Radiofrequency Ablation Technique Research Articles

Advancements in Adenoid Removal: Evaluating the Efficacy and Outcomes of Endoscopic-Assisted Coblation Adenoidectomy

Background: With the goal of enhancing accuracy and results in pediatric patients, endoscopic-assisted coblation adenoidectomy is an innovative method for removing adenoid tissue. Though successful, traditional adenoidectomy methods may come with varying degrees of healing and complications after the procedure. Objective: The effectiveness, safety, and clinical results of endoscopically assisted coblation adenoidectomy are assessed in this study. Methods: We performed a prospective cohort study on patients undergoing coblation adenoidectomy with endoscopic assistance. Important parameters included length of surgery, problems during surgery, pain after surgery, time to recovery, and rates of adenoid regrowth. With an emphasis on both quantitative measurements and patient-reported outcomes, data were gathered from medical records and patient surveys. Results: There was a statistically significant decrease in both intraoperative blood loss and operating time with the endoscopic-assisted coblation approach. Following surgery, patients reported less pain and a quicker return to their regular activities. The rates of complications, such as bleeding and infection, were quite low. The technique for radiofrequency ablation of adenoid tissue with a coblator is described in this publication. Creating a bloodless field, precisely removing tissue, and causing minimal harm to neighbouring tissues are its main benefits. Conclusion: An efficient and workable substitute for traditional adenoidectomy methods is endoscopic-assisted coblation adenoidectomy. It is a good alternative for both adult and pediatric patients because of its benefits, which include shorter operating times, less bleeding, and better recuperation after surgery. Additional extended research is necessary to validate these results and evaluate the longevity of the effects.

A Novel Technique for Sacroiliac Joint Radiofrequency Ablation: Combining Ultrasound and X-Ray Annotation for Enhanced Precision and Patient Comfort

A Novel Technique for Sacroiliac Joint Radiofrequency Ablation: Combining Ultrasound and X-Ray Annotation for Enhanced Precision and Patient Comfort

Abstract 4119611: Catheter ablation approach and outcome in HIV+ patients with atrial fibrillation: a systematic review and meta-analysis

Background: Catheter ablation has emerged as an effective treatment option for atrial fibrillation (AF) in the general population. However, limited data exist on the outcomes of catheter ablation in patients infected with the Human Immunodeficiency Virus (HIV+) with concomitant AF. Objectives: This systematic review and single arm meta-analysis aims to comprehensively evaluate the literature on catheter ablation approach and outcome in HIV+ patients with AF. Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted following PRISMA guidelines.Studies meeting the intervention of catheter ablation for AF in HIV+ patients, using radiofrequency, cryoballoon, or pulsed field ablation techniques, were included and data were collected and synthesized using proportion meta-analysis techniques. Statistical analysis was carried out using R software. Results: Three studies met the inclusion criteria, involving 89 HIV+ patients, with an average age of 51.5 years, of whom 83.1% were men, undergoing catheter ablation. Two studies performed received isolation of the pulmonary vein (PV) + posterior wall and superior vena cava. And one study evaluated only the isolation of the pulmonary veins. Of these patients, 43.8% had paroxysmal AF and 56.1% had persistent AF. In two studies reporting freedom from atrial arrhythmias, all patients (62) experienced recurrence of atrial arrhythmias within 5 years of follow-up. Freedom from repeat ablation was 6.26% (Figure 1A). The rate of Pulmonary Vein Trigger was 31.28% (Figure 1B), while the rate of Non-Pulmonary Vein Trigger (non-PV) was 76.64% (Figure 1C). Conclusion: In this systematic review and meta-analysis assessing outcomes of ablation in HIV patients with AF, we observed a similar prevalence of paroxysmal and persistent AF. Furthermore, contrary to the non-HIV+ patients, a high incidence of non-pulmonary vein triggers of AF was noted in this population.

Evaluation of a novel nerve ablation technique to relieve lower back pain: a cadaveric feasibility pilot study.

