Ablação por Cateter para Fibrilação Atrial em Pacientes com Fração de Ejeção do Ventrículo Esquerdo ≤ 45%: Uma Metanálise de Ensaios Clínicos Randomizados / Catheter Ablation for Atrial Fibrillation in Patients with Left Ventricular Ejection Fraction ≤ 45%: A Meta-Analysis of Randomized Controlled Trials

Resumo Fundamento A fibrilação atrial (FA) e a insuficiência cardíaca (IC) coexistem frequentemente, resultando em desfechos adversos. No entanto, permanecem controvérsias quanto à eficácia da ablação por cateter (AC) em pacientes com FA com disfunção ventricular esquerda grave. Objetivos O objetivo deste estudo foi realizar uma metanálise de ensaios prospectivos randomizados e controlados para avaliar a eficácia da AC versus terapia médica (TM) em pacientes com FA com fração de ejeção do ventrículo esquerdo (FEVE) ≤45%. Métodos Procuramos na literatura estudos que comparassem AC com TM em pacientes com FA com FEVE ≤45%. Foi realizada uma metanálise de 7 ensaios clínicos, incluindo 1.163 pacientes com FA e IC. A análise de subgrupo foi realizada com base na FEVE basal. Todos os testes foram bilaterais; apenas o valor p <0,05 foi considerado estatisticamente significativo. Resultados Descobrimos que a AC estava associada a menor mortalidade por todas as causas (taxa de risco: 0,52, IC 95%: 0,37 a 0,72; p<0,01) e maiores melhorias na FEVE (diferença média: 4,80%, IC 95%: 2,29% a 7,31%; p<0,01) em comparação com TM. Os pacientes do grupo AC apresentaram menor risco de hospitalização por IC e recorrência de FA e qualidade de vida significativamente melhor do que aqueles do grupo TM. Os resultados da análise de subgrupo indicaram que pacientes com disfunção ventricular esquerda mais leve melhoraram a FEVE após a ablação de FA (diferença média: 6,53%, IC 95%: 6,18% a 6,88%; p<0,01) em comparação com pacientes com doença mais grave (diferença média : 2,02%, IC 95%: 0,87% a 3,16%; p<0,01). Conclusões Nossa metanálise demonstrou que a AC foi associada a melhorias significativas nos resultados de pacientes com FA com FEVE ≤45%. Além disso, pacientes com FA com disfunção ventricular esquerda mais leve poderiam se beneficiar mais com a AC.

Abstract Background Atrial fibrillation (AF) and heart failure (HF) frequently coexist, resulting in adverse outcomes. However, controversies remain regarding the efficacy of catheter ablation (CA) in AF patients with severe left ventricular dysfunction. Objectives The purpose of this study was to perform a meta-analysis of prospective randomized controlled trials to evaluate the efficacy of CA versus medical therapy (MT) in AF patients with left ventricular ejection fraction (LVEF) ≤45%. Methods We searched the literature for studies that compared CA to MT in AF patients with LVEF ≤45%. A meta-analysis of 7 clinical trials was performed, including 1163 patients with AF and HF. Subgroup analysis was performed based on baseline LVEF. All tests were 2-sided; only the p-value <0.05 was considered statistically significant. Results We found that CA was associated with lower all-cause mortality (risk ratio: 0.52, 95% CI: 0.37 to 0.72; p<0.01) and greater improvements in LVEF (mean difference: 4.80%, 95% CI: 2.29% to 7.31%; p<0.01) compared to MT. Patients in the CA group had a lower risk of HF hospitalization and AF recurrence and a significantly better quality of life than those in the MT group. The results of subgroup analysis indicated that patients with milder left ventricular dysfunction improved LVEF after AF ablation (mean difference: 6.53%, 95% CI: 6.18% to 6.88%; p<0.01) compared to patients with more severe disease (mean difference: 2.02%, 95% CI: 0.87% to 3.16%; p<0.01). Conclusions Our meta-analysis demonstrated that CA was associated with significant improvements in outcomes of AF patients with LVEF ≤45%. Additionally, AF patients with milder left ventricular dysfunction could benefit more from CA.

