INTRODUCTION: Atrial fibrillation (AF) can cause or aggravate heart failure (HF). Catheter ablation (CA) is an effective treatment for AF. This study focused on the feasibility and outcomes of emergent AF ablation performed during hospitalization for acute HF. METHODS AND RESULTS: We retrospectively investigated patients who underwent emergent CA for AF during hospitalization for acute HF in 2018-2024. Arrhythmia recurrence was the primary endpoint. The combination of arrhythmia recurrence, HF hospitalization, and all-cause death was the secondary endpoint. Patients were censored 1 year after the index procedure. We included 46 patients, 35% females, with median age of 67 [interquartile rage: 61, 72] years and left ventricular ejection fraction (LVEF) of 25 [23, 28]%. Thermal CA was performed in 14 patients, and pulsed field ablation (PFA) in 32 patients. Procedure time was significantly shorter with PFA compared to thermal CA (77 [57, 91] vs. 166 [142, 200] minutes, p < 0.001). Fluoroscopy time was longer with PFA (9.5 [7.6, 12.0] vs. 3.9 [2.9, 6.0] minutes, p < 0.001), with a borderline trend towards higher radiation dose (75 [53, 170] vs. 50 [30, 94] μGy.m2, p = 0.056). Extrapulmonary ablation was frequent (86% and 84% for thermal CA and PFA, p > 0.9). The estimated freedom from the primary endpoint was 79% after PFA and 64% after thermal CA (p = 0.44). The estimated freedom from the secondary endpoint was 76% after PFA and 57% after thermal CA (p = 0.43). LVEF improved by 24% ± 2% (p < 0.001) in patients with the first manifestation of HF and by 14% ± 4% (p = .004) in patients with decompensated HF diagnosed earlier. CONCLUSIONS: Emergent CA of AF during acute HF hospitalization is safe and associated with improved LVEF and good clinical outcomes. In the PFA era, the rate of these procedures is progressively increasing as they are readily available and easy to perform compared to thermal ablation.

• MeSH
• Action Potentials MeSH
• Acute Disease MeSH
• Time Factors MeSH
• Atrial Fibrillation * physiopathology   surgery   diagnosis   MeSH
• Ventricular Function, Left * MeSH
• Catheter Ablation * adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Recurrence * MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Heart Rate MeSH
• Heart Failure * physiopathology   diagnosis   therapy   mortality   MeSH
• Feasibility Studies * MeSH
• Stroke Volume MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

BACKGROUND AND OBJECTIVE: While active surveillance (AS) is an alternative to surgical interventions in patients with small renal masses (SRMs), evidence regarding its oncological efficacy is still debated. We aimed to evaluate oncological outcomes for patients with SRMs who underwent AS in comparison to surgical interventions. METHODS: In April 2024, PubMed, Scopus, and Web of Science were queried for comparative studies evaluating AS in patients with SRMs (PROSPERO: CRD42024530299). The primary outcomes were overall (OS) and cancer-specific survival (CSS). A random-effects model was used for quantitative analysis. KEY FINDINGS AND LIMITATIONS: We identified eight eligible studies (three prospective, four retrospective, and one study based on Surveillance, Epidemiology and End Results [SEER] data) involving 4947 patients. Pooling of data with the SEER data set revealed significantly higher OS rates for patients receiving surgical interventions (hazard ratio [HR] 0.73; p = 0.007), especially partial nephrectomy (PN; HR 0.62; p < 0.001). However, in a sensitivity analysis excluding the SEER data set there was no significant difference in OS between AS and surgical interventions overall (HR 0.84; p = 0.3), but the PN subgroup had longer OS than the AS group (HR 0.6; p = 0.002). Only the study based on the SEER data set showed a significant difference in CSS. The main limitations include selection bias in retrospective studies, and classification of interventions in the SEER database study. CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients treated with AS had similar OS to those who underwent surgery or ablation, although caution is needed in interpreting the data owing to the potential for selection bias and variability in AS protocols. Our review reinforces the need for personalized shared decision-making to identify patients with SRMs who are most likely to benefit from AS. PATIENT SUMMARY: For well-selected patients with a small kidney mass suspicious for cancer, active surveillance seems to be a safe alternative to surgery, with similar overall survival. However, the evidence is still limited and more studies are needed to help in identifying the best candidates for active surveillance.