Radiofrequency ablation is a treatment for facetogenic low back pain that targets medial branches of lumbar dorsal rami to denervate facet joints. Clinical outcomes vary; optimizing cannula placement to better capture the medial branch could improve clinical outcomes. A novel parasagittal technique was proposed from an anatomic model; this technique was proposed to optimize capture of the medial branch. The anatomic feasibility of the novel technique has not been evaluated. To simulate and evaluate the proposed parasagittal technique in its ability to achieve proper cannula placement and proximity of uninsulated cannula tips to the medial branches of the dorsal rami in cadaveric specimens. Under fluoroscopic guidance, the parasagittal technique was used to place 14 cannulae targeting the lumbar medial branches of 2 cadavers. Meticulous dissection was undertaken to assess cannula alignment and measure proximities to target nerves with a digital caliper. The novel parasagittal technique was successfully performed in a cadaveric model in 12 of 14 attempts. The technique achieved close proximity of cannula tips to medial branches (0.8 ± 1.1 mm). In 2 instances, cannulae were placed unsuccessfully; in one instance, the cannula was too far anterior, and in the other, it was too far retracted. In this cadaveric simulation study, the feasibility of performing the parasagittal technique for lumbar radiofrequency ablation was evaluated. This study suggests that the parasagittal technique is a feasible option for lumbar medial branch radiofrequency ablation.

Development of an ultrasound-guided radiofrequency ablation technique in the equine cadaveric distal limb: histological findings and potential for treating chronic lameness.

Radiofrequency (RF) relieves chronic pain in humans, but it is unexplored in horses affected by chronic lameness. This study aims to describe the technique and the histological effects of ultrasound (US)-guided radiofrequency ablation (RFA) of palmar digital nerves (PDNs) in horse's fetlock and pastern, ex vivo. After assessing the US anatomy of lateral and medial PDNs in fetlock and pastern in vivo (n = 10 horses; 20 forelimbs), US-guided RFA was performed on these sites in cadaveric forelimbs (n = 10) applying four different settings with increasing invasiveness (n = 40 total treatments): 60°C, 6 min (GROUP LOW); 70°C, 4 min (GROUP MEDIUM); 90°C, 2 min (GROUP HIGH); 80°C, 8 min (GROUP VERY HIGH). Needle-tip-to-nerve proximity was assessed with US and methylene blue, injected through the port of the RF needle. Nerves were collected for microscopical assessment. Transverse palmaro-lateral and palmaro-medial US images of fetlock and pastern detected PDNs consistently, close to the palmar digital artery. With in-plane US technique, RFA was performed at target in 31/40 cases, with significantly higher number of failures in fetlock (p = 0.008). PDNs histology identified thermal injury/coagulation with axonal degeneration and collagen homogenation. Nuclear smearing of arterial leyomyocytes was also observed. Nerve coagulation was significantly associated with treatment (p = 0.03) and needle-tip-to-nerve proximity (US distance: p = 0.009; blue distance: p = 0.04). The PDNs were easily visualized and reached with the RF needle by US in-plane-guided technique. RFA produced axonal thermal damage and intensity-related coagulation effectiveness. To ensure effective nerve coagulation, it is crucial that the needle is accurately positioned in close proximity to the target nerve. Based on the histopathological findings, HIGH and VERY HIGH RFA treatments might be worth of being tested in vivo in clinical studies aimed at treating chronic lameness of the distal forelimb in horses.

Incremental high power radiofrequency ablation with multi-electrodes for small hepatocellular carcinoma: a prospective study

Radiofrequency ablation (RFA) offers a minimally invasive treatment for small hepatocellular carcinoma (HCC), but it faces challenges such as high local recurrence rates. This prospective study, conducted from January 2020 to July 2022, evaluated a novel approach using a three-channel, dual radiofrequency (RF) generator with separable clustered electrodes to improve RFA’s efficacy and safety. The study employed a high-power, gradual, stepwise RFA method on HCCs (≤ 4 cm), utilizing real-time ultrasound-computed tomography (CT)/magnetic resonance imaging (MRI) fusion imaging. Involving 110 participants with 116 HCCs, the study reported no major complications. Local tumor progression (LTP) and intrahepatic remote recurrence (IRR) rates were low, with promising cumulative incidences at 1, 2, and 3 years for LTP (0.9%, 3.6%, 7.0%) and IRR (13.9%, 20.5%, 31.4%). Recurrence-free survival (RFS) rates were similarly encouraging: LTP (99.1%, 96.4%, 93.0%) and IRR (86.1%, 79.5%, 68.6%). This innovative gradual, incremental high-power RFA technique, featuring a dual switching monopolar mode and three electrodes, represents an effective and safer management option for small HCCs.Trial registrationclinicaltrial.gov identifier: NCT05397860, first registered on 26/05/2022.

