Search Results (75)

Background/Objectives: Electrographic flow (EGF) mapping allows for the visualization and quantification of atrial fibrillation (AF) wavefront propagation patterns. EGF-identified sources were shown in the randomized controlled FLOW-AF trial to significantly increase the likelihood of AF recurrence within 1 year if left unablated. Electrographic flow consistency (EGFC) additionally measures the stability of observed wavefront patterns, such that patients with more organization have a healthier substrate and lower recurrence. Source presence and EGFC can be used collectively to assign mechanistic phenotypes to AF patients. Methods: The patient phenotypes, treatment modalities, and outcomes in FLOW-AF were compared with those of patients in the ensuing AF-FLOW Global Registry, which was conducted by separate physicians at discrete clinical centers. Results: Patients with low EGFC (≤0.62) had a 12-month freedom from AF (FFAF) of 46%, while those with a high mean EGFC (>0.62) had a FFAF of 81%. Right atrial EGFC was correlated with left atrial EGFC, and the highest recurrence occurred in those with biatrial low EGFC. Source presence also affected the recurrence rates in both trials, such that the presence of EGF-identified sources in PVI-only patients lowered the FFAF from 65% to 36%, but the elimination of sources produced a 30% absolute increase in FFAF from 36% to 66%. Conclusions: Patient outcomes by EGF-based AF phenotype were consistent across two cohorts of patients from separate clinical trials at distinct centers. Patients with a high EGFC and no sources post-procedure had the best outcomes. EGF mapping provides insights into underlying disease pathophysiology and may be employed prospectively to predict recurrence. Full article

This paper presents an approach for event recognition in sequential images using human body part features and their surrounding context. Key body points were approximated to track and monitor their presence in complex scenarios. Various feature descriptors, including MSER (Maximally Stable Extremal Regions), SURF (Speeded-Up Robust Features), distance transform, and DOF (Degrees of Freedom), were applied to skeleton points, while BRIEF (Binary Robust Independent Elementary Features), HOG (Histogram of Oriented Gradients), FAST (Features from Accelerated Segment Test), and Optical Flow were used on silhouettes or full-body points to capture both geometric and motion-based features. Feature fusion was employed to enhance the discriminative power of the extracted data and the physical parameters calculated by different feature extraction techniques. The system utilized a hybrid CNN (Convolutional Neural Network) + RNN (Recurrent Neural Network) classifier for event recognition, with Grey Wolf Optimization (GWO) for feature selection. Experimental results showed significant accuracy, achieving 98.5% on the UCF-101 dataset and 99.2% on the YouTube dataset. Compared to state-of-the-art methods, our approach achieved better performance in event recognition. Full article

Background/Objectives: Catheter ablation for atrial fibrillation (AF) is a well-established therapeutic approach for maintaining sinus rhythm, though its efficacy remains suboptimal in certain patients. The left atrium (LA) volume, commonly assessed through transthoracic echocardiography (TTE), is a recognized predictor of AF recurrence after pulmonary vein isolation (PVI). However, the complex three-dimensional structure of the LA makes precise measurement challenging with traditional TTE techniques. Electroanatomic mapping (EAM) offers a more accurate evaluation of LA geometry and volume, which may enhance the prediction of ablation outcomes. Methods: This prospective study included 197 patients with AF who were referred for PVI to our center (Hospital Universitario Central de Asturias, Spain) between 2016 and 2020. All participants underwent pre-ablation TTE and EAM to assess the electric active volume (EAV) of the LA. Clinical follow-up included regular Holter monitoring and electrocardiograms to detect AF recurrences. Results: The mean age was 56.3 ± 9.67 years, and 34% had persistent AF. The mean LA volumes measured by TTE and the EAV by EAM were 62.86 ± 15.58 mL and 126.75 ± 43.35 mL, respectively, with a moderate positive correlation (r = 0.49, p < 0.001). AF recurrences were observed in 51.27% of patients over a 36 ± 15-month follow-up period. Cox regression analyses (univariate and multivariate), Kaplan–Meier curves and log-rank tests were used to illustrate freedom from atrial arrhythmia during follow-up. Both EAV by EAM and TTE volumes were significant predictors of AF recurrence in the univariate analysis (HR 1.002 [1.001–1.003], p = 0.033 and HR 1.001 [1.006–1.012], p < 0.01, respectively). Among clinical variables, persistent AF was significantly associated with a higher risk of recurrence (HR 1.17 [1.096–1.268], p = 0.02). Conclusions: EAV of the LA assessment by EAM demonstrates a significant correlation with TTE measurements and is a predictor of AF post-ablation recurrence. In patients selected for catheter ablation, EAV by EAM provides additional insights that could contribute to therapeutic decision-making and risk stratification of AF recurrences. Full article