Progressão da Lesão Miocárdica após Ablação por Radiofrequência em Crianças em Idade Escolar / Myocardial Injury Progression after Radiofrequency Ablation in School-Age Children

Resumo Fundamento As últimas décadas têm assistido ao rápido desenvolvimento do tratamento invasivo de arritmias por procedimentos de ablação por cateter. Apesar da sua segurança e eficácia bem estabelecida em adultos, até o momento, há poucos dados nos cenários pediátricos. Uma das principais preocupações é a possível expansão da cicatriz do procedimento de ablação nessa população e suas consequências ao longo dos anos. Objetivos Este estudo teve como objetivo analisar o risco da progressão da lesão miocárdica após ablação por cateter de radiofrequência em pacientes pediátricos. Métodos Este é um estudo retrospectivo de 20 pacientes pediátricos com tratamento prévio de arritmia supraventricular com ablação, submetidos à ressonância magnética cardíaca e angiografia coronária para avaliação de fibrose miocárdica e da integridade das artérias coronárias durante o acompanhamento. Resultados A idade mediana no procedimento de ablação foi 15,1 anos (Q1 12,9, Q3 16,6) e 21 anos (Q1 20, Q3 23) quando a ressonância magnética cardíaca foi realizada. Quatorze dos pacientes eram mulheres. Taquicardia por reentrada nodal e síndrome de Wolf-Parkinson-White foram os principais diagnósticos (19 pacientes), com um paciente com taquicardia atrial. Três pacientes apresentaram fibrose miocárdica ventricular, mas com um volume inferior a 0,6 cm 3 . Nenhum deles desenvolveu disfunção ventricular e nenhum paciente apresentou lesões coronarianos na angiografia. Conclusão A ablação por cateter de radiofrequência não mostrou aumentar o risco de progressão de lesão miocárdica ou de lesões na artéria coronária.

Abstract Background The past decades have seen the rapid development of the invasive treatment of arrhythmias by catheter ablation procedures. Despite its safety and efficacy being well-established in adults, to date there has been little data in pediatric scenarios. One of the main concerns is the possible expansion of the ablation procedure scar in this population and its consequences over the years. Objectives This study aimed to analyze the risk of myocardial injury progression after radiofrequency catheter ablation in pediatric patients. Methods This is a retrospective study of 20 pediatric patients with previous ablation for treatment of supraventricular arrhythmia that underwent cardiac magnetic resonance and coronary angiography for evaluation of myocardial fibrosis and the integrity of the coronary arteries during follow-up. Results The median age at ablation procedure was 15.1 years (Q1 12.9, Q3 16.6) and 21 years (Q1 20, Q3 23) when the cardiac magnetic resonance was performed. Fourteen of them were women. Nodal reentry tachycardia and Wolf-Parkinson-White Syndrome were the main diagnosis (19 patients), with one patient with atrial tachycardia. Three patients had ventricular myocardial fibrosis, but with a volume < 0.6 cm 3 . None of them developed ventricular dysfunction and no patient had coronary lesions on angiography. Conclusion Radiofrequency catheter ablation did not show to increase the risk of myocardial injury progression or coronary artery lesions.

Research advances in thermal ablation for lung cancer / 中国胸心血管外科临床杂志

@#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.

Corrected sinus node recovery time as a screening test in patients with typical atrial flutter post-ablation to predict pacemaker implantation / Tiempo de recuperación del nodo sinusal corregido como prueba de tamizaje en pacientes con aleteo atrial típico postablación para predecir la implantación de marcapasos

