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.
Objective To compare the effect of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease. Methods The clinical data of 261 patients who underwent valve replacement and radiofrequency Maze Ⅲ procedure in Shanghai First People's Hospital from 2010 to 2015 were retrospectively analyzed. According to the radiofrequency ablation system, patients were assigned to a monopolar radiofrequency ablation group (n=209, 129 males, 80 females, aged 59.6±9.7 years) and a bipolar radiofrequency ablation group (n=52, 36 males, 16 females, aged 58.6±11.2 years). After procedures, clinical factors such as patients' basic information, perioperative complication and mortality, the elimination rate of atrial fibrillation were measured. Results There was no statistic difference in perioperative morbidity and mortality between two groups. The ablation time of the monopolar radiofrequency ablation group was longer than that of the bipolar group (29.7±3.3 minvs. 22.3±7.8 min,P=0.035). Postoperative diameter of left atrium was reduced in both groups. Compared with the monopolar radiofrequency ablation group, bipolar group had a better elimination rate of atrial fibrillation at three months and one year follow-up (82.0%vs. 66.3%,P=0.037; 80.0%vs. 59.6%,P=0.008). Conclusion Valve replacement combined with radiofrequency Maze Ⅲ procedure is safe and efficient. Compared with monopolar radiofrequency ablation, bipolar radiofrequency ablation has advantage on elimination rate of atrial fibrillation, ablation time and cardiopulmonary bypass time.
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.
Objective To evaluate the clinical effects of bi-polar radiofrequency ablation (BRFA) for the surgical treatment of atrial fibrillation (AF) in rheumatic heart disease (RHD) patients. Methods We involved 96 RHD patients who underwent valve replacement in Department of Cardiovascular Surgery, West China Hospital from July 2014 through May 2015. There were 74 patients with AF, 22 in sinus rhythm. All patients with AF were fully informed of BRFA, in which 40 of the 74 patients received while the other 34 patients refused. The 40 patients with AF who received BRFA were classified into a treatment group and the other 34 patients were classified into a control group. The 20 patients with sinus rhythm were classified into a blank group as well. The clinical effect and quality of life of the patients were analyzed. Results Left atrial diameter (LAD), pulmonary arterial systolic pressure (PASP), and conversion rate of sinus rhythm at discharge, maintenance rate of sinus rhythm during follow-up in patients with AF were significantly higher than those in the patients in sinus rhythm. No difference was found in terms of survival rate, mortality, major complications among the three groups. The treatment group experienced higher scores in physical functioning (PF), role-physical (RP), general health (GH), vitality (VT), social functioning (SF), mental health (MH), physical component summary (PCS), mental component summary(MCS) and total score compared with the control group both at postoperative 3-month and 6-month . At postoperative 12-month, the treatment group experienced higher scores in PF, RP, GH, PCS, and total score compared with the control group. Conclusion AF would enhance the negative impact on structure remodeling in RHD patients. BRFA is beneficial for the conversion and maintaining of sinus rhythm in RHD patients and the decreasing of LAD & PASP parameter as well. BRFA is more beneficial for the improvement of quality of life in RHD patients with AF during one-year follow-up.
ObjectiveTo compare clinical effect of percutaneous radiofrequency ablation (RFA) and open repeated hepatectomy (ORH) in treatment of liver cancer with late recurrence (recurrence time >12 months) and single tumor diameter ≤5 cm.MethodsThe patients with advanced intrahepatic recurrence after first operation for liver cancer in this hospital from January 2013 to December 2019 were retrospectively collected, who were treated with ORH (ORH group) or percutaneous RFA (RFA group) and met the inclusion criteria. The overall survival rate and disease-free survival rate of the two groups were compared after 1∶1 matching by propensity score matching (PSM), while the factors affecting survival were stratified.ResultsA total of 244 patients with recurrent liver cancer were collected, including 134 patients in the ORH group, 110 patients in the RFA group. The patients in the two groups were matched with 1∶1 by PSM, 90 patients in each group. The median overall survival time of the ORH group and the RFA group was 54 months and 45 months, respectively. There were no significant differences in the curves of cumulative overall survival and cumulative disease-free survival between the two groups (P=0.221, P=0.199). The incidence of severe complications in the ORH group was higher than that in the RFA group (10.00% versus 2.22%, P=0.029). A further subgroup analysis showed that the overall survival time of the ORH group was longer than that of the RFA group when the diameter of recurrent liver cancer was 3 to 5 cm (P=0.035), which had no significant differences for the patients with AFP (>400 μg/L or ≤400 μg/L), tumors number (single or multiple), and tumor diameter ≤3 cm between the two groups (P>0.05).ConclusionsPercutaneous RFA is effective and safe in treatment of advanced recurrent liver cancer, its overall survival and disease-free survival are similar to ORH treatment. However, when diameter of recurrent tumor is3–5 cm, ORH treatment has a advantage in prolonging survival time of patients.
