ObjectiveTo explore the feasibility of radiofrequency ablation of great saphenous varicose veins in ambulatory surgery.MethodsPatients who underwent radiofrequency ablation of great saphenous varicose veins between May 2018 and June 2019 in General Hospital of Northen Theater Command were prospectively selected. According to their choices of treatment modes, patients were divided into two groups, day surgery group and routine inpatient group. The preoperative waiting time, length of hospital stay, and hospitalization expenses of the two groups were compared. The postoperative pain, tenderness, and complications were followed up on the first day (the next day after operation), the third day, and the fourteenth day after operation, and the time of return to normal life and work and patients’ satisfaction in two groups were recorded.ResultsA total of 95 patients were enrolled, including 52 in the day surgery group and 43 in the routine inpatient group. There was no significantly difference in age, gender, heart rate, mean arterial pressure, or operation time between the two groups (P>0.05). Compared with the routine inpatient group, the day surgery group had shorter preoperative waiting time, shorter length of hospital stay, and lower hospitalization expenses (P<0.05). In the day surgery group, the time of return to normal life and the time of return to work were shorter and patients’ satisfaction was significantly higher than those in the routine inpatient group (P<0.05). There was no significant difference in pain, tenderness, or paresthesia scores between the two groups after surgery according to the follow-up assessment (P>0.05); the pain, tenderness, and paresthesia scores on the first day and the third day were significantly different from those on the fourteenth day after surgery, indicating that the longer the postoperative time of the two groups, the less pain, tenderness, and paresthesia scores were.ConclusionRadiofrequency ablation of great saphenous varicose veins in ambulatory surgery has a short hospital stay, low medical cost, high patient satisfaction, and can ensure the safety of treatment at the same time, which is worthy of clinical promotion
ObjectiveTo study the clinical results of Mini Maze procedure in atrial fibrillation patients with impaired left ventricular systolic function.MethodsFrom June 2010 to December 2017, 86 atrial fibrillation patients with impaired left ventricular systolic function received Mini Maze procedure including 54 males and 32 females, with an average age of 60.7±5.9 years. Among them, 12 were with paroxysmal, 27 were with persistent and 47 were with long-standing persistent atrial fibrillation. The mean atrial fibrillation duration was 6.5±4.8 years. CHA2DS2-VASc score was 2.2±1.1. The mean diameter of left atrium was 46.9±3.8 mm. The mean diameter of left ventricle was 51.7±4.6 mm. The preoperative ejection fraction was 42.2%±4.7%. All patients received Mini Maze procedure after general anesthesia. The ablation included 3 annular ablations and 3 linear ablations. The left atrial appendage was excised by Endo-Gia. Ablation of Marshall ligament and epicardial autonomic ganglions were made by an ablation pen.ResultsEighty-six patients successfully completed the procedure without transition to thoracotomy. There was no death during the perioperative period. Seventy-seven patients (89.5%) maintained sinus rhythm at discharge. Eighty patients were followed up for 27.2±12.1 months and 72 patients maintained sinus rhythm. The overall postoperative left ventricular ejection fraction was 47.1%±6.2%. The ejection fraction of the postoperative sinus rhythm group was 48.2%±5.8%, and the ejection fraction of the non-sinus group was 41.6%±5.8% (P<0.05). Multivariate regression analysis showed a left atrial diameter (HR=1.485, 95%CI 1.157-1.906, P<0.05) and an increase in ejection fraction over 10% (HR=18.800, 95%CI 1.674-189.289, P<0.05) were closely related to postoperative recurrence. Kaplan-Meier curve analysis showed that the recurrence rate of atrial fibrillation was significantly lower in patients with an increase in postoperative ejection fraction over 10% (P<0.05).ConclusionMini Maze procedure is safe and effective in the treatment of atrial fibrillation patients with left ventricular systolic dysfunction, which helps to improve left ventricular function to prevent the vicious circle of atrial fibrillation and heart failure.