Abstract Objective: The objective of the study was to establish the prognostic value of CSNRT regarding the necessity for pacemaker implantation in patients with atrial flutter (AFL) post-ablation. Methods: This prospective cohort study, conducted at the National Institute of Cardiology "Ignacio Chavez" in Mexico City, assessed patients who had undergone ablation procedures to correct AFL, posterior to which an autonomic blockade was performed, and CSNRT was measured. Results: The sample for this investigation was 40 patients. These were subdivided into two study groups depending on their requirement of pacemaker implant post-ablation (Pacemaker P, No Pacemaker NP). Sinus node (SN) dysfunction was diagnosed in 13 (32.5%) of the 40 participants, 10 (71.43%) of which required a pacemaker implant, while only 4 participants (28.57%) with normal SN function required pacemakers. Ten out of the 14 patients (71.43%) who required a pacemaker had an elevated CSNRT > 500 ms (p ≤ 0.01). Post-ablation CSNRT mean was 383.54 ms ± 67.96 ms in the NP group versus 1972.57 ms ± 3423.56 ms in the P group. Furthermore, SN pause in the P group had a mean of 1.86 s ± 0.96 s versus the NP group with 1.196 s ± 0.52 s. Conclusion: CSNRT has the potential to be a quantitative prognostic tool for the assessment of future pacemaker implants in patients with AFL post-ablation. This could aid in the timely diagnosis of sinus node dysfunction, which could, in the long run, result in the reduction of cardiac functional capacity loss due to cardiac remodeling.

Resumen Objetivo: Establecer el valor pronóstico del TRNSC basado en la necesidad de marcapasos en pacientes diagnosticados con aleteo atrial, pos-ablación. Métodos: Este cohorte prospectivo, realizado en el Instituto Nacional de Cardiología "Ignacio Chávez" en la Ciudad de México, evaluó pacientes sometidos a ablación para corregir el aleteo atrial; se midió el TRNSC post bloqueo autonómico. Resultados: La muestra de 40 pacientes se subdividió en 2 grupos según su requerimiento de marcapasos posterior a la ablación (P y NP). Se diagnosticó disfunción del nodo sinusal en 13 participantes (32.5%), de los cuales 10 (71.43%) requirieron marcapasos en comparación a 4 (28.57%) con función normal. En el grupo P la pausa del nodo sinusal post-ablación tuvo una media de 1.86 ± 0.96 s versus el grupo NP con 1.196 ± 0.52 s. En relación con el TRNSC, el grupo NP tuvo una media de 383.54 ± 67.96 ms vs. 1972.57 ± 3423.56 ms en el grupo P. 10 pacientes (25%) obtuvieron un TRNSC > 500 ms, de los cuales 100% requirieron marcapasos; de los 14 pacientes que requirieron marcapasos 10 (71.43%) tenían un TRNSC elevado (p ≤ 0.01). Conclusiones: El TRNSC tiene el potencial de ser una herramienta de pronóstico cuantitativo para la necesidad de futuros implantes de marcapasos en pacientes con disfunción del nodo sinusal, resultado de aleteo atrial pos-ablación. Esto podría ayudar a diagnosticar más temprano una disfunción del nodo sinusal, resultando en la reducción de la pérdida a largo plazo de la función cardíaca como efecto de la remodelación.

Resultados del aislamiento eléctrico de las venas pulmonares en pacientes menores y mayores de 70 años / Outcomes of pulmonary vein electrical isolation in patients younger than and older than 70 years

Resumen Introducción y objetivos: Comparar las características clínicas y los resultados de cohortes contemporáneas de pacientes menores y mayores de 70 años que han sido sometidos a ablación de fibrilación auricular (FA) mediante catéter. Métodos: Se llevó a cabo un estudio de cohortes retrospectivo en pacientes sometidos a ablación con catéter debido a la presencia de FA refractaria. Se realizó un seguimiento mínimo de 12 meses por paciente. Resultados: En el estudio se incluyeron un total de 239 pacientes sometidos a ablación de FA, de los cuales 171 (71,5%) pertenecían al grupo de edad < 70 años y 68 (28,5%) al grupo de edad > 70 años. La edad promedio de la población estudiada fue de 62,4 años (desviación estándar [DE] = 10,87). El grupo < 70 años presentó una edad promedio de 58,03 años (DE = 9,71), mientras que el grupo > 70 años tuvo una edad promedio de 73,4 años (DE = 3,05). Además, se observó una mayor prevalencia de FA paroxística en el grupo de pacientes menores de 70 años, mientras que en el grupo de pacientes mayores de 70 años se encontró una mayor prevalencia de FA persistente. Estas diferencias fueron estadísticamente significativas en ambos casos. Las tasas de recurrencia después del primer procedimiento de ablación fueron similares entre los dos grupos (21,43% en el grupo menor de 70 años frente a 23,53% en el grupo mayor de 70 años, p = 0,79). No se encontraron diferencias significativas en cuanto a complicaciones. El grupo menor de 70 años experimentó 18 complicaciones, mientras que el grupo mayor de 70 años tuvo 5 complicaciones, con un valor de p de 0,472. Conclusión: Los pacientes mayores de 70 años sometidos al primer procedimiento de ablación de FA por catéter presentan resultados clínicos similares a los pacientes menores de 70 años.

