The treatment of liver cancer is still a challenge in the world, and it is mainly refers to hepatocellular carcinoma (HCC). There are many factors affecting the overall survival rate of HCC; the recurrence of HCC is the main risk factor affecting the survival of patients, hence, it is urgent to explore the clinical treatment of recurrent HCC to obtain long-term survival of the patients. Up to now, surgical treatment is a radical treatment for HCC. Similarly, liver resection and liver transplantation are still the main therapy methods for recurrent HCC. In addition, radiofrequency ablation and transcatheter arterial chemoembolization and other local treatments still play an irresistible role. Therefore, emphasizing the postoperative follow-up of patients, diagnosing recurrent HCC in early stage, paying attention to the risk factors of HCC recurrence and selecting a suitable treatment plan for individuals are critical ways to prolong the survival of patients.
ObjectiveTo investigate the short-term efficacy and safety of thoracoscopy-assisted epicardial radiofrequency ablation for atrial fibrillation (AF) and/or left atrial appendage exclusion (LAAE).MethodsThe clinical data of 12 patients with solitary AF admitted to Beijing Tiantan Hospital from November 2018 to August 2020 were retrospectively analyzed, including 7 males and 5 females, with an average age of 65.2±5.3 years. Of them, 2 had paroxysmal AF, 1 had persistent AF and 9 had permanent AF.ResultsNo patient died during hospitalization, 5 patients underwent radiofrequency ablation for AF and LAAE, and 6 received LAAE alone. The operation time was 293±70 min in radiofrequency ablation for AF+LAAE patients and 71±14 min in LAAE patients. Two patients restored sinus rhythm, two restored after electric cardioversion, and one remained AF in AF+LAAE patients. Postoperatively, 1 patient had pleural effusion and 1 had subcutaneous emphysema. No stroke was observed.ConclusionThoracoscopy-assisted radiofrequency ablation for AF and/or LAAE reduce the risk of procedure, and provide alternative approach to treat AF-associated diseases. However, large sample size studies using prospective cohort designs are required to corroborate the present findings.
ObjectiveTo assess the effect of a novel modified epicardial radiofrequency (RF) ablation for preoperative atrial fibrillation (AF) combined with aortic valve disease. MethodsWe retrospectively analyzed the clinical data of 28 patients with AF and aortic valve disease underwent the novel modified epicardial RF ablation combined with aortic valve replacement (AVR) in our hospital between December 2009 and December 2014. There were 18 males and 10 females at age of 53-73 (64.9±4.8) years. The patients were performed epicardial atrial fibrillation RF ablation plus aortic valve replacement. ResultsThe modified epicardial RF ablation and AVR were performed successfully in all the patients. The maintenance of sinus rhythm was 96.4% (27/28) at discharge. There were no early death and permanent pacemaker implantation in perioperation. At a mean following-up of 29.2±17.7 months, 26 of 28 (92.9%) patients were in sinus rhythm. Following-up transthoracic echocardiography(TTE) at 6 months postoperatively showed that left atrial diameter was significantly reduced and left ventricular ejection fraction was significantly increased. ConclusionThe novel modified epicardial RF ablation procedure is safe, feasible, and effective. It may be useful in selecting the best ablation approaches for patients with AF and aortic valve disease.