Endovenous thermal ablation mid-term outcomes for the treatment of large diameter incompetent great saphenous veins.

The aim of this study was to assess the efficacy and safety of endovenous thermal ablation (EVTA) in treating large diameter, ≥12mm, incompetent great saphenous vein (GSV) in comparison to smaller ones. A retrospective comparative study was undertaken including 196 patients (205 limbs) undergoing EVTA. According to maximum GSV diameter patients were divided into two groups (group A <12mm, group B ≥12mm). Primary outcome was anatomic success defined as absence of reflux of GSV. Secondary outcomes were complications, postoperative pain using the 10-cm Visual Analog Scale (VAS) and improvement of Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ-20) scores assessed at 7- days, 1month, 12months and 24months postoperatively. 118 patients with GSV diameter <12mm (group A) and 87 with GSV diameter ≥12mm (group B) were included. Patients' demographics, CEAP classification and length of ablated vein did not differ between the groups. Preoperative VCSS and VAS pain score were significant greater in group B (6.03 vs 6.94, p = .04 and 5.21 vs 5.77, p = .032, respectively). No differences in adverse events were observed post-operatively among groups. GSV occlusion rate at 1month was 98.3% (SE 1.3%) in group A and 96.5 % (2.2%) in group B (p = .3), at 12months 95.7% (SE 2%) and 94.2% (SE 2.8%) (p = .5), and at 24months 94% (SE 2.4%) and 93.1% (SE 3%) (p = .4) respectively. Both groups experienced significant and similar improvement in their VCSSs and CIVIQ scores postoperatively. In a subgroup analysis among different EVTA and GSV >12mm, 1470nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) showed comparable results in terms of occlusion rates, complications, VCSS and CIVIQ scores. Endovenous thermal ablation techniques are efective and safe in the treatment of GSV incompetence regardless the diameter of the GSV. Both 1470nm EVLA and RFA techniques performed similar outcomes.

Comparative Study between Radiofrequency Ablation and Laser Ablation in Treatment of Varicose Vein

Abstract Background Varicose veins are avery common problem all over the world. Surgery has been the gold standard treatment for many years, however now other less invasive options are available and sometimes more efficient. Aim of the Work The purpose of this study was to evaluate the RFA technique in treatment of GSV varicosities and to compare the results, clinical outcome, complications and recurrence rate after RFA and CS of GSV. Patients and Methods In this study 25 patients with varicose vein were randomized to laser ablation of GSV and another 25 patients underwent RFA of the GSV in Nasser institute. Both techniques were done under local (tumescent) anesthesia helped by sedation (Deprivan) in some patients or spinal anethesia in the other patients. Operative time was nearly the same in both techniques. no statistically significant difference between both techniques Results This study proved that radiofrequency and laser ablation techniques are safe and efficient in treating varicose veins and there was no statistically significant difference between both groups regarding postoperative complications or recanalization and recurrence. Conclusion Duplex guided radiofrequency ablation and laser ablation are efficient and safe modalities in the treatment of great saphenous vein varicosities. Conventional surgery has been used for a long time for treatment of varicose veins with variable degrees of minor to major complications. R radiofrequency and laser ablation of GSV in treatment of varicose vein provides high ablation rates in conjunction with a very moderate side effect profile

Clinical effectiveness of focused ultrasound combined with plasma radiofrequency ablation technique in the treatment of persistent strain rhinitis.

