ObjectiveTo analyze the clinical characteristics of stiff left atrial syndrome (SLAS) after Mei mini maze procedure for atrial fibrillation (AF), and to explore its risk factors and treatments. Methods We retrospectively analyzed the clinical data of the patients who underwent Mei mini maze procedure in Xinhua Hospital between 2010 and 2020. According to whether SLAS occurred in the early postoperative period, patients were divided into a SLAS group and a non-SLAS group. The basic data, perioperative echocardiogram and laboratory test indexes of the two groups were compared. Results A total of 1 056 patients were collected. There were 672 (63.6%) males with an average age of 63.6±9.3 years, including 489 patients with persistent AF and 567 patients with paroxysmal AF. Fourteen (14/1 056, 1.3%) patients developed SLAS, with an average occurrence time of 2.1±1.1 days after the surgery. The average follow-up time of the whole group was 21.4±7.8 months. Two patients in the SLAS group developed SLAS again after discharge, and the occurrence time was 3 weeks and 4 weeks after the operation, respectively; while no SLAS occurred after discharge in the non-SLAS group. Diabetes and small preoperative left atrial diameter were risk factors for SLAS after surgery. Patients with SLAS had a good prognosis after adequate diuretic therapy. Conclusion The incidence of SLAS after Mei mini maze procedure for AF is low, and it mostly occurs in the early postoperative period. After adequate diuretic treatment, the prognosis is good.
ObjectiveTo compare clinical outcomes between biatrial ablation and right atrial ablation in the surgical treatment of atrial fibrillation (AF)for adult patients with atrial septal defect (ASD). MethodsClinical data of 47 patients with ASD and AF who underwent surgical ASD repair and radiofrequency ablation from January 2007 to December 2012 were retrospectively analyzed. There were 20 male and 27 female patients with their age of 35-76 years. AF duration ranged from 3 months to 15 years. There were 18 patients with persistent AF and 29 patients with long-standing persistent AF. There were 10 patients with mild-to-moderate or more severe mitral regurgitation (MR), and 28 patients with mild-to-moderate or more severe tricuspid regurgitation (TR). According to different surgical strategies, all the 47 patients were divided into 2 groups. In right atrial ablation group, there were 19 patients who received ASD repair and right atrial ablation. In biatrial ablation group, there were 28 patients who received ASD repair and biatrial ablation. For patients with mild-to-moderate or more severe MR or TR, concomitant mitral or tricuspid valvuloplasty was performed. All the patients received 24-hour Holter monitoring at 3, 6 and 12 months after discharge, and were intermittently followed up thereafter. ResultsCardio-pulmonary bypass time, aortic cross-clamping time and postoperative hospital stay of biatrial ablation group were significantly longer than those of right atrial ablation group. But there was no statistical difference in postoperative morbidity or recovery between the 2 groups. After heart rebeating, there were 25 patients (89.3%)with sinus rhythm (SR)and 3 patients with junc-tional rhythm (JR), and none of the patients had AF in biatrial ablation group. There were 14 patients (73.7%)with SR, 2 patients with JR and 3 patients with AF in right atrial ablation group. At discharge, 28 patients (100%)in biatrial ablation group had SR, and in right atrial ablation group there were 15 patients (78.9%)with SR and 4 patients with AF relapse (P=0.045). All the patients were followed up for 3-75 months, and there was no death or residual ASD shunt during follow-up. Two patients had mild-to-moderate or more severe MR, and 4 patients had mild-to-moderate or more severe TR. Cumulative SR maintenance rate of biatrial ablation group (87.7%±6.7%)was significantly higher than that of right atrial ablation group (47.4%±11.5%, P=0.003)at 2 years after discharge. ConclusionFor adult patients with ASD and AF, biatrial ablation can produce better clinical outcomes than right atrial ablation without increasing surgical risks.