To solve the problems of small one-time ablation range and easy charring of the tissue around the electrode associated with the tumor radiofrequency ablation needle, based on the multiphysical field coupling analysis software COMSOL, the effects of needle material, the number of sub needles and the bending angle of sub needles on the ablation effect of radiofrequency ablation electrode needle were studied. The results show that compared with titanium alloy and stainless steel, nickel titanium alloy has better radiofrequency energy transmission efficiency and it is the best material for electrode needle. The number of sub needles has a great influence on the average necrosis depth and the maximum necrosis diameter. Under the same conditions, the more the number of sub needles, the larger the volume of coagulation necrosis area. The bending angle of the needle has a great effect on the maximum diameter of the coagulated necrotic area, but has little effect on the average necrotic depth. Under the same other conditions, the coagulation necrosis area formed by ablation increased with the increase of the bending angle of the sub needle. For the three needles with bending angles of 60 °, 90 ° and 120 ° analyzed in this paper, the one with bending angle of 120 ° can obtain the largest coagulation necrosis area. In general, the design of nickel titanium alloy with 120 ° bending 8-pin is the optimal. The average depth of radiofrequency ablation necrosis area is 32.40 mm, and the maximum necrosis diameter is 52.65 mm. The above optimized design parameters can provide guidance for the structure and material design of tumor radiofrequency ablation needle.
Abstract： Objective To analyze the influence of preoperative left atrial dimension （LAD） on the effectiveness of surgical radiofrequency ablation for the treatment of atrial fibrillation （AF） through a 5-year postoperative follow-up of AF patients after surgical radiofrequency ablation. Methods Clinical data of 433 patients with persistent or permanent AF who received bipolar radiofrequency ablation procedures during concomitant cardiac surgery in Beijing Anzhen Hospital from 2006 to 2009 were retrospectively analyzed. All the patients were divided into 4 groups according to their preoperative LAD：Group A， 75 patients with their LAD＜50 mm， including 22 males and 53 females with their average age of 56.50±10.05 years；Group B， 89 patients with their LAD ranging from 50 to 60 mm， including 32 males and 57 females with their average age of 55.63±10.28 years；Group C， 117 patients with their LAD ranging from 60 to 70 mm， including 41 males and 76 females with their average age of 55.13±10.96 years；and Group D， 152 patients with their LAD＞70 mm， including 68 males and 84 females with their average age of 53.22±11.49 years. Postoperative ECG records right after surgery， before discharge， at 6 months and 1，2，3，4 and 5 years during follow-up were collected. The relationship between preoperative LAD and postoperative sinus rhythm restoration rate was analyzed. Results There was statistical difference in sinus rhythm restoration rate right after surgery（P=0. 011）， before discharge（P=0. 002）， at 6 months（P＜ 0. 001） and 1 year （P＜0. 001）， 2 years（P＜0. 001）， 3 years（P＜0. 001）， 4 years（P＜0. 001） and 5 years（P= 0. 006） during follow-up among the 4 groups. Postoperative sinus rhythm restoration rates right at 6 months and 1，2，3， 4 and 5 years during follow-up was 90.4%， 89.9%， 90.3%， 91.3%， 89.1%， and 90.9% in Group A， 80.2%，79.0%，78.1%， 76.1%，72.5%，70.0% in Group B，74.7%，74.0%，71.2%，72.4%，70.0%， and 64.7% in Group C， and 61.8%，57.6%，56.8%，53.9%，50.7%，and 48.6% in Group D， respectively. Conclusion Patients with a larger preoperative LAD have a lower postoperative sinus rhythm restoration rate after surgical radiofrequency ablation for the treatment of AF.