Examine the effects of focused ultrasound in combination with plasma radiofrequency ablation technology on the physiological stability and postoperative recovery of persistent strain rhinitis. For a control experiment, 90 patients with persistent strain rhinitis were chosen and split into two groups: the control group (CG) and the experimental group (EG). The CG used conventional radiofrequency ablation technology, while the EG used focused ultrasound technology combined with radiofrequency ablation technology to treat persistent strain rhinitis. Between the EG and the CG, compare and contrast the recovery of nasal symptoms, nasal signs, postoperative discomfort, and postoperative respiratory status. One quarter after surgery, there was a substantial difference in physical sign ratings between the EG and the CG, and a particularly significant difference was seen after six months of treatment. One year following surgery, there was a statistical difference between the EG and the CG in the comparison of effective rates at various intervals, with a P value of .013. At 6 months following surgery, the MTT times in the EG and CG for the comparison of nasal function were 12.63 2.65 and 17.68 2.84, respectively, with statistically significant differences. The difference between the EG and the CG in the MTR comparison is statistically significant. In the comparison of NNO values between the EG and the CG after different treatment times. The nitric oxide value of the EG patients decreased over time, with statistical significance one month after surgery and one year after surgery. It is evident from the comparison of various symptom efficacy rates that the EG has a higher treatment effectiveness rate than the CG, and the total treatment effect difference following surgery has statistical significance. Indicators for PONV, PA, directional ability, respiratory recovery, and olfactory recovery performed better in the EG than in the CG, and the differences were statistically significant. Focused ultrasound and plasma radiofrequency ablation technology have a good therapeutic impact in the treatment of persistent strain rhinitis and can significantly reduce MTT. This technology can effectively improve symptoms such as nasal congestion, nasal flow, and headache in patients, and the therapeutic effect is long-lasting. The hospitalization time after treatment is significantly shortened.

Particle swarm optimization solution for roll-off control in radiofrequency ablation of liver tumors: Optimal search for PID controller tuning.

The study investigates the efficacy of a bioinspired Particle Swarm Optimization (PSO) approach for PID controller tuning in Radiofrequency Ablation (RFA) for liver tumors. Ex-vivo experiments were conducted, yielding a 9th order continuous-time transfer function. PSO was applied to optimize PID parameters, achieving outstanding simulation results: 0.605% overshoot, 0.314 seconds rise time, and 2.87 seconds settling time for a unit step input. Statistical analysis of 19 simulations revealed PID gains: Kp (mean: 5.86, variance: 4.22, standard deviation: 2.05), Ki (mean: 9.89, variance: 0.048, standard deviation: 0.22), Kd (mean: 0.57, variance: 0.021, standard deviation: 0.14) and ANOVA analysis for the 19 experiments yielded a p-value ≪ 0.05. The bioinspired PSO-based PID controller demonstrated remarkable potential in mitigating roll-off effects during RFA, reducing the risk of incomplete tumor ablation. These findings have significant implications for improving clinical outcomes in hepatocellular carcinoma management, including reduced recurrence rates and minimized collateral damage. The PSO-based PID tuning strategy offers a practical solution to enhance RFA effectiveness, contributing to the advancement of radiofrequency ablation techniques.

A New Hope for the Treatment of Atrial Fibrillation: Application of Pulsed-Field Ablation Technology.

In recent years, the prevalence of and mortality associated with cardiovascular diseases have been rising in most countries and regions. AF is the most common arrhythmic condition, and there are several treatment options for AF. Pulmonary vein isolation is an effective treatment for AF and is the cornerstone of current ablation techniques, which have one major limitation: even when diagnosed and treated at a facility that specializes in ablation, patients have a greater chance of recurrence. Therefore, there is a need to develop better ablation techniques for the treatment of AF. This article first compares the current cryoablation (CBA) and radiofrequency ablation (RFA) techniques for the treatment of AF and discusses the utility and advantages of the development of pulsed-field ablation (PFA) technology. The current research on PFA is summarized from three perspectives, namely, simulation experiments, animal experiments, and clinical studies. The results of different stages of experiments are summarized, especially during animal studies, where pulmonary vein isolation was carried out effectively without causing injury to the phrenic nerve, esophagus, and pulmonary veins, with higher safety and shorter incision times. This paper focuses on a review of various a priori and clinical studies of this new technique for the treatment of AF.

Current status of endoscopic ultrasound-guided antitumor treatment for pancreatic cancer.

Endoscopic ultrasound (EUS) was developed in the 1990s and has significantly transformed pancreatic tumor diagnosis. Subsequently, EUS has rapidly shifted from being a purely diagnostic procedure to being used in a wide range of interventional procedures. Recently, new therapeutic techniques, such as EUS-guided fine needle injection (EUS-FNI) or radiofrequency ablation (RFA), have been developed to deliver various antitumor agents. Despite technological advancements, pancreatic cancer (PC) has a poor prognosis and improvements in treatment outcomes are urgently required. One of the reasons for the limited response to antitumor agents in PC is the abundant desmoplasia and hypovascular nature of the tumor, complicating drug delivery into the tumor. Thus, changing the tumor microenvironment may be important to enhance the effectiveness of chemotherapy, and direct injection of antitumor agents into the tumor under EUS guidance can help overcome treatment challenges in PC. Treatment approaches using the EUS-FNI or RFA technique are expected to further improve the prognosis of PC. Therefore, this study reviewed the existing literature on EUS-guided antitumor therapy, specifically highlighting its application in PC to address the current challenges and to identify potential advancements in the field.