Abstract Introduction and objectives: The objective of this study is to compare the clinical characteristics and outcomes of contemporary cohorts of patients undergoing catheter ablation for atrial fibrillation (AF), stratified by age (< 70 years and ≥ 70 years). Methods: This retrospective cohort study included patients who underwent catheter ablation for refractory AF. The minimum follow-up duration per patient was 12 months. Results: A total of 239 patients were included in the study, with 171 (71.5%) in the < 70 years group and 68 (28.5%) in the ≥ 70 years group. The mean age of the study population was 62.4 years (SD 10.87). The < 70 years group had a mean age of 58.03 years (SD 9.71), while the ≥ 70 years group had a mean age of 73.4 years (SD 3.05). Furthermore, a higher proportion of paroxysmal AF was observed in patients < 70 years, whereas a higher proportion of persistent AF was found in patients ≥ 70 years. These differences were statistically significant. The recurrence rates after the initial ablation procedure were similar between the two groups (21.43% in the < 70 years group vs. 23.53% in the ≥ 70 years group, p = 0.79). Additionally, there were no significant differences in terms of complications. The < 70 years group experienced 18 complications, while the ≥ 70 years group had 5 complications (p = 0.472). Conclusion: The findings of this study suggest that patients aged 70 years and older who undergo their first catheter ablation procedure for AF demonstrate similar clinical outcomes compared to patients younger than 70 years.

Impact of catheter ablation procedure on optical coherence tomography angiography findings in patients with ventricular arrhythmia

SUMMARY OBJECTIVE: Catheter ablation procedure may cause retinal complications associated with the risk of thromboembolism. We aimed to evaluate retina and optic disc microvascularity with optical coherence tomography angiography before and after the catheter ablation process in patients with ventricular arrhythmia. METHODS: A total of 40 eyes of 21 ventricular arrhythmia patients were included in this cross-sectional study. Demographic characteristics and ophthalmic examination findings of patients were recorded. optical coherence tomography angiography measurements were evaluated before (group 1) and after (group 2) catheter ablation. Optical coherence tomography angiography was applied to all eyes with 6×6 mm sections for the macula and 4.5×4.5 mm sections for the optic nerve head. Foveal retinal thickness, peripapillary retinal nerve fiber layer thickness, vessel density in different parts of the retina, and optic disc were analyzed. RESULTS: The mean age of ventricular arrhythmia patients was 53.48±13.02 years. In all, 13 (61.9%) of the patients were males and 8 (38.1%) were females. There was no significant difference between the groups in terms of average, inferior, superior, and temporal retinal nerve fiber layer thicknesses, foveal avascular area, flow areas, superficial and deep vessel densities, and optic disc capillary densities of the optic disc. However, when compared with group 1, significantly lower values in foveal retinal thickness and higher values in nasal retinal nerve fiber layer thickness were observed in group 2 (248.42±20.50 vs. 247.20±20.44, p<0.001 and 94.22±18.43 vs. 96.12±20.18, p=0.044, respectively). CONCLUSION: Although foveal retinal thickness and nasal retinal nerve fiber layer thickness are affected in patients undergoing catheter ablation for ventricular arrhythmia, the stable retinal and optic disc vessel densities can be explained by the administration of effective anticoagulants during the procedure.

