Radiofrequency ablation for hepatic hemangioma is safe and effective, and can obtain the same curative effect as traditional surgical resection. For hepatic hemangiomas with large volume, abundant arterial blood supply and long ablation time, systemic inflammatory response syndrome (SIRS) often occurs after radiofrequency ablation, which can lead to injury or dysfunction of important organs. This paper systematically summarizes the mechanism, prevention and treatment of SIRS after radiofrequency ablation of hepatic hemangioma, so as to provide reference for improving the safety of radiofrequency ablation of hepatic hemangioma.
Based on the experience of more than 10 000 times of radiofrequency ablation treatment and the clinical and basic research results of radiofrequency ablation treatment of liver cancer obtained during the period, the author shares the experience of radiofrequency ablation indication selection, preoperative preparation, concept of radiofrequency ablation and postoperative follow-up of liver cancer. The purpose is to explore how to improve the curative effect of RFA treatment for small liver cancer, and reduce local residue, recurrence, as well as relevant complications.
Surgical treatment of atrial septal defect (ASD) mainly includes occlusion or repair under cardiopulmonary bypass. Surgical treatment of atrial fibrillation includes transcatheter radiofrequency ablation or Maze surgery under cardiopulmonary bypass. There are many treatments for ASD patients combined with atrial fibrillation, but each has its own advantages and disadvantages. We reported an ASD patient combined with atrial fibrillation treated by totally endoscopic "one-stop" radiofrequency ablation and simultaneous transthoracic ASD occlusion of atrial fibrillation, with good postoperative results.
ObjectiveTo analyze the long-term efficacy and its influencing factors in the treatment of the permanent atrial fibrillation(AF) using monopolar radiofrequency ablation during concomitant cardiac valve replacement surgery with rheumatic heart disease. MethodsClinical data of the 116 patients with rheumatic heart disease and permanent AF who underwent modified maze procedure using monopolar radiofrequency ablation and concomitant cardiac valve replacement in the affiliated hospital of Qingdao university from October 2004 to December 2010 were collected and retrospectively analyzed, including 43 males and 73 females with their age of 50.5±7.5 years. Electrocardiogram (ECG) with 12-lead and echocardiography data, as well as the related complications, cardiac function and life quality were collected at the time of the immediately after the operation, discharge from hospital, 3 months, 6 months, 1 year postoperatively and every year after the operation. Patients were divided into eliminating group of AF (including sinus rhythm and nodal rhythm) and AF group according to the results of the ECG at the time of the ending follow-up. In the eliminating group of AF, there were 52 patients (16 males, 36 females) with their age of 48.4±7.3 years, and in the AF group, there were 50 patients (22 males, 28 females) with their age of 51.9±7.1 years. Analyzed the difference of the related factors between the two groups using statistical methods and tried to find the factors affecting the long-term clinical efficacy of the operation. ResultsThree patients died in hospital (one died of the hemolysis, acute renal insufficiency and hyperkalemia. One died of the multiple organ dysfunction syndrome caused by the acute renal insufficiency. And the other one died of the multiple organ dysfunction syndrome caused by the repetitive ventricular tachycardia and ventricular fibrillation on the day of the automatic discharge). Three patients died during the follow-up (one died after the reoperation because of the perivalvular leakage in other hospital, and the causes of death in the two others could not be catched). One patient occurred cerebral embolism, and the other one occurred cerebral hemorrhage in the af group during the follow-up. There was statistical significance between two group at the aspects of age, preoperative AF duration, preoperative left atrium diameter, time of the cardiopulmonary bypass and time of the cross-clamp ascending aorta. In multivariate analysis, age and preoperative left atrium diameter are risk factors affecting the long-term efficacy. ConclusionThe treatment of the permanent atrial fibrillation using monopolar radiofrequency ablation concomitant cardiac valve replacement with rheumatic heart disease is effective and has good long-term efficacy. The factors of affecting the long-term clinical efficacy are the patient's age and the diameter of left atrium.