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

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

Modified technique improves efficacy for in-office posterior nasal nerve ablation.

Posterior nasal nerve (PNN) ablation is a minimally invasive treatment option for patients with chronic rhinitis. Recent evidence shows that parasympathetic innervation of the nasal cavity is more extensive and there are many fibers posterior to the lateral attachment of the middle turbinate. We describe a modified ablative technique that targets the extensive innervation of the posterior nasal nerves. Description of the technique and retrospective cohort analysis. In addition to the traditional radiofrequency and cryoablation targets, three additional treatment sites posterior to the middle turbinate were targeted using radiofrequency ablation, as well as one focused treatment posteroinferior to the middle turbinate attachment using cryotherapy ablation. The primary outcome collected was a 30% improvement in overall rhinitis symptoms. Forty-five patients received treatment and completed 3-month follow-up using the modified technique for radiofrequency and cryotherapy PNN ablation. Previously, our institution documented a 64.5% responder rate at 3 months. After introducing the modified technique, the response rate at 3 months significantly improved (64.5% vs. 91.1%, p = .004). This report suggests improved efficacy with implementation of the modified technique for in-office PNN ablation. Given the extensive nature of the post-ganglionic parasympathetic fibers of the nasal cavity which often emerge posterior to the middle turbinate attachment, a modified technique to target these branches should be considered. Prospective randomized studies comparing this modified technique to the traditional technique are needed. III.

Ultrasonography-guided radiofrequency ablation of vascular malformations-The moving shot technique.

To describe a novel ultrasound-guided technique for percutaneous radiofrequency ablation of vascular malformations-the "moving shot technique." Preliminary observational cohort study, conducted from June 1, 2019, to January 31, 2021, including all consecutive patients diagnosed with vascular malformations who were treated with ultrasound-guided radiofrequency ablation using the moving shot technique. Only patients who had undergone at least one unsuccessful previous treatment were included (sclerotherapy with ethanol/aethoxysklerol or embolization/surgery). Eight patients with a median age of 22 years (interquartile range, 13-31) were included. Patients had different vascular malformations consisting of 1 arteriovenous malformation, 4 venous malformations, and 1 each a mixed venous-lymphatic malformation, a glomuvenous malformation and a FAVA (fibroadipose vascular anomaly). Malformations were located at the limbs in 5 patients (62.5%), the subcutaneous/intramuscular tissue of the body in 2 patients (25%) and at the chin in 1 patient (12.5%). Clinical symptoms were pain in 8 patients (100%), swelling in 6 patients (75%), and partial immobility in 4 patients (50%). All patients showed an improvement of clinical symptoms after treatment with 7 (87.5%) being completely asymptomatic and 1 (12.5%) showing improvement of immobility and pain. No procedural complications, such as nerve damage or skin burns occurred. The moving shot technique using ultrasonography-guided radiofrequency ablation is a promising technique for the interventional treatment of vascular malformations and should be validated in multicenter-approaches.

Lumbar Facet Joint Radiofrequency Ablation With a 3-Tined Cannula: A Technical Report and Observational Study.