• MeSH
• Ablation Techniques methods   MeSH
• Humans MeSH
• Kidney Neoplasms * surgery   mortality   pathology   MeSH
• Nephrectomy * methods   MeSH
• Watchful Waiting * MeSH
• Tumor Burden MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Comparative Study MeSH
• Systematic Review MeSH

Epicardial access during electrophysiology procedures offers valuable insights and therapeutic options for managing ventricular arrhythmias (VAs). The current clinical consensus statement on epicardial VA ablation aims to provide clinicians with a comprehensive understanding of this complex clinical scenario. It offers structured advice and a systematic approach to patient management. Specific sections are devoted to anatomical considerations, criteria for epicardial access and mapping evaluation, methods of epicardial access, management of complications, training, and institutional requirements for epicardial VA ablation. This consensus is a joint effort of collaborating cardiac electrophysiology societies, including the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, the Latin American Heart Rhythm Society, and the Canadian Heart Rhythm Society.

• MeSH
• Electrophysiologic Techniques, Cardiac standards   MeSH
• Epicardial Mapping MeSH
• Catheter Ablation * methods   standards   MeSH
• Tachycardia, Ventricular * surgery   diagnosis   physiopathology   MeSH
• Consensus * MeSH
• Humans MeSH
• Pericardium surgery   MeSH
• Arrhythmias, Cardiac surgery   diagnosis   physiopathology   therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Practice Guideline MeSH

PURPOSE: To comprehensively evaluate the efficacy of different energy sources used for en-bloc transurethral resection of bladder tumors (ERBT) on perioperative outcomes. METHODS: This sub-analysis derived from a prospective randomized study that enrolled patients undergoing ERBT vs conventional transurethral resection of the bladder (cTURB) from January 2019 to January 2022 (NCT03718754). Endpoints were pathological specimen quality and perioperative outcomes after either monopolar (m-ERBT) or bipolar (b-ERBT) or laser (l-ERBT) ERBT. RESULTS: 237 bladder tumors resected in 188 patients included in the analyses: 29 (12.2%) m-ERBT, 136 (57.4%) b-ERBT and 72 (30.4%) l-ERBT. Detrusor muscle (DM) was detected in 191 (80.6%) specimens. Per-tumor analysis revealed comparable rate of DM in the specimens obtained via different energy modalities (p = 0.7). Operative time was longer in the l-ERBT cohort compared to m-ERBT and b-ERBT (p = 0.02) and no obturator nerve reflex (ONR) onset was reported. On logistic regression analysis, b-ERBT was associated with negative lateral resection margins (OR 2.81; 95% CI 1.02-7.70; p = 0.04). There was no significant association of the resection technique with perforation and conversion rates (all p > 0.05). Within a median follow up of 22mo (IQR 11-29), a total of 35 (18.6%) patients had a local recurrence. On Cox regression analysis, patients resected with b-ERBT were less likely to have a recurrence (HR 0.34; 95% CI 0.15-0.78; p = 0.01); When adjusting for established confounders, this association was confirmed (HR 0.24; 95% CI 0.10-0.60; p = 0.002). CONCLUSIONS: Different energy sources might achieve comparable perioperative outcomes. Further perspectives involve the assessment of long-term differential oncological outcomes associated with various energy modalities.

• MeSH
• Cystectomy * methods   MeSH
• Laser Therapy methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Urinary Bladder Neoplasms * surgery   pathology   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Urethra surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

Východiska: Solitární hepatocelulární karcinom (hepatocellular carcinoma – HCC) o průměru 3–5 cm představuje náročnou klinickou výzvu, zejména u pacientů, u kterých není kvůli komorbiditám vhodná chirurgická léčba. Případ: U 74letého muže s renálním karcinomem v anamnéze byla na MR zjištěna nová náhodná solitární léze jater o velikosti 5 cm. Po přezkoumání multidisciplinární komisí a vzhledem k věku a vysokému riziku pooperačních komplikací se léčebný plán skládal z perkutánní termické segmentektomie pomocí mikrovlnné ablace s balonkovou okluzí (baloon-occluded microwave abblation – b-MWA) a následné transarteriální chemoembolizace s balonkovou okluzí (balloon-occluded transarterial chemoembolization – b-TACE), přičemž došlo ke kompletní nekróze nádoru, jak ukázaly následných kontrolní snímky. Tento případ ukazuje, že b-MWA a b-TACE by mohly být bezpečnou a účinnou kombinovanou léčbou velkých neresekabilních lézí HCC, a to i u lézí s velikostí nad 3 cm. Závěr: Ačkoli se jedná o nepodložený případ, kterému přirozeně chybí srovnání nebo kontroly, zdůrazňuje potenciální hodnotu jednoho zákroku v podobě perkutánní termické segmentektomie pomocí b-MWA s následnou b-TACE při léčbě velkých neresekabilních solitárních lézí HCC.