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.
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.
Multiple primary lung cancer is a special type of lung cancer. Its detection rate is increasing year by year, and there is no clear diagnosis and treatment strategy, which makes the diagnosis and treatment become a hotspot in clinical work. The molecular genetics is gradually changing the status quo of relying only on imaging and tumor-free interval to distinguish lung metastasis from multiple primary lung cancer, and it is an effective method for differential diagnosis and prediction of biological behavior of lung cancer. Based on our experience and other studies, it is recommended that surgical treatment should be preferred when there is no contraindication. The advantages and disadvantages of bilateral thoracoscopic surgery for bilateral multiple primary lung cancer during the same period are discussed, and its feasibility and safety are confirmed. For the lesions that cannot be completely resected, active surgical local treatment is recommended. The diagnosis and treatment of multiple primary lung cancer is still a clinical difficulty, and we hope that our research can provide theoretical and practical guidance for clinicians.
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.
ObjectiveTo evaluate the safety and efficacy of simultaneous surgical resection combined with thermal ablation in sequential treatment of patients with multiple primary lung cancer (MPLC). MethodsPatients with MPLC who underwent simultaneous, sequential surgical resection combined with thermal ablation at Shangjin Branch of West China Hospital of Sichuan University from April 2023 to May 2024 were retrospectively included, and their perioperative and follow-up data were analyzed. ResultsA total of 23 patients with MPLC were enrolled, including 4 males and 19 females, with a mean age of (51.61±12.38) years. Cumulatively, 48 lesions were resected and 23 lesions were ablated. About half of the patients (52.17%) had surgery and ablation treatment located in the same lung. All patients completed the combined treatment without intraoperative complications. Four patients had postoperative complications, and were effectively managed and successfully discharged. The median postoperative hospital stay was 4.00 (4.00, 4.00) days. The average follow-up duration was (11.78±4.90) months, with a local control rate of 100.00% at 6 months postoperatively. No deaths or tumor occurred during the follow-up. Conclusion Simultaneous surgery with thermal ablation in sequential treatment for MPLC is safe, flexible and effective, providing a new option for this group of patients, but further studies are needed to evaluate its long-term efficacy.
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.
With the continuous development of China's aging society and the prevalence of unhealthy lifestyles, the incidence of cardiovascular disease in China has been increasing in recent years. Among them, atrial fibrillation (AF) is the most common arrhythmia disease. In recent years, pulsed field ablation (PFA) has been continuously applied to AF treatment as a novel treatment. This paper first introduces the principle of PFA applied to AF treatment, and introduces the research progress of PFA in different directions, such as the comparison of different ablation methods, the study of physical parameters, the study of ablation area, the study of tissue specificity and clinical research. Then, the clinical prior research of PFA is discussed, including the use of simulation software to obtain the simulation effect of different parameters, the evaluation of ablation effect during animal research, and finally the current AF treatment. Various prior studies and clinical studies are summarized, and suggestions are made for the shortcomings found in the study of AF treatment and the future research direction is prospected.
Objective To evaluate the efficacy of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treating primary hepatocellular carcinoma (HCC). Methods From March 2004 to March 2006, 137 patients with primary HCC underwent TACE alone (n=87) and TACE+RFA (n=50), respectively, after the interventional treatment, all patients periodically received CT reexaminations and alpha fetoprotein (AFP) measurement. The therapeutic efficacy, AFP level and survival rate between two groups were compared with each other. Results In TACE group the effective rate (CR+PR) was 34.5%, AFP decreasing amplitude was 54.2%, and 2 years survival rate was 43.7%. While in TACE+RFA group, the effective rate (CR+PR) was 70.0%, AFP decreasing amplitude was 78.0%, and 2 years survival rate was 62.0%, there were significant differences between two groups (P＜0.05). Conclusion Combined application of TACE and RFA is significantly superior to TACE alone in treatment of primary HCC.