Background: Lumbar facet joints are the source of pain in 15%-41% of individuals experiencing low back pain (LBP). Conventional lumbar facet radiofrequency ablation (RFA) has Level II evidence for improving pain and function. The best proven technique, the parallel technique, is technically challenging, time-consuming, and often uncomfortable for the patient. A novel RFA technique using a 3-tined cannula offers a potentially less complex and shorter procedure. Objectives: To describe the novel lumbar facet joint RFA technique with the 3-tined cannula and to evaluate its efficacy in treating chronic lumbar facet joint pain. Methods: Eligible adult patients with chronic lumbar facet joint pain, confirmed by positive medial branch blocks (MBBs), refractory to conservative treatment, received the novel RFA treatment with the 3-tined cannula. The change in pain intensity at 2 months follow-up compared to baseline, percentage of patients reporting a ≥ 30% and ≥ 50% reduction of pain intensity, patient global impression of change (PGIC), need for pain medication, walking ability, sleep quality, and patient satisfaction were evaluated. Results: A total of 44 patients were included. Patients experienced a clinically meaningful and significant pain relief at follow-up and 41% of the patients reported ≥ 50% reduction of pain. Forty-eight percent experienced at least a score of "much improved" on the PGIC. No severe side effects or complications were observed. Conclusions: Our observational study suggests that lumbar facet joint RFA using the novel technique achieves significant pain relief. The larger lesions decrease the likelihood of missing the target nerve while obviating the need to conduct numerous lesions. Limiting is the single-center set-up with a relatively short-term follow-up duration. Randomized controlled clinical trials are warranted to confirm the efficacy of the novel RFA technique to treat lumbar facet joint pain.

Ultrasound-guided percutaneous puncturing technique: novel radiofrequency ablation technique for thoracic sympathectomy in the treatment of palmar hyperhidrosis.

Radiofrequency thoracic sympathectomy is routinely conducted under computed tomographic or fluoroscopic guidance in the treatment of palmar hyperhidrosis. However, it remains a great challenge to perform a thoracic paravertebral puncture precisely and safely, because it is associated with repeated exposure to radiation and the risk of a pneumothorax. Alternatively, an ultrasound-guided technique can provide high-resolution and real-time needle tracking during the percutaneous procedure. We have provided our experience of ultrasonic guidance in radiofrequency sympathectomy for the treatment of primary palmar hyperhidrosis.

Radiofrequency ablation for stage

Pulmonary carcinoma represents the second common cancer for human race while its mortality rate ranked the first all over the world. Surgery remains the primary option for early-stage non-small cell lung cancer (NSCLC) in some surgical traditions. Nevertheless, only less than half of patients are operable subjected to the limited lung function and multiple primary/metastatic lesions. Recent improvements in minimally invasive surgical techniques have made the procedure accessible to more patients, but this percentage still does not exceed half. In recent years, radiofrequency ablation (RFA), one of the thermal ablation procedures, has gradually advanced in the treatment of lung cancer in addition to being utilized to treat breast and liver cancer. Several guidelines, including the American College of Chest Physicians (ACCP), include RFA as an option for some patients with NSCLC although the level of evidence is mostly limited to retrospective studies. In this review, we emphasize the use of the RFA technique in patients with early-stage NSCLC and provide an overview of the RFA indication population, prognosis status, and complications. Meanwhile, the advantages and disadvantages of RFA proposed in existing studies are compared with surgical treatment and radiotherapy. Due to the high rate of gene mutation and immunocompetence in NSCLC, there are considerable challenges to clinical translation of combining targeted drugs or immunotherapy with RFA that the field has only recently begun to fully appreciate.

Optimization of high-power short duration catheter radiofrequency ablation for pulmonary veins isolation in patients with artiral septial defect