ObjectiveTo investigate the dynamic changes of nodule volume in benign thyroid tumors after radiofrequency ablation (RFA), and to analyze the predictive value of risk factors for nodule regeneration. MethodsA total of 165 patients with benign thyroid nodules who received RFA treatment in the People’s Hospital of Yuechi County from June 2019 to June 2021 were retrospectively collected and divided into small nodule volume group (≤15 mL, n=116) and large nodule volume group (>15 mL, n=49) according to the median nodule volume at admission. The clinical data and serological data of the two groups were compared. Multivariate Cox proportional hazard regression model was used to adjust confounding factors to explore the relationship between initial nodule volume, vascular density, nodule location near critical structure and postoperative nodule regeneration in patients with benign thyroid nodules. According to the proposed Nomogram of the model, Bootstrap method was adopted for sampling verification, calibration curve was adopted to evaluate the calibration degree of the model, and area under the curve (AUC) of receiver operating characteristics (ROC) curve was adopted to evaluate the model differentiation. ResultsIn the small volume nodule group, the proportion of unilateral nodule was higher, and the preoperative beauty score, preoperative symptom score, radiofrequency power, ablation time, total energy, operative time, intraoperative blood loss and hospital stay were lower or short, P<0.05. The change value of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), catalase (CAT) after operation in small volume nodule group were higher than those in the large nodule volume group (P<0.05), but change value of the free thyroxine (FT4), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were lower than those in the large nodule volume group (P<0.05). At 1, 3, 6, 12, and 24 months after RFA operation, the nodule volume of the two groups decreased successively, and volume reduction rate (VRR) increased successively. The changes of nodule volume and VRR in the small nodule volume group were better than those in the large nodule volume group. In the large nodule group, the nodule volume was larger at 1, 3, 6, 12, and 24 months after operation, and the VRR was higher at 1 month after operation, the regeneration time was shorter, the number of residual nodules was higher, and the initial ablation rate (IAR) was lower (P<0.05). After adjusting for age, gender and other factors, the correlation effect value increased with the increase of initial volume and blood vessel density, and the differences in trend test were statistically significant (Ptrend <0.05). Nodules located near the critical structure had an increased risk of regeneration (OR=1.76, P<0.001). The Nomogram constructed according to the multi-factor model has good differentiation (AUC before and after ROC curve validation were 0.854 and 0.814, respectively) and accuracy (mean absolute error of 0.023). ConclusionsRFA achieved clinically relevant volume reduction in both ≤15 mL and >15 mL of single benign thyroid nodules, lasting for at least 2 years. However, the nodule VRR and cosmetic effect were better in the small volume nodule group, and the initial nodule volume, blood vessel density and location were closely related to nodule regeneration. The Nomogram model showed good differentiation and accuracy in predicting the risk of nodule regeneration, providing strong support for clinical decision-making.
ObjectiveTo systematically evaluate the efficacy and safety of radiofrequency ablation versus amiodarone in the treatment of atrial fibrillation, so as to provide reference for the chosen of clinical treatment options. MethodsWe searched PubMed, The Cochrane Library (Issue 10, 2014), CNKI, VIP and WanFang data from inception to October 2014 to collect randomized controlled trials (RCTs) comparing radiofrequency ablation versus amiodarone for atrial fibrillation. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 4 RCTs involving 511 atrial fibrillation patients were included. The results of meta-analysis showed that:compared with amiodarone, radiofrequency ablation could reduce the risk of atrial fibrillation recurrence (RR=0.35, 95%CI 0.22 to 0.55, P<0.000 01). There was no significant difference in all-cause mortality (RR=0.97, 95%CI 0.17 to 5.61, P=0.97) between both groups. The incidence of adverse events in the radiofrequency ablation group was 7.7%, and was lower than 12.7% of the amiodarone group, but there was no significant difference between the two groups. ConclusionCurrent evidence shows that, compared with amiodarona, radiofrequency ablation is related to lower recurrence rate and higher efficacy, but there is no difference in the safety between the two interventions. However, due to the limited quality and quantity of included studies, higher quality studies are needed to verify the above conclusion.
ObjectiveTo compare the effectiveness of radiofrequency ablation (RFA) combined with transilluminated powered phlebectomy (TIPP) vs. high ligation and stripping (HLS) combined with TIPP in patients with varicose veins of lower limbs.MethodsA retrospective analysis was made on the clinical data of 190 patients (206 limbs) of varicose veins of lower limbs who underwent surgical treatment in our hospital from December 2017 to July 2018, of them 88 patients (96 limbs) in RFA combined with TIPP group and other 102 patients (110 limbs) in HLS combined with TIPP group. The treatment effectiveness and quality of life was assessed with venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) in three months and one year after surgery. Doppler ultrasound was used to evaluate the closure of great saphenous vein.ResultsBaseline characteristics were similar between the two groups (P>0.05). The RFA combined with TIPP group was better than the HLS combined with TIPP group in operation time, intraoperative bleeding, hospital stay time, postoperative bed time, resumption time of activities, as well as incidences of skin induration and limb numb (P<0.05). Occlusion rates of great saphenous vein in 3 months was 93.8% (90/96) in the RFA combined with TIPP group and 97.3% (107/110) in the HLS combined with TIPP group, and in one year was 91.7% (88/96) and 97.3% (107/110) respectively, there was no significant difference between the two groups at the same time point (P>0.05). The VCSS scores and CIVIQ-14 scores also improved significantly in two groups in 3 months and 1 year follow up (P<0.05), but there was no significant differences between the two groups at the same time point (P>0.05).ConclusionsRFA combined with TIPP is an effective method for the treatment of varicose veins of lower limbs. Compared with HLS, RFA has the same good effectiveness and quality of life, but it has the advantages of short operation time, rapid postoperative recovery, and less postoperative complications.