Background: Solitary hepatocellular carcinoma (HCC) with a diameter of 3–5 cm represents a challenging clinical entity, especially for non-surgical candidates due to comorbidities. Case: A 74-year-old man with previous history of renal cell carcinoma presented with a new incidental solitary 5 cm liver lesion on MRI. Due to his age and a high risk for post-surgical complications, after multidisciplinary tumor board review the treatment plan consisted of percutaneous thermal segmentectomy using balloon-occluded microwave ablation (b-MWA) followed by balloon-occluded transarterial chemoembolization (b-TACE) with complete tumor necrosis, as evident in subsequent follow-up imaging. This case demonstrates that b-MWA plus b-TACE could be a safe and effective combined therapy for unresectable large HCC lesions, even for those exceeding 3 cm in size. Conclusion: Although the presented case is anecdotal and naturally without comparisons or control, it highlights the potential value of percutaneous thermal segmentectomy with a single session combined b-MWA followed by b-TACE for the treatment of large unresectable solitary HCC lesions.

• MeSH
• Ablation Techniques * methods   MeSH
• Balloon Occlusion methods   MeSH
• Chemoembolization, Therapeutic * methods   MeSH
• Carcinoma, Hepatocellular * therapy   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH

Hypertrofická obstrukční kardiomyopatie (HokmP) je charakterizována ztluštěním stěn a zvětšením masy myokardu nedilatované levé komory srdeční bez vysvětlujících hemodynamických příčin a přítomností gradientu ve výtokovém traktu levé komory (lVoTG). u pacientů s maximální farmakologickou terapií HokmP je indikována invazivní metoda terapie. V minulosti metodou volby k redukci septální hypertrofie byla chirurgická myektomie, kterou vystřídala alkoholová septální ablace (aSa), nyní jde o všeobecně užívanou metodu v redukci septální hypertrofie. V posledních letech se objevila nová nefarmakologická metoda, a to radiofrekvenční ablace mezikomorového septa – v literatuře uváděná jako endocardial radiofrequency ablation of septal hypertrophy (eRaSH). cílem naší kazuistiky je popsat první zkušenosti s touto metodou. Jedná se o třiačtyřicetiletého pacienta s diagnostikovanou HokmP, významným lVoTG a maximální farmakologickou terapií, který podstoupil v roce 2019 alkoholovou septální ablaci pouze s přechodným efektem na regresi lVoTG, a zároveň s nově vzniklou blokádou pravého Tawarova raménka (RBBB). V roce 2021 u pacienta při kontrolní echokradiografii perzistuje vysoká lVoTo až 127 mm Hg a progredující symptomatologie. Proto byla pacientovi navržena eRaSH, se kterou souhlasil. Během výkonu byl mapován a označen převodní systém a hranice ztluštění septa s maximem v blízkosti předního cípu mitrální chlopně s patrným dopředným pohybem předního cípu mitrální chlopně v systole (Sam). Převodní systém byl označen v anatomické mapě body, aby se předešlo jeho poškození. Radiofrekvenční ablace byla zahájena ve střední části ztluštění septa v dostatečné vzdálenosti od převodního systému. Během ablace ale došlo k intermitentní atrioventrikulární blokádě III. stupně, následně ke střídaní bifascikulární blokády charakteru preexistujícího RBBB a levého předního a zadního hemibloku, s následnou restitucí do atrioventrikulární (aV) blokády Wenckebach 3 : 2, ablace byla pro riziko poškození převodního systému ukončena. Po výkonu bylo provedeno kontrolní měření lVoTG, který dosahoval 3,1 mm Hg, po komorové extrasystole 84,4 mm Hg. Během následujících hodin došlo k restituci aV vedení, 12 hodin po výkonu byl na povrchovém ekG patrný sinusový rytmus s aV blokádou I. stupně a RBBB bez převodní poruchy vyššího stupně, na dalších kontrolách po současnost je pacient bez převodních poruch rytmu a s trvajícím nízkým gradientem v lVoT. Pacienti s RBBB po předchozí aSa se jeví jako suboptimální kandidáti eRaSH vzhledem k vysokému riziku vzniku blokády levého Tawarova raménka během výkonu eRaSH a následné kompletní aV blokády. Při eRaSH v terénu předchozí aSa mohou vznikat bizarní poruchy aV převodu jako v níže popsané kazuistice.