Objective To systematically evaluate the effectiveness and safety of pulsed field ablation (PFA) and radiofrequency ablation (RFA) in the treatment of atrial fibrillation. Methods Computer searches were conducted on PubMed, EMbase, The Cochrane Library, The Web of Science, China Biomedical Literature Database, CNKI, Wanfang, and VIP databases, with a search period from the establishment of each database until April 2025. Two researchers conducted literature screening, data extraction, and quality evaluation of the included studies based on predetermined inclusion and exclusion criteria. Standardized electronic forms were used for data extraction, with a focus on the balanced dataset after propensity score matching (PSM). Quality evaluation was conducted using the improved Newcastle Ottawa scale (NOS). Meta analysis was conducted using RevMan 5.4 and Stata 18.0 software, and subgroup analysis was performed based on the study type (whether PSM method was used or not). ResultsFinally, 14 studies were ultimately included, of which 6 studies applied the PSM method, with a total sample size of 3 172 cases (PFA group: 1 582 cases; RFA group: 1 590 cases. NOS score≥5 points. The meta-analysis results showed that the PFA group had a lower recurrence rate of atrial fibrillation [OR=0.75, 95%CI (0.63, 0.90), P=0.002], surgical complications [OR=0.63, 95%CI (0.41, 0.98), P=0.04], and surgical time [WMD=–37.32, 95%CI (–45.85, –28.78), P<0.001] compared to the RFA group, and the differences were statistically significant. In addition, compared to the PFA group, the RFA group had a shorter X-ray exposure time [WMD=7.65, 95%CI (4.41, 10.88), P<0.001], and the difference was statistically significant. There was no statistically significant difference between the two groups in terms of re ablation rate [OR=1.17, 95%CI (0.59, 2.31), P=0.65] and acute surgical success rate [OR=0.86, 95%CI (0.22, 3.35), P=0.82]. ConclusionCompared with RFA, PFA treatment for atrial fibrillation can reduce the recurrence rate, shorten the surgical time, and reduce surgical complications, indicating its good effectiveness and safety in the treatment of atrial fibrillation.
ObjectiveTo analyze the correlation between the gray value of epicardial fat and the prognosis of patients with atrial fibrillation (AF) treated by thoracoscopic radiofrequency ablation.MethodsThe clinical data of 97 patients, including 75 males and 22 females with an average age of 57.8±9.4 years, who underwent thoracoscopic radiofrequency ablation in Fuwai Hospital from 2017 to 2018 were analyzed retrospectively. The left atrial fat volume and average gray scale were calculated by left atrial enhanced CT. According to the average gray scale of left atrial fat tissue, the patients were divided into three groups: a high gray scale group, a medium gray scale group and a low gray scale group. The patients were followed up at 3, 6 and 12 months after operation. The end point of follow-up was the recovery rate of sinus rhythm. Survival analysis was used to analyze the correlation between CT features of epicardial fat enhancement and prognosis.ResultsAfter adjustment of body mass index, body surface area, gender and left atrial end diastolic diameter, regression analysis showed that the fat gray of left atrial enhanced CT was correlated with the type of AF (OR=0.30, 95%CI 0.12-0.79, P=0.014). Cox regression analysis showed that the fat gray value of left atrial CT predicted the recurrence of AF after thoracoscopic radiofrequency ablation (OR=0.92, 95%CI 0.85-0.99). The Kaplan-Meier curve showed significant difference in the long-term recurrence rate of AF among the three groups (P=0.011). The lower left atrial fat enhanced CT gray scale was, the higher long-term recurrence rate of AF was.ConclusionThe gray value of left atrial fat enhanced CT can effectively predict the recurrence of AF after radiofrequency ablation in thoracoscopic surgery.
