Radiofrequency ablation combined with transcatheter arterial chemoembolization therapy versus surgical resection for Barcelona-Clinic Liver Cancer (BCLC) A hepatocellular carcinoma: a meta-analysis

Purpose: The objective of our study was to compare the effectiveness of the combination of transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) with that of surgical resection (SR) in Barcelona-Clinic Liver Cancer (BCLC) A hepatocellular carcinoma.Materials and Methods: PubMed, Medline, Embase, and Cochrane Library were searched for comparisons of the two therapies from January 2006 to December 2017. Overall survival rate (OS), recurrence-free survival rate (RFS), complications, and the average length of hospital stay were compared and analyzed. Review Manager v. 5.2 from the Cochrane Collaboration was used for statistical analyses.Results: Seven case-control studies and one randomized controlled trial were identified, of which 717 were treated with a combination of TACE and RFA and 785 were treated with SR. Meta-analysis data revealed that TACE plus RFA had significantly better effectiveness on 1.0-y OS (OR = 0.50, p = .009). The major complications (ORcomplications = 1.88, p = .02) after the combined therapy were significantly lower than those after SR. There were three studies that reported the average length of hospital stay. The hospital stay for the SR group vs the combined therapy group was 19.8 ± 8.4 d vs 7.4 ± 2.2 d, respectively (p < .0001); 18.7 ± 4.9 d vs 11.5 ± 6.9 d, respectively (p < .0001); and 16.6 ± 6.7 d vs 8.5 ± 4.1 d, respectively (p < .0001). There was no significant difference in 3.0- or 5.0-y OS and 1.0-, 3.0-, or 5.0-y RFS.Conclusion: The combination of TACE and RFA has advantages in improving 1.0-y OS, reducing complications, and shortening the length of hospital stay over that of SR in the treatment of patients with BCLC A HCC.     

Optimal approach for complete liver tumor ablation using radiofrequency ablation: a simulation study

Purpose: To investigate the effect of radiofrequency ablation (RFA) electrode trajectory on complete tumor ablation using computational simulation.

Material and methods: The RFA of a spherical tumor of 2.0?cm diameter along with 0.5?cm clinical safety margin was simulated using Finite Element Analysis software. A total of 86 points inside one-eighth of the tumor volume along the axial, sagittal and coronal planes were selected as the target sites for electrode-tip placement. The angle of the electrode insertion in both craniocaudal and orbital planes ranged from ?90° to +90° with 30° increment. The RFA electrode was simulated to pass through the target site at different angles in combination of both craniocaudal and orbital planes before being advanced to the edge of the tumor.

Results: Complete tumor ablation was observed whenever the electrode-tip penetrated through the epicenter of the tumor regardless of the angles of electrode insertion in both craniocaudal and orbital planes. Complete tumor ablation can also be achieved by placing the electrode-tip at several optimal sites and angles.

Conclusions: Identification of the tumor epicenter on the central slice of the axial images is essential to enhance the success rate of complete tumor ablation during RFA procedures.     

Preliminary experimental study on splenic hemodynamics of radiofrequency ablation for the spleen

Purpose: To test the splenic blood flow change after radiofrequency ablation (RFA) of the spleen in a porcine experimental model.

Material and methods: Six pigs underwent RFA of the spleen via laparotomy. During the procedure of RFA, clamping of splenic artery (one) and both splenic artery/vein (one) was also performed. Measurement of blood flow of both splenic artery (SA) and splenic vein (SV) with flow-wire at pre- and post-RFA of the spleen was also performed.

Results: Ablated splenic lesions were created as estimating ～50% area of the spleen in all pigs. Resected specimens reveal not only the coagulated necrosis but also the congestion of the spleen. On the SA hemodynamics, maximum peak velocity (MPV) changed from 37?±?7?to 24?±?8?cm/s (normal), 11?to 10?cm/s (clamp of the SA), and 12?to 7.5?cm/s (clamp of both SA/SV), respectively. On the SV hemodynamic, MPV changed from 15?±?5?to 13?±?4?cm/s (normal), 17?to 15?cm/s (clamp of the SA), and 17?to 26?cm/s (clamp of both SA/SV), respectively.

Conclusions: RFA of the spleen could induce coagulation necrosis and reduce the splenic arterial blood flow.     