ObjectiveTo investigate heart rhythm outcomes of radiofrequency ablation (RFA)of atrial fibrillation (AF)during mitral valve replacement (MVR)for patients with rheumatic heart disease (RHD), and explore clinical results of radiofrequency catheter ablation (RFCA)for postoperative atrial tachycardia (AT). MethodsEleven RHD patients who developed AT after RFA of AF during MVR were enrolled in this study. There were 4 males and 7 females with their age of 49±8 years. Electroanatomic mapping of the left or right atrium was conducted with three-dimensional electroana-tomic mapping system during continuous AT. RFCA was performed at the key areas of AT. ResultsFor MVR, operation time was 149±18 minutes, postoperative hospital stay was 9.5±2.9 days, and length of ICU stay was 1.8±0.4 days. During electroanatomic mapping, 17 ATs were recorded in 11 patients. Six ATs (35%)of 5 patients originated from the right atrium and 11 ATs (65%)of 6 patients originated from the left atrium (LA). Among them, AT of 2 patients was related to the mitral valve ring. Immediate success of RFCA was obtained in 91% (10/11). After a mean follow-up of 17±4 months, 2 patients whose AT originated from LA had AT recurrence. ConclusionsMajority of postoperative ATs originate from LA, and majority of ATs are not mitral-dependent. RFCA is an effective and safe procedure for AT in patients after RFA of AF during MVR.
Abstract： Objective To analyze the influence of preoperative left atrial dimension （LAD） on the effectiveness of surgical radiofrequency ablation for the treatment of atrial fibrillation （AF） through a 5-year postoperative follow-up of AF patients after surgical radiofrequency ablation. Methods Clinical data of 433 patients with persistent or permanent AF who received bipolar radiofrequency ablation procedures during concomitant cardiac surgery in Beijing Anzhen Hospital from 2006 to 2009 were retrospectively analyzed. All the patients were divided into 4 groups according to their preoperative LAD：Group A， 75 patients with their LAD＜50 mm， including 22 males and 53 females with their average age of 56.50±10.05 years；Group B， 89 patients with their LAD ranging from 50 to 60 mm， including 32 males and 57 females with their average age of 55.63±10.28 years；Group C， 117 patients with their LAD ranging from 60 to 70 mm， including 41 males and 76 females with their average age of 55.13±10.96 years；and Group D， 152 patients with their LAD＞70 mm， including 68 males and 84 females with their average age of 53.22±11.49 years. Postoperative ECG records right after surgery， before discharge， at 6 months and 1，2，3，4 and 5 years during follow-up were collected. The relationship between preoperative LAD and postoperative sinus rhythm restoration rate was analyzed. Results There was statistical difference in sinus rhythm restoration rate right after surgery（P=0. 011）， before discharge（P=0. 002）， at 6 months（P＜ 0. 001） and 1 year （P＜0. 001）， 2 years（P＜0. 001）， 3 years（P＜0. 001）， 4 years（P＜0. 001） and 5 years（P= 0. 006） during follow-up among the 4 groups. Postoperative sinus rhythm restoration rates right at 6 months and 1，2，3， 4 and 5 years during follow-up was 90.4%， 89.9%， 90.3%， 91.3%， 89.1%， and 90.9% in Group A， 80.2%，79.0%，78.1%， 76.1%，72.5%，70.0% in Group B，74.7%，74.0%，71.2%，72.4%，70.0%， and 64.7% in Group C， and 61.8%，57.6%，56.8%，53.9%，50.7%，and 48.6% in Group D， respectively. Conclusion Patients with a larger preoperative LAD have a lower postoperative sinus rhythm restoration rate after surgical radiofrequency ablation for the treatment of AF.
ObjectiveTo systematically evaluate the pharmacoeconomic value of radiofrequency ablation (RFA) versus amiodarone in the treatment of atrial fibrillation (AF), and to provide reference for treatment scheme selection, drug selection and the formulation of drug policy. MethodsWe searched databases including PubMed, The Cochrane Library, CNKI and CBM from 2000 to 2014 to collect pharmacoeconomic studies on RFA versus Amiodarone for treating AF. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. The cost-effectiveness of RFA and Amiodarone for AF was compared according to the cost, effectiveness, and incremental cost-effectiveness ratio (ICER). ResultsA total of three studies were included. The results of pharmacoeconomic evaluation showed that the ICERs for each study were $7 976 to $29 068, ￡7 763 to ￡27 745, and $59 194, respectively. According to country-specific willingness to pay thresholds, the ICER of each included study was acceptable. ConclusionCompared to Amiodarone, RFA is a cost-effective therapy for AF.