Explore the vast range of titles available.

BackgroundAtrial fibrillation (AF) recurrence post catheter ablation can occur in up to 50% within 12 months of treatment. Previously, several novel scoring systems have been suggested, inclusive of CHADS2VASc, R2CHADS2, CHADS2 and APPLE score. Nevertheless, prediction of AF recurrence and subsequent readmission remains difficult.Methods and Results383 consecutive patients attended the Golden Jubilee National Hospital, Glasgow, to undertake cryoablation for AF. Average age 58 (± 13), 64% male, BMI 29 (± 4.7), 60% paroxysmal AF. Degrees of socioeconomic deprivation as per Scottish Index of Multiple Deprivations (SIMD) were recorded in deciles. Patients were followed up to at least 12 months post procedure. After initial 3-month blanking period, symptomatic recurrence of documented AF (not SVT/Atrial tachycardia/Flutter) requiring admission to hospital were observed in 86 patients (22.5%).Individual CHADS2VASc Score, R2CHADS2 (R for renal dysfunction), APPLE Score(one point for Age >65 years, Persistent AF, imPaired eGFR (<60 ml/min/1.73m2), Left atrial diameter ≥43 mm, left ventricular Ejection fraction <50%) were recorded and compared to Scottish Index of Multiple Deprivations (SIMD) using statistical methods to assess for AUC as per ROC Curve.In the current cohort of patients, previous scoring systems CHA2DS2-VASc score (AUC 0.5337 (95% CI 0.4336 – 0.6338, p = 0.287), R2CHADS2 score (AUC 0.5202 (95% CI 0.4201 – 0.6203, p = 0.874) and APPLE score (AUC0.5523 (95% CI 0.4522 – 0.524, p = 0.049)) demonstrated lower predictive values, while SIMD demonstrating better prediction of AF recurrence requiring readmission (AUC 0.6145 (95% CI 0.5144 - 0.7146, p=0.001)). SIMD also demonstrated to better predicts recurrence of subjective AF recurrence (AUC 0.6096 , 0.5095 - 0.7097, p <0.001). Addition of SIMD into CHADS2VASc, R2CHADS2 or APPLE Score through various modeling did not improve predictive value of AF recurrence or readmission.ConclusionScottish Index of Multiple Deprivation is superior to the CHA2DS2-VASc, R2CHADS2 and APPLE scores for prediction of readmission and recurrence of symptomatic AF after AF cryoablation.Conflict of InterestNo

Background. Radiofrequency ablation (RFA) of CTI dependent atrial flutter (CTI-AFL) is conventionally performed under fluoroscopic guidance, or alternatively with 3D mapping and contact force (CF) catheters. Ultra-high density mapping (UHDm) and local impedance (LI) guided ablation have not yet been evaluated for this indication.Methods. An observational study comparing conventional, CF and LI-guided ablation of CTI-AFL to understand whether LI offers superior ablation metrics and UHDm allows accurate identification of breakthrough after initial RFA.Retrospective analysis of consecutive CTI-AFL cases was performed. Irrigated RFA was used in all groups. Contact was determined in the CF group with target >9 g and in the LI group with patient-specific LI. Target LI drop of -20 ohms was used to determine effective lesion formation. Standard generator impedance was used for the conventional group. Power was limited to 40-50W in all groups. In the LI group, if the CTI was not blocked after initial ablation, UHDm was used to identify breakthrough. Mean RFA time, time to CTI block, number of lesions required to achieve block, acute procedural success and complications were analysed with ANOVA. Breakthrough points were manually assessed.Results. Data is presented for 27 patients; 7 conventional, 10 CF and 10 LI. Mean RFA time was 6, 5.8, 3.2min respectively (p=0.0227). Significant differences also seen with LI vs Fluo (p=0.0194), LI vs CF (p=0.0164). Time from first application of RF to block was 22.8, 20.4, 14.2 min (p=ns). No significant difference was seen in the number of lesions required to achieve block. Acute procedural success was 100% in all groups, and there were no acute complications.Breakthrough was identified in 50% of CF and LI cases (5 patients in each group). With LI, there was one case of epicardial-endocardial breakthrough (EEB) 11mm from the CTI (figures A, B), three posterior, and one anterior aspect of the CTI, identified with UHDm. Subsequent LI-guided RFA resulted in block, on average six minutes quicker vs CF.Abstract 66 Figure 1A) Left lateral caudal view of CTI line following failure to demonstrate bi-directional isthmus block. UHD mapping shows EEB away from the line (point ‘y’); B) Right anterior oblique caudal view of ablation line following further RFA of EEB site (pink lesions at point ‘y’) resulting in bi-directional CTI blockDiscussionThis data illustrates that UHDm and LI-guided RFA significantly reduces the amount of ablation required (by 47% and 45% versus conventional and CF respectively; p=sig) by shortening lesion duration guided by LI change. A reduction from first RFA to block is also seen (47% and 30% respectively; p=ns). Many patients require further ablation following the initial RFA line, resulting in longer procedures. UHD mapping quickly and accurately identifies breakthrough for further focused RFA, including EEB away from the CTI which may otherwise be difficult to identify and treat using the conventional or standard 3D mapping, and result in prolonged procedure time and/or increased radiation exposure. LI also resulted in more predictable procedure times. We could not directly compare overall procedure times as many in the CF group had CTI combined with left atrial ablation.Conclusion. LI-guided ablation is safe and effective, and has shown favourable ablation metrics when compared with conventional and CF-guided ablation for CTI dependent AFL. Ultra-high density mapping more rapidly and effectively identifies sites of breakthrough after initial RFA application. A larger study is planned to provide more insight.Conflict of InterestNone