Reduction of atrial fibrillation inducibility by radiofrequency ablation: an experimental study

A study is made of the antifibrillatory effects of radiofrequency (RF)-induced atrial lesions using nine Langendorff-perfused rabbit hearts in which the atrial electrophysiological properties and atrial fibrillation (AF) inducibility were modified by atrial stretching. Using a multiple electrode consisting of 121 unipolar electrodes, determinations were made of the atrial refractory periods, conduction velocity, wavelength of the atrial activation process, and the inducibility of sustained AF episodes (duration over 30 s) by atrial burst pacing in four situations: (a) control; (b) following dilatation of the right atrium; (c) after adding an RF linear lesion at the cava-tricuspid annulus isthmus; and (d) after adding two RF linear lesions rounding the base of the right atrial appendage and extending from the inferior zone of the sulcus terminalis to the anterior wall of the appendage. Under control conditions, AF was not induced in any of the experiments. The wavelengths were 10.5 +/- 1.2 cm for basic cycles of 250 ms and 6.6 +/- 0.5 cm for cycles of 100 ms. Following dilatation, a significant decrease was recorded in the atrial refractory periods, conduction velocity, and wavelength, which reached values of 6.1 +/- 0.7 cm (250-ms cycle, P < 0.01), and 3.9 +/- 0.3 cm (100-ms cycle, P < 0.01); AF was induced in five cases (P < 0.05). After producing the lesion at the cava-tricuspid isthmus, the electrophysiological modifications induced by atrial dilatation persisted (wavelength = 6.2 +/- 0.6 cm (250-ms cycle) and 4.3 +/- 0.3 cm (100-ms cycle); P < 0.01 vs the control) and AF was triggered in eight cases (P < 0.0001). In turn, on adding the two lesions at the right atrial free wall and appendage, AF was induced only in one experiment (P = NS vs control), and the dilatation-induced decrease in refractoriness and wavelength was attenuated. Nevertheless, differences remained significant with respect to the controls, with the exception of the functional refractory periods determined at cycles of 100 ms. In this phase, the wavelength was 6.6 +/- 0.7 cm (250-ms cycle, P < 0.01 vs control) and 4.9 +/- 0.5 cm (100-ms cycle; P < 0.05). Atrial conduction between the zones separated by the lesions was blocked at any frequency, or selectively at rapid atrial activation frequencies. In conclusion: (a) the production of three linear lesions in the right atrium (cava-tricuspid isthmus, atrial appendage, and inferior free wall) reduces AF inducibility in the experimental model used; (b) conduction block (either absolute or frequency dependent) through the lesions, reduction in tissue mass caused by lesion creation, and possibly the attenuation of the shortening of atrial refractoriness and wavelength in the zones not separated by the lesions are implicated in the reduction of AF inducibility; and (c) the single lesion in the cava-tricuspid isthmus does not impede AF inducibility.     

持续负压引流术应用于耳廓假囊肿治疗的临床分析

目的 研究耳廓假囊肿应用持续负压引流术的治疗效果.方法 将2009年1月至2011年6月长葛市人民医院初诊耳廓假囊肿患者86例随机分为观察组与对照组,观察组予持续负压引流治疗,对照组予常规手术治疗,比较两组的治疗效果.对各指标率的变化采用组间t检验,计数资料采用组间χ2检验.结果 观察组治疗有效率为93.0%（40/43）,对照组治疗有效率为90.7%（39/43）,两组比较差异无统计学意义（χ2=0.156,P=0.500）.观察组治疗满意度为97.7%（42/43）,对照组治疗满意度为79.1%（34/43）,两组比较差异有统计学意义（χ2=7.242,P=0.015）.结论 持续负压引流术治疗耳廓假性囊肿具有手术操作简便、创伤小、费用节省等特点,值得临床进一步验证应用.     

低温等离子射频消融与微波凝固治疗慢性肥厚性鼻炎的疗效比较

目的比较低温等离子射频消融和微波凝固治疗慢性肥厚性鼻炎的临床疗效。方法 124例慢性肥厚性鼻炎患者随机分为两组,A组(n=64)采用低温等离子射频消融治疗,B组(n=60)采用微波凝固治疗。观察和比较两组患者临床疗效,疼痛视觉模拟(VAS)评分及术后并发症情况。结果 A组治疗总有效率(90.6%)明显高于B组治疗总有效率(75.0%)(P<0.05);两组术后VAS评分比较差异无统计学意义(P>0.05);A组并发症发生率明显低于对照组(P<0.05)。结论低温等离子射频消融治疗慢性肥厚性鼻炎疗效显著,并发症少,值得临床推广应用。     