Background: Non-melanoma skin cancers (NMSCs) are the most common cancers in the United States. Image-guided superficial radiation therapy (IGSRT) is an effective treatment for NMSCs. Patient comorbidities and socioeconomic status (SES) are known contributors to health disparities. However, the impact of comorbidities or SES on the outcomes of IGSRT-treated NMSCs has not yet been studied. This study evaluated freedom from recurrence in IGSRT-treated NMSCs stratified by SES and the number of comorbidities. Methods: This large retrospective cohort study evaluated associations between SES (via Area Deprivation Index (ADI)) or comorbidity (via Charlson Comorbidity Index (CCI)) and 2-, 4-, and 6-year year freedom from recurrence in patients with IGSRT-treated NMSC (n = 19,988 lesions). Results: Freedom from recurrence in less (ADI ≤ 50) vs. more (ADI > 50) deprived neighborhoods was 99.47% vs. 99.61% at 6 years, respectively (p = 0.2). Freedom from recurrence in patients with a CCI of 0 (low comorbidity burden) vs. a CCI of ≥7 (high comorbidity burden) was 99.67% vs. 99.27% at 6 years, respectively (p = 0.9). Conclusions: This study demonstrates that there are no significant effects of SES or comorbidity burden on freedom from recurrence in patients with IGSRT-treated NMSC. This supports the expansion of IGSRT in deprived neighborhoods to increase access to care, and IGSRT should be a consideration even in patients with a complex comorbidity status. Full article

Background: Peripheral arterial disease (PAD) is becoming an increasingly prevalent clinical issue, leading to a growing number of patients requiring surgical interventions. Consequently, there is an increasing occurrence of para-anastomotic aneurysms as late complications following primary treatment for PAD. These aneurysms typically arise at the sites of graft implantation and necessitate individualized management strategies based on factors such as location, size, and the patient’s overall condition. Materials and Methods: This five-year retrospective study, conducted at a single center, aimed to evaluate the anatomical location, clinical presentation, diagnostic methods, and management strategies for 55 patients treated for femoral and popliteal artery para-anastomotic pseudoaneurysms of the lower limb between January 2018 and June 2024. Treatment approaches were determined based on aneurysm size, the extent of atherosclerosis, and the patient’s surgical risk. This study analyzed patient demographics, surgical techniques, postoperative complications, and aneurysm characteristics. Results: Most pseudoaneurysms occurred between 6 and 10 years after the primary procedure. The most common surgical intervention was aneurysmectomy with graft interposition, performed in 46 patients (83.64%), followed by aneurysmectomy with extra-anatomical bypass in 6 patients (10.91%), and endovascular repair (EVAR) in 3 patients (5.45%). Early postoperative complications occurred in 16.36% of patients. The 12-month freedom from graft stenosis was 87.23%, and freedom from anastomotic aneurysm recurrence at 12 months was 100%. Conclusions: This study highlights the critical need for individualized treatment strategies and ongoing surveillance in managing lower-limb para-anastomotic pseudoaneurysms, particularly given the prevalence of lower-limb pain and the high occurrence of such in the common femoral artery. The favorable long-term graft patency rates observed suggest that aneurysmectomy with graft interposition is an effective intervention, reinforcing its role as the primary approach within this patient population. Full article