Hypertrophic obstructive cardiomyopathy (HOCMP) is characterized by abnormal thickening or enlargement of the left ventricular myocardium mass of non-dilated left ventricle not explained solely by loading conditions and presence of obstruction in outflow tract of left ventricle. Surgical septal myectomy was the first choice method of invasive treatment of septal hypertrophy in the past which was replaced by alcohol septal ablation in the nineties of the 20th century and nowadays it is still worldwide used, safe, and effective method in reduction of septal hypertrophy. Nowadays there is a new method of non-pharmacological treatment of septal hypertrophy which is endocardial radiofrequency ablation of septal hypertrophy (ERASH). Main goal of our case report is to describe first experiences with ERASH method in our department. A forty- -three-year-old patient with diagnosed HOCMP and severe left ventricle outflow tract gradient (LVOTG) despite maximal pharmacological treatment who underwent alcohol septal ablation (ASA) in 2019, only with transient effect on LVOTG, and the new onset of right bundle branch block (RBBB). In 2021, there was still high LVOTG present on echocardiography - 127 mmHg and progressive symptomatology. The patient agreed to undergo ERASH. Hypertrophic part of septum and conduction system have been mapped and marked to avoid destruction. Radiofrequency ablation was started in the middle part of septal hypertrophy in safe distance from conduction system, however, during ablation there was a sudden onset of atrioventri- cular block of third degree, forwarded with alternating bifascicular block RBBB and left anterior or posterior hemiblock, with restitution to AV block of the second degree 3 : 2. Ablation was terminated at this point because of risk of harming conduction system. Immediate measurements straight after procedure were LVOTG 3.1 mmHg at rest and 84.4 mmHg after ventricle extrasystole. In next hours there was a restitution of conduction system to AVB of the first degree with preexisting RBBB. Nowadays the patient is without any conduction disorders of higher degree and low LVOTG still lasts. The patients after alcohol septal ablation with preexisting RBBB seem to be inappropriate candidates for ERASH procedure due to high risk of conduction disorders of higher degree as was seen in our case report.

• MeSH
• Adult MeSH
• Echocardiography MeSH
• Cardiomyopathy, Hypertrophic * surgery   pathology   MeSH
• Catheter Ablation * methods   instrumentation   adverse effects   MeSH
• Humans MeSH
• Ventricular Outflow Obstruction, Left surgery   etiology   pathology   MeSH
• Arrhythmias, Cardiac etiology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

Cíl: Zjistit, zda časovaná preemptivní radiofrekvenční (RF) katétrová ablace povede k nižšímu výskytu arytmií a bude spojena s příznivějším klinickým průběhem ve srovnání se samotným CryoMaze u pacientů se strukturálním srdečním onemocněním indikovaným ke konkomitantní chirurgické léčbě fibrilace síní (FiS). Metody: Do studie byli zařazeni pacienti s neparoxysmální FiS podstupující koronární by-pass anebo chlopenní operaci, kteří byli po CryoMaze randomizováni k provedení následné RF katétrové ablace s odstupem 3 měsíců (sekvenční hybridní léčba) nebo ke konzervativnímu postupu. Primárním cílem byla účinnost, tj. rekurence arytmií (FiS nebo síňových tachykardií) bez antiarytmické léčby, což bylo hodnoceno pomocí implantabilních záznamníků. Primárním kompozitním klinickým cílem byla hospitalizace pro rekurenci arytmií, zhoršení srdečního selhání, kardioembolická příhoda nebo významné krvácení. Výsledky: Analyzovali jsme celkem 113 pacientů v hybridní skupině a 116 pacientů v konzervativní skupině, kteří byli sledováni po střední dobu 715 dnů (mezikvartilové rozpětí 528–1 072 dnů). Rekurence arytmií byla v hybridní skupině ve srovnání se samotným CryoMaze významně snížena (41,1 % vs. 67,4 %, HR = 0,38, 95 % CI:0,26–0,57, P < 0,001), stejně jako i výskyt primárního kompozitního cíle (19,9 % vs. 40,1 %, HR = 0,51, 95 % CI: 0,29–0,86, P = 0,012). Celková mortalita se mezi skupinami nelišila (10,6 % vs. 8,6 %, HR = 1,17, 95 % CI: 0,51–2,71, P = 0,71). Komplikace RF katétrové ablace byly relativně vzácné (1,9 %) a nevedly k žádným závažným klinickým konsekvencím. Závěr: Samotný konkomitantní CryoMaze nevede k optimální kontrole arytmií. Preemptivní RF katétrová ablace je bezpečná a vede k významnému snížení výskytu arytmií a následně i k příznivějšímu klinickému průběhu.