Arrhythmia in Adult Congenital Heart Disease

This case report highlights the significance of a multidisciplinary approach in the management of patients with repaired membranous ventricular septal defect (VSD) who develop postoperative arrhythmias. We present the case of a young female who experienced symptomatic episodes of supraventricular tachycardia following VSD repair. Through electrophysiological study and radiofrequency ablation, multiple tachycardia substrates were identified and successfully ablated. This report underscores the importance of combining surgical repair, electrophysiological evaluation and intervention to achieve optimal outcomes in this specific patient population.

Higher-order aberrations and visual quality after incision lenticule extraction surgery with intraoperative angle kappa adjustments between small and large kappa patients: A 2-year follow-up

Purpose: To evaluate the postoperative visual outcomes, that is, corneal higher?order aberrations (HOAs) and visual quality, of patients with an angle kappa greater than 0.30 mm who underwent angle kappa adjustment during small?incision lenticule extraction (SMILE) 2 years after surgery compared to eyes with an angle kappa less than 0.30 mm. Methods: This was a retrospective study and included 12 patients from October 2019 to December 2019 who underwent the SMILE procedure for correction of myopia and myopic astigmatism and had one eye with a large kappa angle and another eye with a small kappa angle. Twenty?four months after surgery, an optical quality analysis system (OQAS II; Visiometrics, Terrassa, Spain) was used to measure the modulation transfer function cutoff frequency (MTFcutoff), Strehl2D ratio, and objective scatter index (OSI). HOAs were measured with a Tracey iTrace Visual Function Analyzer (Tracey version 6.1.0; Tracey Technologies, Houston, TX, USA). Assessment of subjective visual quality was achieved using the quality of vision (QOV) questionnaire. Results: At 24 months postoperatively, the mean spherical equivalent (SE) refraction was ? 0.32 ± 0.40 and ? 0.31 ± 0.35 in the S?kappa group (kappa <0.3 mm) and the L?kappa group (kappa ?0.3 mm), respectively (P > 0.05). The mean OSI was 0.73 ± 0.32 and 0.81 ± 0.47, respectively (P > 0.05). There was no significant difference in MTFcutoff and Strehl2D ratio between the two groups (P > 0.05). Total HOA, coma, spherical, trefoil, and secondary astigmatism were not significantly different (P > 0.05) between the two groups. Conclusion: Adjustment of angle kappa during SMILE helps reduce the decentration, results in less HOAs, and promotes visual quality. It provides a reliable method to optimize the treatment concentration in SMILE.

Ethanol Ablation for Odontogenic myxoma: New alternative of conservative treatment

Odontogenic myxoma is a maxillofacial tumor that is benign in nature. It is characterized by a slow-growing, painless, and site-aggressive behavior. A main feature is that it is not encapsulated so it has high potential of invasiveness and penetration into peripheral tissues. Large lesions may cause extensive compromise of the region. Treatment strategy for Odontogenic Myxoma is still controversial. Radical resection with an appropriate surgical margin is recommended, but emerging evidence has suggested that a more conservative approach will result in less morbidity and adequate results. This report shows a remarkable result on a 16-year-old patient who had a Mandibular Odontogenic Myxoma treated with a conservative approach. Intra-lesional absolute alcohol irrigation was performed during a 5-month period. Considerable volume reduction of the lesion happened which allowed a minimal overall resection. No recurrence was found after a 3 year follow-up.

The success rate of radiofrequency catheter ablation in Wolff-Parkinson-White-Syndrome patients: A systematic review and meta-analysis

Introduction: radiofrequency catheter ablation (RFA) is the first-line therapy for symptomatic Wolff Parkinson White (WPW) patients according to the American Heart Association. We conducted this study to assess the success rate, recurrence rate, and rate of complications associated with the utilization of radiofrequency catheter ablation for managing patients with WPW. Method: We searched PubMed, Cochrane library, Web of Science and Scopus databases using all identified keywords and index terms through 4 January 2022. We included all studies conducted on WPW patients who were treated with ablation. We conducted the analysis using Open Meta Analyst and MedCalc version 19.1. Results: Among 2268 unique articles identified, only 11 articles met our inclusion criteria. The pooled effect estimates showed high success rate (94.1%[95%CI:92.3e95.9], p < 0.001)), low recurrence rate (6.2% [95%CI:4.5e7.8, p < 0.001]) and low rate of complications (1%[95%CI:0.4e1.5, p < 0.001]). Conclusion: RFA showed a high success rate, low recurrence rate and low rate of complications in WPW patients