ObjectiveTo investigate the efficacy of bipolar radiofrequency ablation for left ventricular aneurysm-related ventricular arrhythmia associated with mural thrombus. MethodsFifteen patients with left ventricular aneurysm-related frequent premature ventricular contractions associated with mural thrombus were enrolled in Beijing Anzhen Hospital between June 2013 and June 2015. There were 11 male and 4 female patients with their age of 63.5±4.8 years. All patients had a history of myocardial infarction, but no cerebral infarction. All patients received bipolar radiofrequency ablation combined with coronary artery bypass grafting, ventricular aneurysm plasty and thrombectomy. Holter monitoring and echocardiography were measured before discharge and 3 months following the operation. ResultsThere was no death during the operation. Cardiopulmonary bypass time was 92.7±38.3 min. The aortic clamping time was 52.4±17.8 min.The number of bypass grafts was 3.9±0.4. All the patients were discharged 7-10 days postoperatively. None of the patients had low cardiac output syndrome, malignant arrhythmias, perioperative myocardial infarction, or cerebral infarction in this study. Echocardiography conducted before discharge showed that left ventricular end diastolic diameter was decreased (54.87±5.21 cm vs. 60.73±6.24 cm, P=0.013). While there was no significant improvement in ejection fraction (45.20%±3.78% vs. 44.47%±6.12%, P=1.00) compared with those before the surgery. The number of premature ventricular contractions[4 021.00 (2 462.00, 5 496.00)beats vs. 11 097.00 (9 327.00, 13 478.00)beats, P < 0.001] and the percentage of premature ventricular contractions[2.94% (2.12%, 4.87%) vs. 8.11% (7.51%, 10.30%), P < 0.001] in 24 hours revealed by Holter monitoring were all significantly decreased than those before the surgery. At the end of 3-month follow-up, all the patients were angina and dizziness free. Echocardiography documented that there was no statistical difference in left ventricular end diastolic diameter (55.00±4.41 mm vs. 54.87±5.21 mm, P=1.00). But there were significant improvements in ejection fraction (49.93%±4.42% vs. 45.20%±3.78%, P=0.04) in contrast to those before discharge. Holter monitoring revealed that the frequency of premature ventricular contractions[2 043.00 (983.00, 3 297.00)beats vs. 4 021.00 (2 462.00, 5 496.00)beats, P=0.03] were further lessened than those before discharge, and the percentage of premature ventricular contractions[2.62% (1.44%, 3.49%)vs. 8.11% (7.51%, 10.30%), P < 0.001] was significantly decreased than those before the surgery, but no significant difference in contrast to those before discharge. ConclusionThe recoveries of cardiac function benefit from integrated improvements in myocardial ischemia, ventricular geometry, pump function, and myocardial electrophysiology. Bipolar radiofrequency ablation can correct the electrophysiological abnormality, significantly decrease the frequency of premature ventricular contractions, and further improve the heart function.
ObjectiveTo evaluate the methodological quality and impacts on outcomes for systematic reviews (SRs) of radiofrequency ablation (RFA) versus hepatic resection (HR) for early hepatocellular carcinoma (HCC). MethodsWe comprehensively searched six databases and five official websites for health technology assessment (HTA), to collect HTAs, SRs, or meta-analyses from inception to Nov. 11th, 2012. The Overview Quality Assessment Questionnaire (OQAQ) was applied for quality assessment of included studies, the tools recommended by the Cochrane Collaboration was applied for quality assessment for randomized controlled trials (RCTs), and the modified MINORS score was applied to assess non-randomized controlled trials (NRCTs). The odds ratios (ORs) and 95% confidence intervals (CIs) were integrated using Stata 10.0 software. ResultsOne HTA, 3 SRs and 15 meta-analyses were included in total. The mean OQAQ score was 3.3 with 95%CI 2.6 to 4.1. Only five (26.3%) SRs were assessed as good quality. Seven studies misused statistical models, and 3 of them changed outcome direction after modification. Five studies (5/19) included retrospective controlled studies as RCTs. A total of 39 primary studies referenced by SRs were included, of which, 3 RCTs were levelled grade B, 35 NRCTs were of moderate quality, with an estimated mean MINORS score of 15.0 (totally, scored 18) with 95%CI 14.6 to 15.4, and only 13 studies (37.1%) scored more than 16. Seventeen primary studies (43.6%) did not meet inclusion criteria of the SRs, of which, 9 (23.1%) studies were mixed with other effective interventions in both groups (TACE, PEI, etc.). Four studies included patients with non-primary HCC. ConclusionCurrently, the overall quality of HTAs, SRs and meta-analyses about comparing the effects between RFA and HR for early HCC is fairly poor (high heterogeneity exists, and the evidence level is low. Physicians should apply the evidence with caution in clinical practice.
