedure with concomitant LAA exclusion confers excellent freedom from recurrent AT at one year and should be considered in PsAF or LSPsAF patients.

BackgroundAlthough there is general agreement on performing concomitant ablation of atrial fibrillation (AF) during left-sided heart valve surgery in low-risk patients due to its proven long-term clinical benefits, its role in reoperative cases remains debated because of perceived high risks.MethodsThis study included 338 consecutive patients with AF who underwent redo surgery for left-sided valve disease between 2000 and 2015 at 2 tertiary referral centers. Among them, 143 patients underwent concomitant surgical ablation for AF (ablation group), while 195 did not (no-ablation group). To evaluate comparative long-term clinical outcomes between the 2 groups, inverse probability of treatment weighting was applied.ResultsEarly mortality rates were 3.5% (4/143) in the ablation group and 9.2% (18/195) in the no-ablation group (p=0.064). At 5 years, the cumulative incidence of AF recurrence was 12.3%±0.1% in the ablation group and 85.2%±0.1% in the no-ablation group (p<0.001). During follow-up (median, 103 months), the ablation group demonstrated significantly lower risks of death (adjusted hazard ratio [aHR], 0.495; 95% confidence interval [CI], 0.312–0.784; p=0.003) and thromboembolic events (aHR, 0.212; 95% CI, 0.058–0.771; p=0.019) compared with the no-ablation group.ConclusionsConcomitant AF ablation during redo valve surgery was associated with improved rhythm outcomes, survival, and freedom from thromboembolic events, supporting its consideration as a reasonable option even in this high-risk group.