Analysis of influencing factors for complications during percutaneous radiofrequency ablation of pulmonary tumor / 中国胸心血管外科临床杂志

@# Objective    To explore and analyze the related influencing factors for common intraoperative complications during CT-guided percutaneous radiofrequency ablation of pulmonary tumor. Methods    We retrospectively analyzed the clinical data of the patients who underwent CT-guided percutaneous radiofrequency ablation of pulmonary tumor in our hospital from December 2018 to December 2019, and analyzed the influencing factors for complications. Results    A total of 106 patients were enrolled. There were 58 (54.7%) males and 48 (45.3%) females aged 46-81 (68.05±8.05) years. All patients successfully completed the operation. The operation time was 47.67±16.47 min, and the hospital stay time was 2.45±1.35 d. The main intraoperative complications were pneumothorax (16.0%, 17/106) and intrapulmonary hemorrhage (22.6%, 24/106). Univariate analysis showed that the number of pleural punctures had an impact on the occurrence of pneumothorax (P=0.00). The length of the puncture path (P=0.00), ablation range (P=0.03) and ablation time (P=0.00) had an impact on the occurrence of intrapulmonary hemorrhage. Multivariate logistic regression analysis showed that the size of the lesion (OR=17.85, 95%CI 3.41-93.28, P=0.00) and the number of pleural punctures (OR=0.02, 95%CI 0.00-0.11, P=0.00) were independent influencing factors for the occurrence of pneumothorax. The length of the puncture path (OR=15.76, 95%CI 5.34-46.57, P=0.00) was the independent influencing factor for the occurrence of intrapulmonary hemorrhage. Conclusion    Percutaneous radiofrequency ablation of pulmonary tumor is safe and with a high success rate, but intraoperative complications are affected by many factors, so the surgeons should be proficient in operating skills to avoid complications.

Totally endoscopic transmitral septal myectomy for the treatment of recurrent left ventricular outflow tract obstruction after alcohol septal ablation / 中国胸心血管外科临床杂志

@#Objective    To investigate the surgical strategies and clinical efficacy of transmitral septal myectomy in the treatment of recurrent left ventricular outflow tract obstruction (LVOTO) after alcohol septal ablation. Methods    The clinical data of patients with recurrent LVOTO after alcohol septal ablation from July 2020 to July 2021 in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital were retrospectively analyzed. Patients were preoperatively evaluated by echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, 3D modeling and printing technology. A personalized surgical strategy was preoperatively developed according to multimodality imaging assessment, while visual exploration was performed on the digital model and simulated surgical resection was performed on the printed model. Results     Two female patients were enrolled, aged 62 years and 64 years, respectively. Totally endoscopic transmitral extended myectomy was successfully performed on both patients with aortic cross-clamping time of 96 min and 85 min, respectively. LVOTO was relieved immediately (subaortic peak pressure gradient decreased from 100 mm Hg to 4 mm Hg and from 84 mm Hg to 6 mm Hg, respectively) and the mitral regurgitation significantly improved after the procedure. No patient had complete atrioventricular block or required permanent pacemaker implantation. The patients were discharged uneventfully without postoperative complications. Conclusion    Personalized totally endoscopic transmitral extended myectomy combined with multimodality imaging assessment and 3D modeling and printing has an acceptable clinical effect in patients with recurrent LVOTO after alcohol septal ablation. The procedure can precisely resect the hypertrophic septal myocardium while avoiding serious complications such as septal perforation or complete atrioventricular block.