Aims: To assess whether the timely pre-emptive radiofrequency (RF) catheter ablation would achieve higher freedom from atrial fibrillation (AF) or atrial tachycardia (AT) and be associated with better clinical outcomes than surgical ablation (CryoMaze) alone in patients with structural heart disease indicated for concomitant AF treatment. Methods: The trial investigated patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement with mandatory concomitant CryoMaze procedure who were randomly assigned to undergo either RF catheter ablation three months post CryoMaze (Hybrid Group) or no further treatment (Surgery Group). The primary efficacy endpoint was the first recurrence of AF/AT without antiarrhythmic drugs as assessed by implantable cardiac monitors. The primary clinical endpoint was a composite of hospitalization for arrhythmia recurrence, worsening of heart failure, cardioembolic event, or major bleeding. Results: We analyzed 113 and 116 patients in the Hybrid and Surgery Groups, respectively, with a median follow-up of 715 (IQR: 528-1072) days. The primary efficacy endpoint was significantly reduced in the Hybrid Group (41.1% vs 67.4%, hazard ratio (HR)= 0.38, 95% confidence interval (CI): 0.26-0.57, P<0.001) as well as the primary clinical endpoint (19.9% vs 40.1%, HR=0.51, 95% CI: 0.29-0.86, P=0.012). The trial groups did not differ in all-cause mortality (10.6% vs. 8.6%, HR=1.17, 95%CI: 0.51-2.71, P=0.71). The major complications of catheter ablation were infrequent (1.9%) and resulted in no clinical sequelae. Conclusions: Concomitant CryoMaze alone leads to suboptimal arrhythmia control. Pre-emptively performed catheter ablation after the CryoMaze procedure was safe and associated with higher freedom from AF/AT and consequently improved clinical outcomes.

• Keywords
• studie SURHYB,
• MeSH
• Atrial Fibrillation * surgery   therapy   MeSH
• Catheter Ablation methods   MeSH
• Humans MeSH
• Maze Procedure methods   MeSH
• Randomized Controlled Trials as Topic MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Studie CASTLE HTx prokázala snížení kombinovaného primárního endpointu u nemocných s pokročilým srdečním selháním se sníženou ejekční frakcí levé komory a fibrilací síní, kteří byli léčeni katetrizační ablací nad rámec zvyklé terapie srdečního selhání. Ablační léčba byla srovnávána s optimální farmakoterapií srdečního selhání. Primární endpoint zahrnoval celkovou mortalitu, zavedení levostranné srdeční podpory a indikaci k urgentní srdeční transplantaci.

The CASTLE HTx trial showed a significant reduction in the primary composite endpoint in patients with advanced heart failure with reduced ejection fraction and atrial fibrillation who were treated with catheter ablation in addition to optimal medical treatment of heart failure. Catheter ablation was compared with optimal medical treatment alone. The primary endpoint was a composite of death from any cause, implantation of a left ventricular assist device, and urgent heart transplantation.

• Keywords
• studie CASTLE-HTx,
• MeSH
• Catheter Ablation methods   MeSH
• Humans MeSH
• Randomized Controlled Trials as Topic MeSH
• Heart Failure, Systolic * surgery   MeSH
• Check Tag
• Humans MeSH