Objective ‒ to perform the analysis and biophysical substantiation of a new technique of catheter radiofrequency ablation (RFA) with high power and short duration based on mathematical modeling of own clinical data of the electro-thermodynamic effect of RFA on the myocardium; to investigate the morphological characteristics of the myocardium in different areas of the atrium and to determine the morphometric parameters of the display on the electroanatomical model of the heart of the ablation zone in the EnSite Precision navigation system, necessary for effective and safe high-power and short-duration RFA.Materials and methods. Clinical studies were performed in Amosov National Institute of Cardiovascular Surgery NAMS of Ukraine. Specialized high-tech medical equipment was used for the objectivity of clinical data obtained and used in the work. Morphological characteristics of the myocardium (thickness of the wall of the left atrium, distance from the back wall of the heart to the esophagus, diameters of the pulmonary veins) were evaluated on the computed tomography images of the heart of the patients, which were obtained in the radiology department on a Toshiba device (Japan) using a spiral scanning. The morphometric parameters of the ablation zone, which were later used to evaluate the effectiveness of RFA and which formed the basis of standardized protocols for the operation, were determined for display on the electro-anatomical maps of the patients' hearts in the EnSite Precision system (Abbott, USA). Biophysical substantiation of the RFA technique with high power and short duration was performed using mathematical modeling of the electro-thermodynamic effect of RFA on the myocardium and own clinical data in the Comsol Multiphysics automated simulation of biophysical processes.Results. It is proposed for a group of patients with combined atrial fibrillation with an atrial septal defect to perform RFA using a new ablation technique with high power and short duration at one point of application of radio frequency energy. Achieving transmurality of ablation in a shorter time makes it possible to hold the electrode more precisely and stably in this area when isolating the pulmonary veins in a complex geometry and without support for the electrode in case of a defect. The morphological characteristics of the myocardium were studied and the morphometric parameters of the display on the electroanatomical heart model of the ablation zone, necessary for effective and safe RFA, were determined. These include: the diameter of the point-label of radiofrequency ablation on the anatomical model of the heart, which must correspond to the real data of the size of the destruction; the percentage of overlap of RFA points for the formation of an effective transmural line; estimated number of ablation points to standardize the evaluation of the effectiveness of the procedure.Conclusions. The conducted research made it possible to solve the current problems of catheter radiofrequency ablation in patients with atrial fibrillation and atrial septal defect, namely to increase the efficiency and safety of pulmonary vein isolation. Transmurality and integrity of the isolating line was achieved due to the determined morphological characteristics of the myocardium and the calculated morphometric parameters of the ablation zone. The obtained data are adapted to a real display visible to the surgeon on the electro-anatomical map of the heart in the EnSite Precision navigation system. This system is actively used in clinical practice, but it was necessary to optimize the clinical protocols of RFA with high power and short duration, which was achieved as a result of this work.

Efficacy of Cervical Facet Joint Radiofrequency Ablation Using a Multitined Cannula, a Technical Note, and Observational Study

BACKGROUND: Chronic cervical facet joint pain is a leading cause of pain and disability. In patients nonresponsive to conservative treatment, cervical facet radiofrequency ablation (RFA) has shown to be efficacious. However, the conventional RFA technique can be cumbersome. A novel RFA technique with a multitined cannula allows for a lateral approach and represents an attractive alternative option for cervical facet RFA. It offers a potentially shorter, less cumbersome procedure, with consequently less x-ray exposure and patient discomfort than the conventional cervical RFA. OBJECTIVES: To describe the novel RFA technique using the lateral approach with the multitined cannula at the cervical facet joints and to assess its efficacy in chronic cervical facet joint pain. STUDY DESIGN: This is a single-center observational study. SETTING: Interventional Pain Management Center, Switzerland. METHODS: The aim of this study is to describe the RFA technique using the lateral approach with the multitined cannula at the cervical facet joints and to assess its efficacy in chronic cervical facet joint pain. Eligible adult patients with chronic (&gt; 3 months) cervical facet joint pain refractory to conservative treatment and confirmed by dual positive medial branch blocks, received a fluoroscopic-guided cervical facet RFA treatment using the multitined cannula. The primary outcome was pain relief. Secondary outcome measures included the proportion of patients reporting a &gt;= 30% reduction of pain intensity 2 months after RFA, patient global impression of change (PGIC), need for pain medication, sleep quality, and patient satisfaction. RESULTS: We included 26 patients. The patients showed a clinically meaningful and significant pain relief at 2 months after cervical facet RFA (mean Numeric Rating Scale of 7.5 [1.9] at baseline to 4.2 [2.4]) and 58% of the patients reported &gt;= 30% reduction of pain. An improvement on the PGIC was reported by 88.2% of the patients. No severe side effects or complications were observed. LIMITATIONS: Key limitations of our study were the relatively small sample size, the lack of a control group, and a relatively short-term follow-up duration. CONCLUSIONS: Our results suggest that cervical facet joint RFA using the novel technique with the multitined cannula results in significant pain reduction and improvement on the PGIC. While the conventional technique requires multiple ablations at each target level, the RFA with the multitined needle requires only a singular ablation, likely sparing time, radiation dose, discomfort, and costs. Our results merit consideration of replacement of the conventional technique with the novel technique using the multitined cannula. However, larger-scale clinical trials with an adequate long-term follow-up period are needed to prove the efficacy of RFA using the multitined cannula in cervical facet joint pain. KEY WORDS: Neck pain, facet joint pain, cervical, radiofrequency, ablation, denervation, multitined cannula, lateral approach, observational study