Survival results of surgical resection versus CT-guided percutaneous ablation for stage Ⅰnon-small cell lung cancer: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To evaluate the survival results of surgical resection (SR) and CT-guided percutaneous ablation (PA) for stageⅠnon-small cell lung cancer (NSCLC). Methods    The PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, VIP, Wanfang databases from inception to June 2021 were searched to collect comparative studies on the survival results between SR and CT-guided PA treatment for stageⅠNSCLC. RevMan 5.3 software was used for statistical analysis of data. Results    A total of 3 114 patients were included in 11 studies. The results of meta-analysis showed that compared with the PA group, the SR group had a higher 2-year postoperative overall survival (OS) rate (OR=1.44, 95%CI 1.00-2.06, P=0.05), 3-year postoperative OS rate (OR=2.37, 95%CI 1.47-3.81, P<0.001), 5-year OS rate (OR=1.64, 95%CI 1.19-2.28, P<0.01), 5-year progression-free survival rate after operation (OR=2.43, 95%CI 1.54-3.82, P<0.001) and lower local recurrence rate (OR=0.26, 95%CI 0.13-0.54, P<0.001). There were no statistical differences between the two groups in terms of 1-year postoperative OS rate, 1-year, 2-year, and 3-year tumor-related survival rates, 1-year, 2-year tumor-free survival rates, or distant postoperative recurrence rate (P>0.05). Conclusion    For patients with stageⅠNSCLC with optimal basic conditions, surgery is a more appropriate treatment. For patients who cannot withstand surgical injuries or refuse surgery, CT-guided PA is also a potential alternative treatment. However, this conclusion needs  to be verified by prospective controlled trials with larger sample sizes and a more rigorous design.

Atrial septal defect with atrial fibrillation treated by one-stop radiofrequency ablation and transthoracic closure under total endoscopy: A case report / 中国胸心血管外科临床杂志

@#Surgical treatment of atrial septal defect (ASD) mainly includes occlusion or repair under cardiopulmonary bypass. Surgical treatment of atrial fibrillation includes transcatheter radiofrequency ablation or Maze surgery under cardiopulmonary bypass. There are many treatments for ASD patients combined with atrial fibrillation, but each has its own advantages and disadvantages. We reported an ASD patient combined with atrial fibrillation treated by totally endoscopic "one-stop" radiofrequency ablation and simultaneous transthoracic ASD occlusion of atrial fibrillation, with good postoperative results.

Mei mini maze procedure for atrial fibrillation patients with atrial functional mitral regurgitation / 中华胸心血管外科杂志

Objective:To study the influence of Mei mini maze procedure for atrial functional mitral regurgitation.Methods:The data of 33 patients with atrial fibrillation and atrial functional mitral regurgitation from January 2017 to June 2020 were retrospectively analyzed. All patients received Mei mini maze procedure for atrial fibrillation. The procedure is carried out thoracoscopically through the left thoracic approach. The ablation of atrial fibrillation includes bilateral circumferential pulmonary vein ablation, isolation of the left atrium posterior wall, left atrial appendage resection, ablation of Marshall's ligament and autonomic ganglion, etc. Follow-up was conducted by outpatient follow-up and telephone. Postoperative heart rhythm was recorded by the patient's symptoms, electrocardiogram, 24 h holter and other examinations. Postoperative mitral valve lesions were obtained by echocardiography.Results:33 patients successfully completed the operation. There was no conversion to thoracotomy and no perioperative death. Thirty patients(90.9%) maintained sinus rhythm at discharge. Before discharge, 16 patients had no mitral regurgitation in echocardiography, 8 patients had mild mitral regurgitation, and 9 patients had moderate mitral regurgitation. Follow-up was 1-4 years after discharge, with a mean of(2.6±1.1) years. Sinus rhythm was maintained in 23 patients(69.7%). 17 patients had no mitral regurgitation, 9 had mild mitral regurgitation, 6 had moderate, and 1 had severe mitral regurgitation. The degree of regurgitation in 25 patients was reduced compared with pre-operation, 5 patients remained unchanged, and 3 patients mitral regurgitation aggravated. Unreduced atrial functional mitral regurgitation was associated with recurrence of atrial fibrillation by Cox multivariate analysis.Conclusion:This study found a close relationship between atrial fibrillation rhythm and atrial functional mitral regurgitation. Most moderate atrial functional mitral regurgitation can be alleviated by effective treatment for atrial fibrillation. It is not recommended that patients with severe atrial functional mitral regurgitation only receive treatment for atrial fibrillation.