BACKGROUND: Among inherited cardiomyopathies involving the left ventricle, whether dilated or not, certain genotypes carry a well-established arrhythmic risk, notably manifested as sustained monomorphic ventricular tachycardia (SMVT). Nonetheless, the precise localization and electrophysiological profile of this substrate remain undisclosed across different genotypes. METHODS: Patients diagnosed with cardiomyopathy and left ventricle involvement due to high-risk genetic variants and SMVT treated by electrophysiological study were recruited from 18 European/US centers. Electrophysiological study, imaging, and outcomes data after ablation were assessed in relation to genotype. RESULTS: Seventy-one patients were included (49.6 Q1-Q3 [40-60] years, 76% men). They were divided into 4 groups according to the affected protein: desmosomal (DSP, PKP2, DSG2, and DSC2), nuclear membrane (LMNA and TMEM43), cytoskeleton (FLNC and DES), and sarcoplasmic reticulum (PLN). Desmosomal genes, TMEM43, and PLN were associated with biventricular disease, while variants in LMNA and cytoskeleton genes had predominant left ventricle involvement (P=0.001). The location of the clinical-SMVT substrate was significantly different based on genotype (P=0.005). DSP and cytoskeleton genes presented SMVTs with right bundle branch block morphology, which origin was identified in the inferolateral segments of the left ventricle. The other desmosomal genes (PKP2 and DSG2), along with TMEM43, showed SMVTs with left bundle branch block morphology and predominantly right ventricular substrate. In contrast, LMNA substrate was mainly observed in the interventricular septum. During a median of 26 Q1-Q3 (10.6-65) months, 27% of patients experienced recurrences of clinical SMVT with differences between genotypes (log-rank 0.016). Nuclear membrane genes demonstrated the highest recurrence rate compared with desmosomal genes (hazard ratio, 4.56 [95% CI, 1.5-13.8]). CONCLUSIONS: The anatomic substrate of SMVTs shows a strong correlation with the underlying genotype, electrocardiographic morphology, and recurrence rate. Particularly, patients with nuclear membrane gene variants have a significantly higher recurrence rate compared with those with desmosomal gene variants.

• MeSH
• Action Potentials MeSH
• Adult MeSH
• Electrophysiologic Techniques, Cardiac MeSH
• Phenotype * MeSH
• Genetic Predisposition to Disease * MeSH
• Genetic Association Studies MeSH
• Genotype MeSH
• Risk Assessment MeSH
• Cardiomyopathies genetics   physiopathology   diagnosis   MeSH
• Catheter Ablation MeSH
• Tachycardia, Ventricular * genetics   physiopathology   diagnosis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Risk Factors MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Geographicals
• Europe MeSH

Incidentální cystické léze pankreatu jsou diagnostikovány se zvýšenou frekvencí v důsledku častějšího používání zobrazovacích vyšetření pomocí počítačové tomografie nebo magnetické rezonance u asymptomatických pacientů, kteří podstupují vyšetření z jiných důvodů. U určitých lézí, jako jsou neuroendokrinní tumory, mucinózní cystadenomy a intraduktální papilární mucinózní neoplazie, existuje významné riziko přítomnosti či vzniku malignity. Endosonograficky navigovaná radiofrekvenční ablace (EUS-RFA) umožňuje selektivní ablaci ložiska pankreatu s minimálním poškozením okolní tkáně a mohla by být alternativní metodou léčby pro pacienty, kteří operaci nechtějí, nebo ji nemohou absolvovat, nebo si nepřejí dlouhodobé sledování. Na základě dostupných pilotních studií se EUS-RFA jeví jako slibná, technicky proveditelná metoda léčby neoplazií pankreatu, která dle dostupných studií prokázala vysokou technickou a přijatelnou klinickou úspěšnost při nízké morbiditě. Sdělení nabízí přehledný souhrn užití EUS-RFA u solidních a cystických neoplazií pankreatu a v závěru popisuje dvě vlastní kazuistiky. V obou případech byla endoskopická léčba technicky proveditelná a nevyskytly se žádné periprocedurální ani postprocedurální komplikace.

Incident cystic lesions of the pancreas are diagnosed with increased frequency due to increased use of CT or MR imaging in asymptomatic patients who undergo imaging for other reasons. Certain lesions such as neuroendocrine tumors, mucinous cystadenomas, and intraductal papillary mucinous neoplasia are at significant risk of the presence or development of malignancy. Endosonographically guided radiofrequency ablation allows selective ablation of the pancreatic lesion with minimal damage to surrounding tissue and could be an alternative treatment modality for patients who do not want or cannot undergo surgery or do not wish to have a long-term follow-up. Based on the available pilot studies, EUS-RFA appears to be a promising technically feasible method for the treatment of pancreatic neoplasia, which has demonstrated high technical and acceptable clinical success rates with low morbidity. This communication offers a clear summary of the use of EUS-RFA in solid and cystic pancreatic neoplasia concluding with two case reports of patients. In both cases, endoscopic treatment was technically feasible and no periprocedural or postprocedural complications occurred.

• MeSH
• Ultrasonography, Interventional methods   MeSH
• Humans MeSH
• Pancreatic Neoplasms * surgery   diagnostic imaging   MeSH
• Neuroendocrine Tumors surgery   diagnostic imaging   MeSH
• Radiofrequency Ablation * instrumentation   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Review MeSH