医用臭氧联合射频消融治疗神经根型颈椎病的临床效果

目的研究医用臭氧联合射频消融治疗神经根型颈椎病(CSR)的临床效果。方法选取2016年3月至2019年2月我院收治的CSR患者70例作为研究对象,根据治疗方法的不同将其分为对照组和观察组,各35例。对照组患者使用射频消融方法进行治疗,观察组患者在对照组的基础上使用医用臭氧疗法。比较两组患者的临床疗效、治疗前、后的疼痛评分以及血清炎症因子水平的变化情况。结果治疗后,观察组患者的治疗总有效率明显高于对照组,差异具有统计学意义(P<0.05)。治疗后,两组的感觉、情绪评分和PRI总分均明显降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。治疗后,两组患者TNF-α、hs-CRP和IL-6水平均明显降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。结论医用臭氧联合射频消融术治疗CSR具有操作简便、创伤小、治疗有效率高的优势,能够明显降低CSR患者的疼痛评分以及机体炎症因子水平,值得在临床中推广应用。     

超声引导下射频消融治疗子宫肌瘤的临床应用进展

目子宫肌瘤是女性生殖器最常见的良性肿瘤,多发于30~50岁的育龄妇女。子宫肌瘤的传统治疗方法是手术切除,包括子宫切除术和肌瘤剔除术,但手术创伤大、恢复期长。随着微创医疗技术的发展和女性认知的提高,越来越多的子宫肌瘤患者选择疗效好且保留子宫的微创治疗方法。射频消融是常用的治疗子宫肌瘤的微创方法,其安全性和有效性已被临床证实,术后患者症状改善,生活质量提高,复发率低。本文依据穿刺路径和超声引导方式不同分将其归纳为经腹部超声引导、腹腔镜术中超声引导、经阴道超声引导和经宫颈宫腔内超声引导4种射频消融方式,并从原理、方法、消融途径、有效性、安全性及对生育功能影响等方面对4种子宫肌瘤消融方法进行简要综述。     

An unusual treatment of coronary injury following radiofrequency ablation in a 5-year-old child: Systemic steroid usage

Radiofrequency catheter ablation (RFCA) procedure is performed for many tachyarrhythmias. We performed successful RFCA in a 5-year-old child for supraventricular tachyarrhythmia and Wolff-Parkinson-White syndrome. Acute circumflex artery (CxA) occlusion occurred due to RFCA. After percutaneous balloon angioplasty was performed into the CxA, the patient was treated with systemic steroid to resolve myocardial edema. To the best of our knowledge, systemic steroid was used first time for acute coronary artery injury related myocardial ischemia.     

肝癌射频消融术后超声造影引导下无水乙醇治疗肝癌的临床价值

目的：研究与常规超声引导相比较,超声造影(CEUS)引导下无水乙醇治疗射频消融术(RFA)后残存的肝癌有无优越性。方法：61例原发性肝癌的患者RFA术后行无水乙醇注射进行补充治疗,根据引导方式不同分为治疗组和对照组,治疗组运用超声造影引导方式,对照组采用常规超声引导方式,术后1个月对治疗病灶进行超声造影及增强CT的评价。结果：治疗组30个病灶,28个病灶达到完全灭活,2个病灶存有残存活性区达到部分灭活。对照组31个病灶,22个病灶达到完全灭活,9个病灶达到部分灭活。两者有统计学差异,(P＜0.05)。结论：运用超声造影引导可以有效的提高肝癌RFA术后无水乙醇治疗肝癌的疗效。     