Objective To explore therapeutic effect of radiofrequency ablation (RFA) guided by contrast-enhanced ultrasound in patient with advanced primary liver cancer following transcatheter arterial chemoembolization (TACE). Methods The patients with advanced primary liver cancer treated with the TACE firstly from January to December 2014 in this hospital were prospectively collected, then were randomly divided into a conventional ultrasound guided RFA group (control group) and contrast-enhanced ultrasound guided RFA group (study group). The complete ablation rate, liver function, serum alpha-fetoprotein (AFP) level, and 1-, 2-, and 3-year survival rates were observed in the two groups. Results A total of 42 patients with advanced primary liver cancer treated with the TACE were enrolled in this study, there were 21 patients in each group. ① There were no significant differences in the baseline data such as the gender, age, BCLC stage, AFP level, and Child grade of liver function between the two groups (P>0.05). ② All the treatments were completed according to the plan, no serious complications or treatment-related death happened. The complete ablation rate of the study group was significantly higher than that of the control group (χ2=5.717, P=0.017), and the AFP level was significantly lower than that of the control group (t=2.618, P=0.012). There was no significant difference in the Child grade of liver function between the 2 groups (P>0.05). ③ The rate of repeat RFA in the study group was significantly lower than that in the control group (χ2=4.434, P=0.035), and there was no significant difference in the TACE treatment rate between the two groups (χ2=1.659, P=0.197). ④ The survival rate of the study group was significantly better than that of the control group by comparing the survival curves (χ2=3.999, P=0.046). Conclusion Contrast-enhanced ultrasound guided RFA is superior to conventional ultrasound guided RFA in treatment of advanced primary liver cancer following TACE.
摘要:目的:探讨三维电解剖标测系统(CARTO)指导下进行房性心动过速射频消融的方法及效果。方法:对40例房性心动过速患者应用CARTO标测心房, 构建三维电解剖图,分析房性心动过速的电生理机制。局灶性房速消融最早激动点,大折返性房速消融折返环的关键性峡部。选择利用常规方法行消融的28 例患者作为对照组。比较两组消融的成功率、X线曝光时间。结果:38例患者CARTO三维标测系统标测提示为局灶性房性心动过速, 最早激动点位于右心房35例,其中冠状静脉窦口8例(20%)、间隔部10例(25%)、侧壁8例(20%)、上腔静脉口附近4例(10%)、后壁4例(10 %),1例患者(2.5%)有3种类型房速(分别为间隔部、上腔静脉口的局灶房速和三尖瓣峡部依赖的大折返房速)。位于左心房的局灶房速3例,分别位于右上肺静脉口(2.5%)、左上肺静脉口(2.5%)及左心耳(2.5%)。2例患者为大折返房速(5%),1例为三尖瓣峡部依赖性,1例为围绕界嵴的大折返房速。均消融成功(100%),随访4~16个月,均无复发。常规消融组成功率为89.3%(Plt;0.05)。CARTO组X线曝光时间比常规组明显缩短,分别为(13.8±5.5 ) min 和( 30.4±12.9 ) min,差异有统计学意义（Plt;0.05）。结论:应用CARTO标测房性心动过速, 对分析房性心动过速的机制准确快速, 能有效指导射频消融。Abstract: Objective: To evaluate the methods and effects of radiofrequency ablation of atrial tachycardia guided by CARTO. Methods: The atria of 40 cases were mapped by three dimensional electroanatomic mapping system. In order to analyse the mechanism of atrial tachycardia and perform the ablation of the earliest excited point in focal atrial tachycardia and isthmus in macroreentry atrial tachycardia. 28 cases ablated by conventional procedure were selected as controlled group. The success rate and fluoroscopic time were compared between the two groups. Results: Focal atrial tachycardia was seen in 38 patients. The sites of origin from right atrium were at the coronary sinus ostium in 8 cases (20%), septal in 10 cases (25%), lateral wall in 8 cases (20%), superior vena cava ostium in 4 cases (10%), posterior wall in 4 cases (10%). One case had 3 types of atrial tachycardia (2.5%). The sites of origin from left atrium were at right pulmonary vein ostium in 1 case (2.5%), left pulmonary vein ostium in 1 case (2.5%), left auricular appendage in 1 case (2.5%). 2 cases were macroreentry atrial tachycardia (5%). Ablation was performed successfully (100%) without any complication. No recurrence was found during a followup of 416 months. Success rate in conventional group was 89.3%(Plt;0.05)。Comparing the CARTO group and conventional group, the fluoroscopic time was shorter, ( 13.8±5.5 ) min vs ( 30.4±12.9 ) min （Plt;0.05).Conclusion: The mechanism of atrial tachycardia can be evaluated quickly and accurately. Ablation can be performed safely and effectively guided by CARTO.