Non-melanoma skin cancers (NMSCs), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are highly prevalent and a significant cause of morbidity. Image-guided superficial radiation therapy (IGSRT) uses integrated high-resolution dermal ultrasound to improve lesion visualization, but it is unknown whether efficacy varies by histology. This large retrospective cohort study was conducted to determine the effect of tumor histology on freedom from recurrence in 20,069 biopsy-proven NMSC lesions treated with IGSRT, including 9928 BCCs (49.5%), 5294 SCCs (26.4%), 4648 SCCIS cases (23.2%), and 199 lesions with ≥2 NMSCs (1.0%). Freedom from recurrence at 2, 4, and 6 years was 99.60%, 99.45%, and 99.45% in BCC; 99.58%, 99.49%, and 99.49% in SCC; and 99.96%, 99.80%, and 99.80% in SCCIS. Freedom from recurrence at 2, 4, and 6 years following IGSRT did not differ significantly comparing BCC vs. non-BCC or SCC vs. non-SCC but were slightly lower among SCCIS vs. non-SCCIS (p = 0.002). There were no significant differences in freedom from recurrence when stratifying lesions by histologic subtype. This study demonstrates that there is no significant effect of histology on freedom from recurrence in IGSRT-treated NMSC except in SCCIS. These findings support IGSRT as a first-line therapeutic option for NMSC regardless of histology. Full article

Background/Objectives: A comprehensive comparison of intraoperative, oncological, and functional outcomes of RARP performed with different robotic surgical platforms is critically needed. Our aim is to compare the oncological and functional outcomes of RARP performed using the novel Hugo™ RAS system with those from the daVinci system, the reference standard, at a high-volume robotic center, with an extended follow-up period (one year). Methods: We analyzed the data of 400 patients undergoing RARP ± pelvic lymph node dissection between 2021 and 2023, using propensity score (PS) matching to correct for treatment selection bias. All procedures were performed by three surgeons with HugoTM RAS or daVinci. This analysis extends the follow-up period to 1 year, focusing on specific functional and oncological outcomes, building on our previous 3-month evaluation of perioperative outcomes. The primary outcome was the trifecta rate, defined as freedom from biochemical recurrence, continence, and erectile function recovery. Secondary outcomes included detailed assessments of oncological outcomes (PSA levels) and functional outcomes (continence and erectile function). Results: The propensity score-matched cohort included 99 matched pairs (198 patients), balanced for all covariates. No significant differences were found in trifecta rates between the two platforms at 1-year follow-up (Hugo: 25.25%, daVinci: 27.27%, p = 0.743). Both groups showed improved trifecta rates when considering only nerve-sparing procedures (Hugo: 36.84%, daVinci: 35.59%, p = 0.889). Continence rates were similar (Hugo: 87.9%, daVinci: 89.9%, p = 0.327), as were the undetectable PSA rates (Hugo: 92.9%, daVinci: 88.8%, p = 0.158). Also, the erectile function recovery rate did not differ significantly between the groups. Conclusions: This is the first study comparing 1-year functional and oncological outcomes of RARP performed with Hugo™ RAS and daVinci surgical robotic systems using PS matching. Functional and oncological outcomes of RARP were comparable between the two robotic platforms. These findings confirm that the transition to the Hugo™ platform does not compromise surgical proficiency or patient outcomes, even if further long-term studies are necessary to confirm these results. Full article

Regional differences in pulsed field ablation (PFA) adoption for pulmonary vein isolation (PVI) with additional posterior wall ablation (PWA) in Asia remains unknown. We hereby report our experience on the safety and efficacy of PFA in AF ablation. Consecutive AF patients who underwent PFA from September 2022 to January 2024 were included. The primary efficacy endpoint was freedom from atrial arrhythmia recurrence after a 90-day blanking period at 12 months. Safety endpoints included 30 days of all-cause death, cardiac tamponade, stroke, myocardial infarction, and heart failure hospitalization. One hundred and one (72.3% males, 79.2% pAF) patients underwent PFA for AF. Thirty-one (30.7%) had structural heart disease with mean LVEF of 57.4 ± 8.1% and CHA2DS2-VASc score of 1.4 ± 1.3. Twenty-nine (28.7%) underwent additional PWA (PVI + PWA) using PFA. PWA was acutely successful in all patients. Patients who underwent PWA were more likely to have persistent AF and require general anesthesia and electroanatomic mapping (all p < 0.05). Total PFA applications for PVI, LA dwell time, procedural time, and fluoroscopy time were similar between the PVI-only and PVI + PWA groups (all p > 0.05). The 1-year atrial arrhythmia recurrence rates were 10% for pAF and 21% for the persistent AF group. The primary efficacy endpoint was not significantly different between the PVI-only and PVI+PWA groups (12-month KM estimates 90.3% [95% CI, 83.3–97.3] and 82.8% [95% CI, 68.1–97.4], respectively). There were no complications related to PFA use. PFA can be safely, effectively, and efficiently adopted for AF ablation. Additional PWA, if pursued, had similar procedural metrics to the PVI-only strategy without increased complications. Full article

