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 investigate the feasibility, safety and effectiveness of radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery.MethodsThe clinical data of 107 patients with rheumatic mitral disease and atrial fibrillation who underwent mitral valve replacement and radiofrequency ablation at the same time in our hospital from January 2014 to October 2018 were retrospectively analyzed. The patients were divided into two groups: a totally thoracoscopic surgery group (n=51, including 20 males and 31 females, aged 50.57±5.24 years) and a median sternotomy group (n=56, including 21 males and 35 females, aged 52.12±5.59 years) according to the surgical methods. The preoperative, intraoperative and postoperative data of the patients were compared.ResultsAll operations were successfully completed without death. In terms of bleeding volume, drainage volume, ventilator-assisted breathing time, hospital stay and incision length, the totally thoracoscopic surgery group was better than the median sternotomy group, and the difference was statistically significant (P<0.05). The cardiopulmonary bypass time and radiofrequency ablation time in the totally thoracoscopic surgery group were longer than those in the median sternotomy group (P<0.05). There was no significant difference in the operation time, aortic occlusion time, postoperative complications, left ventricular ejection fraction, left atrial diameter and sinus rhythm maintenance between the two groups (P>0.05). There was no atrioventricular block, pulmonary vein stenosis, atrioesophageal fistula, coronary artery injury, stroke or hemorrhage during the follow-up.ConclusionRadiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery is safe and effective, and it is worthy of clinical application.
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 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.
目的:探讨TCR(低温等离子射频)序贯治疗在治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)临床疗效。方法:我院2003年8月至2007年2月收治153例轻中度OSAHS患者,采用TCR序贯治疗,初次手术后追踪患者情况,必要时分阶段分部位反复消融,并在术后半年,1年进行PSG检查等,对其疗效、并发症进行分析。结果:153例患者半年有效率86.27%。1年有效率73.20 %,无严重并发症发生。结论:TCR序贯治疗疗效确切,组织反应轻,可作为治疗轻中度OSAHS的有效方案。
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.
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.
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.