Image-guided percutaneous ablation is considered best in the treatment of early-stage hepatocellular carcinoma (HCC). Ablation is potentially curative, minimally invasive, and easily repeatable for recurrence. Ethanol injection used to be the standard in ablation. However, radiofrequency ablation has recently been the most prevailing ablation method for HCC. Many investigators have reported that radiofrequency ablation is superior to ethanol injection, from the viewpoints of treatment response, local tumor curativity, and overall survival. New-generation microwave ablation can create a larger ablation volume in a shorter time period. Further comparison studies are, however, mandatory between radiofrequency ablation and microwave ablation, especially in terms of complications and long-term survival. Irreversible electroporation, which is a non-thermal ablation method that delivers short electric pulses to induce cell death due to apoptosis, requires further studies, especially in terms of long-term outcomes. It is considerably difficult to compare outcomes in ablation with those in surgical resection. However, radiofrequency ablation seems to be a satisfactory alternative to resection for HCC 3 cm or smaller in Child-Pugh class A or B cirrhosis. Furthermore, radiofrequency ablation may be a first-line treatment in HCC 2 cm or smaller in Child-Pugh class A or B cirrhosis. Various innovations would further improve outcomes in ablation. Training programs may be effective in providing an excellent opportunity to understand basic concepts and learn cardinal skills for successful ablation. Sophisticated ablation would be more than an adequate alternative of surgery for small- and possibly middle-sized HCC.

BackgroundEndobiliary radiofrequency ablation (EB-RFA) has emerged as a palliative treatment for malignant biliary strictures (MBSs); however, concerns about complications related to thermal injury remain. In this study, we evaluated the efficacy and safety of EB-RFA with a novel catheter for MBS.MethodsPatients with inoperable cancer causing MBS were randomly assigned to either the radiofrequency ablation (RFA) group or the non-RFA group. The RFA group underwent EB-RFA at the stricture site with a temperature-controlled catheter (ELRA™; STARmed Co., Goyang, Korea) followed by deployment of a self-expanding metal stent (SEMS). For the non-RFA group, only SEMS placement was performed. The duration of stent patency, overall survival (OS), and 30-day complication rate were evaluated. This trial was registered at ClinicalTrials.gov (number NCT02646514).ResultsA total of 48 patients were enrolled (24 in each group). During a median follow-up period of 135.0 days (RFA group) and 119.5 days (non-RFA group), the 90-day stent patency rate, median duration of stent patency, and median OS were not different between the groups (58.3% vs. 45.8% [P = 0.386], 132.0 days vs. 116.0 days [P = 0.440], and 244.0 days vs. 180.0 days [P = 0.281], respectively). In the RFA group, procedure-related complications including thermal injury-related complications, such as bile duct perforation or hemobilia, were not reported. The early complication (< 7 days) rates were not different between the groups (4.2% vs. 12.5%, P = 0.609), and there were no late complications (7–30 days) in both groups.ConclusionEB-RFA with a temperature-controlled catheter followed by SEMS placement for patients with inoperable MBS can be safe and feasible with acceptable biliary patency.