Background: Cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is the most common atrial macro-reentrant tachycardia, characterized by a typical ECG pattern (type I ECG). Often, tachycardia terminates before it can be confirmed by an electrophysiological study (EPS), necessitating CTI ablation in sinus rhythm (SR). This study aims to compare the success rate of CTI ablation in patients with type I ECG during SR versus ongoing CTI-dependent AFL, focusing on arrhythmia recurrence. Methods: We screened patients at Ulm University Heart Center from January 2010 to November 2020 with type I ECG who underwent CTI ablation. Patients were divided into two groups: those whose tachycardia terminated before EPS and underwent ablation in SR, and those with ongoing CTI-dependent AFL during EPS. CTI ablation was deemed complete when a bidirectional conductance block was achieved, confirmed after 30 min. Results: A total of 230 patients were included, all showing typical AFL in ECG recordings. Of these, 67 patients underwent ablation in SR, while 163 were ablated during ongoing AFL. The median follow-up time was 2.7 years. Recurrence of CTI-dependent AFL occurred in 8.3% of patients: 4.5% in the SR ablation group and 9.8% in the ongoing AFL group. Kaplan–Meier estimation showed similar efficacy for both methods regarding arrhythmia recurrence (log-rank p = 0.07). Conclusions: Our decade-long study indicates that CTI ablation during SR is as effective as ablation during ongoing CTI-dependent AFL in achieving long-term freedom from arrhythmia. This research supports the efficacy of both techniques in clinical settings, validating a widely practiced approach. Full article

Background/Objectives: Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are non-melanoma skin cancers (NMSCs) and the most prevalent cancers in the United States. Image-guided superficial radiotherapy (IGSRT) is a relatively new treatment option that uses high-resolution dermal ultrasound integrated with superficial radiotherapy to improve tumor visualization. IGSRT is a clinically equivalent non-surgical alternative to Mohs micrographic surgery at 2 years of follow-up in early-stage NMSC, but larger cohort studies with longer follow-up periods that allow for analysis of patient outcomes by demographic and disease characteristics are needed. Methods: This large, retrospective cohort study was conducted to determine the effect of risk factors (tumor location, tumor stage, and sex) on 2-, 4-, and 6-year freedom from recurrence rates in 19,988 NMSC lesions treated with IGSRT, including lesions with complete treatment courses. Results: Overall freedom from recurrence rates were 99.68% at 2 years, 99.54% at 4 years, and 99.54% at 6 years; rates did not differ significantly by tumor location (head/neck versus other locations, p = 0.9) or sex (male versus female, p = 0.4). In contrast, there was a significant difference in freedom from recurrence rates when analyzed by tumor stage (p = 0.004). Conclusions: There was no significant effect of tumor location or sex on freedom from recurrence in IGSRT-treated NMSC. Although there was a significant difference according to tumor stage, freedom from recurrence rates exceeded 99% at all stages. Full article

Background/Objectives: Brain metastases (BrMs) are a common complication of non-small cell lung cancer (NSCLC), present in up to 50% of patients. While the treatment of BrMs requires a multidisciplinary approach with surgery, radiotherapy (RT), and systemic therapy, the advances in molecular sequencing have improved outcomes in patients with targetable mutations. With a push towards the molecular characterization of cancers, we evaluated the outcomes by treatment modality at our institution with respect to prioritizing RT and targeted therapies. Methods: We identified the patients with NSCLC BrMs treated with surgical resection. The primary endpoints were in-brain freedom from progression (FFP) and overall survival (OS). The secondary endpoint included index lesion recurrence. The tumor molecular profiles were reviewed. The outcomes were evaluated by treatment modality: surgery followed by adjuvant RT and/or adjuvant systemic therapy. Results: In total, 155/272 (57%) patients who received adjuvant therapy with adequate follow-up were included in this analysis. The patients treated with combination therapy vs. monotherapy had a median FFP time of 10.72 months vs. 5.38 months, respectively (p = 0.072). The patients of Hispanic/Latino vs. non-Hispanic/Latino descent had a statistically significant worse OS of 12.75 months vs. 53.15 months, respectively (p = 0.015). The patients who received multimodality therapy had a trend towards a reduction in index lesion recurrences (χ² test, p = 0.063) with a statistically significant improvement in the patients receiving immunotherapy (χ² test, p = 0.0018). Conclusions: We found that systemic therapy combined with RT may have an increasing role in delaying the time to progression; however, there was no statistically significant relationship between OS and treatment modality. Full article