ObjectiveTo investigate efficacy and safety of three-step radiofrequency ablation (RFA) in treatment for giant hepatic hemangioma (GHH,diameter ≥5 cm) with symptoms. MethodsThe patients with GHH met the inclusion criteria were collected.The main steps were as follows:The first step was to destroy the main arteries of the tumor to block the blood.The second step was to withdraw the blood of the tumor to shrink the tumor.The third step was to damage the shrunk tumor by RFA. ResultsThere were 13 patients with GHH met the inclusion criteria.The median preoperative diameter was 8.0 cm.The median volume of withdrawing blood was 78 mL.The median diameter after withdrawing blood was 5.3 cm.The diameters between after and before withdrawing blood had a significant difference (P<0.01).The time for damaging tumor blood supply was (4.4±1.0) min.The median frequency of tumor RFA was 4 times.The median time of tumor RFA was 16 min.The median time of total operation was 20 min.There were 3 cases of tumor residual after RFA,10 cases were met full damage,and the damage rate was 85.9%-100% with an average of 97.0%.The hospital stay after RFA was (3.9±1.2) d.One case was remission after conservative treatment because of complication. ConclusionThe preliminary results of limited cases in this study show that three-step RFA for GHH is effective and safe,but it needs to be researched for large samples data.
ObjectiveTo review the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension as well as the inadequacy, and to reevaluate the clinical significance of the technology. MethodsDomestic and foreign literatures were collected to summary the progress of percutaneous radiofrequency catheter-based renal sympathetic denervation in treatment of resistant hypertension. ResultsThe percutaneous radiofrequency catheter-based renal sympathetic denervation in the treatment of resistant hypertension had obtained some positive results recently, but the long-term outcomes and safety of the technology were still subjected to further evaluation. ConclusionThe effect of percutaneous radiofrequency catheter-based renal sympathetic denervation for resistant hypertension remains to be controversial, and both the equipment and technology of radiofrequency catheter-based ablation need to be improved.
ObjectiveTo evaluate surgical outcomes of combined off-pump coronary artery bypass grafting (OPCAB)and bipolar radiofrequency ablation (RFA)for atrial fibrillation (AF). MethodsFrom January 2008 to October 2013, 49 patients with coronary artery disease and AF underwent OPCAB and concomitant Atricure bipolar RFA for AF in Beijing Anzhen Hospital. According to their AF duration, all the 49 patients were divided into 2 groups. In group A, there were 14 patients with permanent AF including 9 males and 5 females with their age of 56.7±7.5 years. In group B, there were 35 patients with paroxysmal AF including 27 males and 8 females with their age of 60.2±10.5 years. AF duration was 9.4±6.0 months. Coronary artery stenosis was 85%-100%. Ambulatory electrocardiogram and echocardiography were performed to observe AF recurrence during follow-up. ResultsNone of the patients received intraoperative conversion operation under cardiopulmonary bypass, and there was no in-hospital death. Postoperatively, 81.6% (40/49)patients had conversion to sinus rhythm (SR)or junctional rhythm, 18.4% (9/49)patients remained AF, but none of the patients had second or third-degree atrioventricular block. A total of 139 distal anastomoses were performed with a mean of 2.8 distal anastomoses per patient. Length of hospital stay was 10-15 (12±3)days. SR was observed in 34 patients (69%)before discharge including 9 patients (64%)in group A and 25 patients (71%)in group B. All the patients (100%)were followed up for 5-12 months. 39 patients (80%)maintained SR over 6 months, including 10 patients (71%)in group A and 29 patients (83%)in group B. 44 patients (90%)maintained SR over 12 months, including 11 patients (79%)in group A and 33 patients (94%)in group B. There was no statistical difference in SR maintenance rate between the 2 groups (P > 0.05). ConclusionOPCAB and concomitant bipolar RFA for AF is safe, efficacious and feasible.