ObjectiveTo compare the clinical therapeutic efficacy of radiofrequency ablation (RFA) and external beam radiation (XRT) in the treatment of early hepatocellular carcinoma (HCC). MethodsThe early HCC patients were collected in the SEER (Surveillance, Epidemiology, and End Results) database, from 2010 to 2015, according to the established inclusion and exclusion criteria. The patients were assigned into an XRT group and a RFA group according to according treatment plans. The propensity score matching (PSM) was performed at a ratio of 1∶4 based on age, gender, race, alpha-fetoprotein (AFP), cirrhosis, and tumor diameter. The overall survival of the patients of the two groups was compared, and the risk factors affecting the long-term prognosis for the early HCC patients were analyzed. ResultsA total of 2 861 early HCC patients were collected, including 2 513 in the RFA group and 348 in the XRT group. After PSM, a total of 1 582 patients were enrolled, including 343 in the XRT group and 1 239 in the RFA group. After PSM, the proportion of tumor with larger diameter (>5 cm) in the XRT group was still higher than that in the RFA group (P<0.001), but there were no statistically significant differences in the other clinical pathological characteristics between them (P>0.05). The Kaplan-Meier survival curves of the RFA group was better than that of the XRT group (HR=1.65, P<0.001); The stratified analysis based on the tumor diameter revealed that the survival curves of the RFA group were superior to those of the XRT group in the HCC patients with tumor diameters <3 cm, 3–5 cm, and >5 cm (<3 cm: HR=1.79, P<0.001; 3–5 cm: HR=1.50, P<0.001; >5 cm: HR=1.67, P=0.003). The results of the multivariate Cox regression model analysis showed that the older age (≥65 years), higher AFP level (≥400 μg/L), larger tumor diameter (≥3 cm), and later AJCC stage (stage Ⅱ) were the risk factors for overall survival in the early HCC patients (HR>1, P<0.05), while the XRT treatment was a risk factor for shortening overall survival in the HCC patients [HR(95%CI)=1.62(1.41, 1.86), P<0.001]. ConclusionThe data analysis results from the SEER database suggest that the long-term overall survival of RFA treatment is superior to XRT treatment for patients with AJCC stage Ⅰ or Ⅱ.
Abstract： Objective To summarize the clinical outcomes of maze procedure using bipolar radiofrequency ablation accompanied with valve replacement for the surgical treatment of permanent atrial fibrillation（AF） and rheumatic valve diseases. Methods A total of 124 patients with permanent AF and rheumatic valves diseases undergoing surgical treatment from March 2006 to October 2010 in the First Affiliated Hospital of Sun Yat-sen University were randomly divided into ablation group and control group using coin method with 62 patients in each group. The mean atrial fibrillation duration was（56.1±47.1） months in ablation group, and patients in this group underwent maze procedure using bipolar radiofrequency ablation and valve replacement. The mean atrial fibrillation duration was（43.8±25.6） months in control group, and patients in this group underwent only valve replacement. Demographic characteristics, cardiopulmonary bypass（CPB）time, aortic cross-clamping（ACC）time, mechanical ventilation time, intensive care unit（ICU） length of stay, postoperative complications and follow-up outcomes were compared between the two groups. Results The demographic characteristics of the two groups were not statistically different （P＞0.05）. The CPB time and ACC time between the two groups were not statistically different （P＞ 0.05）. The postoperative hospital stay of ablation group was significantly longer than that of control group （15.8±6.1 d vs. 12.9±3.1d，P=0.001）. No patient needed permanent pacemaker implantation in either group. Postoperative ejection fraction of ablation group was significantly higher than that of control group（59.6%±9.2% vs. 55.5%±5.4%，P＜ 0.01）. The rate of sinus rhythm maintenance at 6 months, 12 months, 18 months, 24 months during follow-up in ablation group were 88.5%, 87.5%, 87.1% and 82.4% respectively, 3.3%, 2.2%, 0.0%, and 0.0% in control group respectively, which was statistically different between the two groups（P＜ 0.05）. Conclusion Maze procedure using bipolar radiofrequency ablation is an effective surgical procedure for the treatment of permanent atrial fibrillation.