Breast cancer (BC) is the most frequently diagnosed malignancy among women. In the past two decades, new technologies and BC screening have led to the diagnosis of smaller and earlier-stage BC (ESBC). Therefore, percutaneous minimally invasive techniques (PMIT) were adopted to treat patients unfit for surgery, women who refuse it, or elderly patients with comorbidities that could make surgery a difficult and life-threatening treatment. The target of PMIT is small-size ESBC with the scope of obtaining similar efficacy as surgery. Minimally invasive treatments are convenient alternatives with promising effectiveness, lower morbidity, less cost, less scarring and pain, and more satisfying cosmetic results. Ablative techniques used in BC are cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused ultrasound (US), and laser ablation. The aim of our study is to discuss the current status of percutaneous management of BC, evaluate the clinical outcomes of PMIT in BC, and analyze future perspectives regarding ablation therapy in BC.

PurposeTo assess safety and outcome of radiofrequency ablation (RFA) and microwave ablation (MWA) as compared to systemic chemotherapy and partial hepatectomy (PH) in the treatment of colorectal liver metastases (CRLM).MethodsMEDLINE, Embase and the Cochrane Library were searched. Randomized trials and comparative observational studies with multivariate analysis and/or matching were included. Guidelines from National Guideline Clearinghouse and Guidelines International Network were assessed using the AGREE II instrument.ResultsThe search revealed 3530 records; 328 were selected for full-text review; 48 were included: 8 systematic reviews, 2 randomized studies, 26 comparative observational studies, 2 guideline-articles and 10 case series; in addition 13 guidelines were evaluated. Literature to assess the effectiveness of ablation was limited. RFA + systemic chemotherapy was superior to chemotherapy alone. PH was superior to RFA alone but not to RFA + PH or to MWA. Compared to PH, RFA showed fewer complications, MWA did not. Outcomes were subject to residual confounding since ablation was only employed for unresectable disease.ConclusionThe results from the EORTC-CLOCC trial, the comparable survival for ablation + PH versus PH alone, the potential to induce long-term disease control and the low complication rate argue in favour of ablation over chemotherapy alone. Further randomized comparisons of ablation to current-day chemotherapy alone should therefore be considered unethical. Hence, the highest achievable level of evidence for unresectable CRLM seems reached. The apparent selection bias from previous studies and the superior safety profile mandate the setup of randomized controlled trials comparing ablation to surgery.

Abstract Context Thermal ablative techniques of the thyroid have recently gained clinical traction as a therapeutic alternative that provides symptomatic relief and confers potential advantages over surgery. A truly multidisciplinary technique, thyroid ablation is currently performed by endocrinologists, interventional radiologists, otolaryngologists, and endocrine surgeons. Radiofrequency ablation (RFA), specifically, has seen widespread adoption, particularly in the treatment of benign thyroid nodules. This review summarizes current evidence on the application of RFA in benign thyroid nodules, and provides a start to finish overview of procedural preparation, performance, and outcomes. Evidence Acquisition A narrative review of literature focusing on RFA in the treatment of benign nodular disease was performed. Emphasis was placed on consensus statements, best practice guidelines, multi-institutional studies, and systematic reviews to summarize key concepts in candidacy, techniques, expectations, and outcomes. Findings RFA is increasingly recognized as a first-line treatment strategy in the management of symptomatic nonfunctional benign thyroid nodules. It can also be considered in functional thyroid nodules with small volumes or in patients ineligible for surgery. A targeted and efficacious technique, RFA results in gradual volume reduction that preserves the function of the surrounding thyroid parenchyma. Proper procedural technique, proficiency in ultrasound, and experience in ultrasound-guided procedures are instrumental to maintaining low complication rates and achieving successful ablation outcomes. Conclusions In pursuit of a personalized approach, physicians across disciplines are increasingly incorporating RFA into their treatment algorithms, most commonly for benign nodules. As with any intervention, thoughtful selection and implementation ensure a safe procedure with optimal patient benefit.