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.
Although surgical resection remains to be the best treatment strategy for stageⅠnon-small cell lung cancer (NSCLC), percutaneous thermal ablation offers an important option for patients who are unable to undergo surgical resection. Currently, there are three main thermal ablation methods used in the treatment of lung cancer, including radiofrequency ablation (RFA), microwave ablation (MWA) and argon-helium cryoablation (AHC). With the improvement of technique and the accumulation of experience in the treatment of lung cancer, some limitations are disclosed in the initial application of RFA, such as heat sink effect, skin burns and rapid carbonization. These shortcomings have been overcome in the development of MWA and AHC. The feasibility and safety of thermal ablation for the treatment of lung cancer has been demonstrated and its efficacy has been significantly improved (especially for the tumour diameter≤3 cm). This article will focus on the application and recent research developments of these ablation techniques in the treatment of lung cancer.
摘要:目的： 探讨肝癌患者行射频消融术围手术期的肝功能变化情况,以及相应的护理措施。方法:对2006～2009年6月在我院接受射频消融术治疗的91例肝癌患者,监测其围手术期的肝功能指标,如丙氨酸氨基转移酶及总胆红素等变化情况,分析射频消融术对肝功能的影响,总结相应的护理措施。 结果:全组无死亡病例。射频消融术后早期丙氨酸氨基转移酶及总胆红素与术前有显著差异（P＜005）。结论: 肝癌患者行射频消融术后早期肝功能减退,应加强护理措施,促进患者恢复。 Abstract: Objective: To explore the influence of radiofrequency ablation (RFA) on hepatic function of patients suffering hepatocelluler carcinoma and to summarize corresponding nursing measures.Methods: Ninetyone patients suffering hepatocelluler carcinoma received RFA were studied with their hepatic function preoperation and postoperation. Alanine aminotransferase (ALT) and total bilirubin (TB) were selected as the liver functional parameters,and perioperative changes of the two parameters were measured. Influence of RFA on hepatic function was analyzed and corresponding nursing measures were summarized. Results: Significant changes of ALT and TB were observed early after RFA,and there were statistical difference between preoperation and postoperation (P＜005). Conclusion: Proper nursing measures should be applied to improve hypohepatia and promote recovery of patients.
ObjectiveTo evaluate the early and mid-term outcomes of total thoracoscopic Box Lesion radiofrequency ablation in patients with atrial fibrillation.MethodsThe clinical data of 31 patients with atrial fibrillation who underwent total thoracoscopic Box Lesion radiofrequency ablation between November 2011 and March 2018 at the Department of Cardiac Surgery in our hospital were retrospectively analyzed, including 23 males and 8 females at an average age of 66.17±8.32 years. All patients did not have concomitant severe organic heart disease which required surgical intervention.ResultsThere were 20 patients with paroxysmal atrial fibrillation, 8 with persistent atrial fibrillation, and 3 with long-standing persistent atrial fibrillation. Twenty-nine patients got the 3-year follow-up, and 2 patients were lost to the follow-up 6 months after the surgery. The procedure was successfully performed in all patients, with an average operation time of 113.00±26.00 min. There was no perioperative death or related complication. All patients were restored to sinus rhythm immediately after surgery. Five patients got atrial fibrillation during postoperative hospitalization, which reverted to sinus rhythm after electrical cardioversion. The rate of sinus rhythm maintenance was 62.9%, 55.9% and 52.4% in postoperative 1, 2 and 3 years, respectively. No patient died during the period, and no procedure-related complication was observed.ConclusionTotal thoracoscopic Box Lesion radiofrequency ablation effectively shortens operation time, and reduces surgical trauma and procedure-related complications, meanwhile, ensures the surgical outcomes.
Objective To investigate the risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy. Methods The clinical data of patients with liver metastases treated by radiofrequency ablation in our hospital from January 2010 to April 2022 were collected retrospectively and analyzed by univariate and multivariate logistic regression analysis. Results A total of 57 patients were included in the study, and the total number of postoperative infections was 19 (33.33%). Univariate logistic regression analysis showed that the tumor location, maximum tumor diameter, number of tumors, ablation times, and ablation duration were related to the occurrence of infection after radiofrequency ablation (P<0.01). The results of multivariate logistic regression analysis showed that the tumor location [OR=6.45, 95%CI (1.11, 37.35), P=0.037] and ablation duration [OR=1.49, 95%CI (1.16, 1.91), P=0.002] were independent risk factors for infection after radiofrequency ablation in patients with choledocho-jejunostomy. Conclusions For patients with metastatic liver cancer with a history of choledochojejunostomy, the tumor location and the duration of ablation are closely related to postoperative infection. We should strengthen the indivi-dualized management of such patients during and after operation should be strengthened to promote disease recovery.