The efficacy of the combination of radiofrequency ablation and endoscopic metal stent in the treatment of 44 patients with unresectable cholangiocarcinoma / 中华消化杂志

Objective:To explore the efficacy of the combination of radiofrequency ablation(RFA) and endoscopic metal stent in the treatment of patients with unresectable cholangiocarcinoma.Methods:From January 3, 2012 to June 30, 2019, at the Department of Endoscopic of the Third Affiliated Hospital of Naval Medical University, the clinical data of 44 patients with unresectable cholangiocarcinoma who were treated by the combination of RFA and endoscopic metal stent were retrospectively collected, which included age, gender, location of cholangiocarcinoma(hilar cholangiocarcinoma and distal cholangiocarcinoma), etc. Postoperative evaluation was conducted based on the follow-up, including clinical success rate, postoperative complication rate, time of stent patency and overall survival time (OS). The Kaplan-Meier method and log-rank test were used to analyze the difference of OS between patients with hilar cholangiocarcinoma and distal cholangiocarcinoma. Mann-Whitney U test was used for statistical analysis. Results:The age of the 44 patients with cholangiocarcinoma was (70.3±11.6) years old, with 20 males (45.5%). There were 22 patients (50.0%) with hilar cholangiocarcinoma and 22 patients (50.0%) with distal cholangiocarcinoma. The clinical success rate of 44 patients was 93.2%(41/44). A total of 5 patients(11.4%) had postoperative complications, which were all improved by appropriate treatment. The median time of follow-up of the 44 patient was 9.2 months(ranged from 3.1 to 57.6 months), the median time of stent patency was 7.0 months (ranged from 5.8 to 8.2 months). Thirty-two patients (72.7%) died during the follow-up, and the median OS was 10.9 months(ranged from 9.0 to 12.8 months). The median OS of patients with hilar cholangiocarcinoma was 7.8 months(ranged from 4.6 to 11.0 months) and that of patients with distal cholangiocarcinoma was 12.5 months(ranged from 5.7 to 19.4 months), and there was no statistically significant difference( P>0.05). Conclusion:RFA combined with endoscopic metal stent is safe and effective in the treatment of patients with unresectable cholangiocarcinoma.

Effects of transcranial magnetic stimulation combined with radiofrequency ablation of dorsal root ganglia in the treatment of herpes zoster neuralgia / 中华物理医学与康复杂志

Objective:To observe the clinical efficacy of combining repeated transcranial magnetic stimulation (rTMS) with radiofrequency ablation (RF) of dorsal root ganglia in treating herpes zoster infection and neuralgia.Methods:Eighty-four individuals with a herpes zoster infection who had suffered from neuralgia for no more than 7 days were divided randomly into a control group, an rTMS group, an RF group, and an observation group, each of 21. All were treated with gabapentin, valciclovir and mecobalamin. The rTMS group received rTMS treatment, 5 days per week, for 2 consecutive weeks. The RF group received RF treatment of the dorsal root ganglia on the 15th day after enrollment, while the observation group received only the medication. Before the experiment as well as after 3, 7, 16, 30 and 60 days, all of the subjects self-assessed their discomfort using a pain visual analog scale (VAS). The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Quality of Life Assessment Scale (QOL-SF36), and Pittsburgh Sleep Quality Index (PSQI) were also administered.Results:The average VAS, HAMA, HAMD, QOL-SF36, and PSQI scores of the observation group improved continuously and significantly during and after the treatment. Beyond 16 days all of those results were significantly better than the control group′s averages, and the observation group′s average VAS, HAMA and HAMD results were also significantly better than those of the rTMS group. The observation group′s average VAS, HAMA, HAMD and PSQI scores had improved significantly more than the RF group′s averages beyond 30 days.Conclusion:Combining rTMS and dorsal root ganglion RF can effectively alleviate the early pain symptoms of herpes zoster infection and neuralgia, relieve anxiety and depression, and significantly improve sleep and life quality. Such therapy is worthy of clinical promotion and application.