Background: Transseptal puncture is a key component of cardiac ablation and structural interventional procedures. The VersaCross RF transseptal puncture (TSP) platform (Baylis Medical) is a novel system comprising a blunt radiofrequency (RF) wire rather than a needle, passed through a malleable sheath/dilator. The wire forms a pigtail on deployment and is firm enough to exchange over. This study details the first experience of the use of this novel technology in Europe, and the first worldwide without echocardiographic guidance. Methods: Consecutive patients undergoing TSP were included in the VersaCross group followed by a control group using standard equipment. All 5 operators used the VersaCross system in 2–3 cases prior to data inclusion in the study. Interventions were performed under general anaesthetic or sedation, with transoesophageal echo (TOE) used in a subset to guide the puncture. TSP and fluoroscopy times were prospectively recorded from the point when the drop down from the superior vena cava (SVC) was started until the VersaCross sheath was passed into the left atrium (LA). For double transseptal access, the latter was taken as the time the second separate transseptal puncture was completed or, based on the operator’s preference, a second sheath had been passed into the LA through the initial puncture. Also recorded were the number of drop downs from the SVC and number of RF applications or needle deployments on the septum. Immediate and post-discharge complications were recorded. Results: The VersaCross (n=50) and control (n=25) groups had a mean age of 61.9 ± 11.1 years vs 64.2 ± 11.3 years; 54% vs 68% male; BMI of 29.1 ± 5.3 vs 29.3 ± 5.1; 34 vs 28% with prior TSP procedures; 98 vs 100% on anticoagulation; 10 vs 16% with pacemakers; and 38 vs 40% under TOE guidance (p>0.05 for all). Ablations for AF predominated in both groups (86 vs 92%), of which approximately half were cryoablations (49% vs 56%). The remaining cases were for atrial or ventricular tachycardia. For both single or dual transseptal access, there was no correlation between transseptal or fluoroscopy time and procedure number in the VersaCross group. There was no difference in transseptal or fluoroscopy time between the VersaCross and control groups (p>0.05 for all) (Figure 1). VersaCross cases needed an average of 1.5 ± 1 drop downs and 1 ± 0.7 RF application per TSP. For control cases this was 1.5 ± 0.9 and 1 ± 0.6 deployments, respectively (p>0.05 for both). In the VersaCross group, four minor complications occurred: one case of atrioventricular block lasting seconds on application of transseptal RF and three small pericardial effusions not requiring intervention. One of these was diagnosed 23 days after the procedure, and another was in a patient with a temporary pacing wire placed pre-ablation. Of the three effusions, two occurred in cases performed without TOE but this was not statistically significant (p=0.5). There was one major complication in this group of haemothorax requiring chest drain insertion. In all VersaCross cases, TSP was completed without converting to another technology, whilst two needed to be abandoned in the control group – one due to patient discomfort and another due to cardiac tamponade. There were no other complications in the control group. Conclusions: The VersaCross transseptal system can be used in a variety of ablation procedures with or without echo guidance. No quantitative learning curve was evident and, compared with conventional TSP technology, no difference in TSP or fluoroscopy time. [Image Omitted]

The combination of transcatheter arterial chemoembolization and radiofrequency ablation was associated with a survival benefit compared with RFA alone.

ObjectivesThis study compares volume reduction of benign thyroid nodules three months after Radiofrequency Ablation (RFA), Microwave Ablation (MWA) or High Intensity Focused Ultrasound (HIFU) to evaluate which of these methods is the most effective and safe alternative to thyroidectomy or radioiodine therapy.Material and MethodsNinety-four patients (39 male, 55 female) with a total of 118 benign, symptomatic thyroid nodules were divided into three subgroups. HIFU was applied to 14 patients with small nodules. The other 80 patients were divided up into two groups of 40 patients each for RFA and MWA in the assumption that both methods are comparable effective. The pre-ablative and post-ablative volume was measured by ultrasound.ResultsRFA showed a significant volume reduction of nodules of 50 % (p<0.05), MWA of 44 % (p<0.05) and HIFU of 48 % (p<0.05) three months after ablation. None of the examined ablation techniques caused serious or permanent complications.ConclusionRFA, MWA and HIFU showed comparable results considering volume reduction. All methods are safe and effective treatments of benign thyroid nodules.Key Points• Thermal Ablation can be used to treat benign thyroid nodules• Thermal Ablation can be an alternative to thyroidectomy or radioiodine therapy• Radiofrequency Ablation, Microwave Ablation, High Intensity Focused Ultrasound are safe and effective