经皮射频消融治疗甲状腺良性结节的疗效及影响因素

目的探讨甲状腺良性结节射频消融治疗的疗效及影响因素,以提高甲状腺良性结节消融治疗的效果。 方法选取2013年4月至2016年6月在解放军总医院就诊的甲状腺结节患者468例,甲状腺良性结节482个,其中,女性356个,男性126个,年龄14~82岁,结节最大径0.7~9.2 cm;实性结节258个,囊实性结节224个,甲状腺结节合并桥本氏甲状腺炎96个。甲状腺结节经皮穿刺射频消融术后即刻、1个月、3个月、6个月、12个月、18个月及24个月行常规超声及超声造影检查,观察局部疼痛、红肿、皮肤感染、声音嘶哑等并发症的发生率,同时计算结节的体积缩小率,将结节按照囊实性比例、大小、是否有桥本病背景、性别、年龄进行分组,结节大小、有无桥本、性别、年龄大小分组组间比较采用独立样本t检验,甲状腺结节囊实性比例组间甲状腺结节体积缩小率比较采用方差分析。 结果甲状腺良性结节射频消融术后体积明显缩小,术后1个月、3个月、6个月、12个月、18个月及24个月结节体积缩小率分别为：（51.2±5.7）%、（69.7±4.3）%、（84.6±3.7）%、（89.3±2.9）%、（93.7±1.6）%、（94.9±1.4）%;甲状腺结节囊性成分<20%、囊性成分20%~80%、囊性成分>80% 3组,术后1、3、6、12、18及24个月组间缩小率比较,差异均有统计学意义（F=66.858、69.101、19.410、49.559、146.653、309.950,P均<0.001）,囊性成分比例越高,消融灶缩小越快;将囊性成分<20%的结节,按照最大径≤3 cm及>3 cm、是否有桥本病背景进行分组,术后1、3、6、12、18及24个月组间缩小率比较,差异均有统计学意义（不同大小分组：t=9.710、8.925、9.899、12.734、17.226、42.580;是否有桥本背景分组：t=5.529、7.981、4.843、6.558、17.976、28.906,P均<0.001）,3 cm以下、无桥本氏甲状腺炎的结节射频消融后体积缩小更为显著;最大径≤3 cm且囊性成分<20%的结节在性别（男性、女性）、年龄（≤40岁、>40岁）组间,同一随访时间结节的体积缩小率比较,差异均无统计学意义（P均>0.05）。 结论经皮射频消融治疗甲状腺良性结节是一种安全、有效的微创治疗方法。     

Safety of pacemaker implantation prior to radiofrequency ablation of atrioventricular junction in a single session procedure

RF current delivery may cause acute and chronic dysfunction of previously implanted pacemakers. The aim of this study was to assess prospectively the effects of RF energy on Thera I and Kappa pacemakers in 70 consecutive patients (mean age 70 ± 11 years, mean left ventricular ejection fraction 48 ± 15%) who underwent RF ablation of the AV junction for antiarrhythmic drug refractory atrial fibrillation (permanent in 42 patients, paroxysmal in 28). These pacing systems incorporate protection elements to avoid electromagnetic interference. The pacemakers (Thera DR 7960 I in 20 patients, Thera SR 8960 1 in 30, Kappa DR 600–601 in 8, Kappa SR 700–701 in 12) were implanted prior to RF ablation in a single session procedure and were transiently programmed to VVI mode at a rate of 30 beats/min. Capsure SP and Z unibipolar leads were used. During RF application there was continuous monitoring of three ECG leads, endocavitary electrograms, and event markers. Complete AV block was achieved in all cases after 3.6 ± 2.9 RF pulses and 100 ± 75 seconds of RF energy delivery. The mean time of pacemaker implantation and RF ablation was 60 ± 20 minutes. Transient or permanent pacemaker dysfunction including under/oversensing, reversion to a "noise-mode" pacing, pacing inhibition, reprogramming, or recycling were not observed. Leads impedance, sensing, and pacing thresholds remained in the normal range in the acute and long-term phase (average follow-up 18 ± 12 months). In conclusion, Thera I and Kappa pacemakers exhibit excellent protection against interference produced by RF current. The functional integrity of the pacemakers and Capsure leads was observed in the acute and chronic phases. Thus, the implantation of these pacing systems prior to RF ablation of the AV junction can be recommended.     

Successful radiofrequency ablation of a slow atrioventricular nodal pathway on the left posterior atrial septum

RF catheter ablation is highly effective in eliminating atrioventricular nodal reentrant tachycardia by targeting the slow pathway in the posteroinferior part of Koch's triangle in the right atrium. We report here a patient in whom "slow-fast" atrioventricular nodal reentrant tachycardia was eliminated only by ablation of the slow pathway in the left atrial posteroseptal region at the level of the mitral annulus after unsuccessful attempts at the traditional site on the right side.     

Pacemapping of the triangle of Koch: a simple method to reduce the risk of atrioventricular block during radiofrequency ablation of atrioventricular node reentrant tachycardia

Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency energy is delivered to the posterior aspect of the triangle of Koch, total AV block may be the consequence of the absence of anterograde conduction along the fast pathway or of inadvertent damage to a fast pathway abnormally located close to the slow pathway. To localize the anterogradely conducting fast pathway, the triangle of Koch was pacemapped in 72 patients who underwent the ablation of common AVNRT. In all cases, before ablation the St-H interval was calculated by stimulating the anteroseptal (AS), mid-septal (MS), and posteroseptal (PS) aspect of the triangle of Koch at a rate slightly faster than the sinus rate. In all patients, common AVNRT was induced. In 64 (89%) of 72 patients (group A) the shortest St-H interval was recorded on stimulating the AS region. In six (8%) patients (group B) the shortest St-H interval was recorded on stimulating the MS region. Finally, in two (3%) patients (group C) the shortest St-H interval was recorded stimulating in the PS region. In group C, AH interval, calculated on stimulating in the AS region, was significantly longer than in patients of groups A and B (200 +/- 99 ms vs 64 +/- 18 and 62 +/- 3, respectively). In group A, on stimulating in the AS, MS, and PS regions, the AH interval remained constant in all patients. In contrast, in groups B and C on stimulation in the MS and PS regions, AH interval shortened (in group B from 56 +/- 8 to 27 +/- 37 and 37 +/- 14, respectively; in group C from 200 +/- 99 to 170 +/- 100 and to 137 +/- 109, respectively). In groups A and B, a posteroseptal slow pathway, and in group C, an anteroseptal retrograde fast pathway were successfully ablated without AV block. Pacemapping of the triangle of Koch can help to recognize patients in whom the anterograde conducting fast pathway is abnormally located far from the anteroseptal region or in whom anterograde conduction of the fast pathway is absent. In these cases the risk of AV block can be reduced by performing slow pathway ablation in a site sufficiently far from the site of the anterograde fast pathway or ablating the retrogradely conducting fast pathway.     

Efficacy and safety of radiofrequency ablation for treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials

ObjectiveTo evaluate the efficacy and safety of radiofrequency ablation for the treatment of knee osteoarthritis.MethodsA literature review was conducted using the PubMed, Cochrane Review, Embase, and Google Scholar databases. Two reviewers independently assessed the eligibility of all retrieved studies. The research was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure the reliability and verity of the results. The statistical analysis was performed using STATA version 13.0.ResultsNine randomized controlled trials were collected for the data extraction and meta-analysis. Significant differences in the pain score at 4, 12, and 24 weeks were found between patients treated with radiofrequency ablation and those treated with placebo. Furthermore, the use of radiofrequency ablation was associated with an improved outcome of the Western Ontario and McMaster Universities Arthritis Index at 4, 12, and 24 weeks. No serious adverse events were observed in any patients who underwent radiofrequency ablation.ConclusionRadiofrequency ablation is efficacious and safe for reducing pain and improving knee function in patients with knee osteoarthritis, without increasing the risk of adverse effects.     

导管射频消融术治疗阵发性心房颤动合并快慢综合征的临床效果

目的 分析导管射频消融术治疗阵发性心房颤动合并快慢综合征的临床效果.方法 选择2015年3月至2020年3月我院收治的58例阵发性心房颤动合并快慢综合征患者作为研究对象,采用随机数字表法将其分为参照组和导管射频消融组,各29例.参照组接受常规抗心律失常药物治疗,导管射频消融组在参照组基础上接受导管射频消融术治疗.比较两...     

肝动脉化疗栓塞联合射频消融术治疗原发性肝癌的疗效分析

目的探讨肝动脉化疗栓塞(TACE)联合射频消融术(RFA)治疗原发性肝癌的临床疗效及安全性。方法根据意愿不同,将70例中晚期原发性肝细胞癌(HCC)患者分为TACE+RFA组37例和TACE组33例。TACE+RFA组采用TACE联合RFA治疗,TACE组采用TACE,观察2组血清甲胎蛋白(AFP)水平的变化,比较治疗3个月后的临床疗效及半年、1年、2年生存率,并记录并发症的发生情况。结果 TACE+RFA组血清AFP水平下降率明显大于TACE组(P0.05),且总有效率显著高于TACE组(P0.05)。TACE+RFA组1、2年生存率明显优于TACE组,差异均有统计学意义(P0.05或P0.01)。治疗期间,2组均未见严重并发症发生。结论 TACE联合RFA能有效治疗HCC,延长患者生存期,其疗效优于TACE单纯治疗。     

Nonsurgical transthoracic epicardial ablation for the treatment of a resistant posteroseptal accessory pathway

A case of Wolff-Parkinson-White syndrome successfully treated by transcutaneous epicardial radiofrequency ablation is described in a patient with a posteroseptal accessory pathway who had failed prior attempts of conventional endocardial and coronary venous system approaches. Simultaneous endocardial and pericardial space mapping was performed and only ablation from the pericardial space was successful, suggesting an epicardial course of the accessory pathway.