Background: Lymphadenectomy plays a crucial role in the surgical management of early- stage esophageal cancer. However, few studies have examined lymphadenectomy outcomes in advanced stages, particularly in patients who initially underwent concurrent chemoradiation therapy. This retrospective study investigates the effect of lymphadenectomy in patients diagnosed with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma who received concurrent preoperative chemoradiation. Methods: Data from 1994 to 2023 were retrieved from our retrospective database. All patients underwent a uniform evaluation and treatment protocol, including preoperative concurrent chemoradiation therapy comprising cisplatin and 5-fluorouracil, followed by esophagectomy. The analysis encompassed clinical T and N stages, tumor location, tumor grade, pathological T and N stages, pathological stage, and the extent of lymph node dissection. Overall survival, “Free-To-Recurrence”, and disease-free survival were assessed via Kaplan–Meier survival curves and the Cox regression model for multivariate analysis. Results: The dataset was stratified into two groups according to extent of lymph node dissection, with one group having <15 dissected nodes and the other having ≥15 dissected nodes. The group with <15 nodes exhibited a shorter “Free-To-Recurrence”, worse disease-free survival, and lower overall survival. In multiple-variate analysis (Cox regression model), the number of dissected lymph nodes emerged as a significant factor influencing overall survival and freedom from recurrence. Conclusions: The quantity of lymphadenectomy is a crucial determinant for patients with AJCC 8th-edition clinical stage III esophageal squamous cell carcinoma receiving preoperative concurrent chemoradiation. Full article

Background: The aim of this single-center retrospective study was to evaluate the long-term outcomes after the convergent procedure (CP) for treatment of AF. Methods: We analyzed the outcomes of patients that underwent CP from January 2009 until July 2020. A total of 119 patients with paroxysmal AF (23.5%), persistent AF (5.9%), or long-standing persistent AF (70.6%) that attended long-term follow-up were included. The outcomes were assessed 1 year after the CP and at long-term follow-up. At the 1-year follow-up, rhythm and AF burden were assessed for patients with an implantable loop recorder (61.2%). For others, rhythm was assessed by clinical presentation and 12-lead ECG. At long-term follow-up, patients with sinus rhythm (SR) or an unclear history were assessed with a 7-day Holter ECG monitor, and AF burden was determined. Long-term success was defined as freedom from AF/atrial flutter (AFL) with SR on a 12-lead ECG and AF/AFL burden < 1% on the 7-day Holter ECG. Results: At 1-year follow-up, 91.4% of patients had SR and 76.1% of patients had AF/AFL burden < 1%. At long-term follow-up (8.3 ± 2.8 years), 65.5% of patients had SR and 53.8% of patients had AF/AFL burden < 1% on the 7-day Holter ECG. Additional RFAs were performed in 32.8% of patients who had AF or AFL burden < 1%. At long-term follow-up, age, body mass index, and left atrial volume index were associated with an increased risk of AF recurrence. Conclusions: CP resulted in high long-term probability of SR maintenance. During long-term follow-up, additional RFAs were required to maintain SR in a substantial number of patients. Full article

Non-melanoma skin cancers (NMSCs) are a significant cause of morbidity and mortality; their incidence is increasing most in older patients. NMSCs have traditionally been treated with surgical excision, curettage, Mohs micrographic surgery (MMS), and superficial radiotherapy (SRT). Image-guided SRT (IGSRT) is a treatment option for poor surgical candidates or patients with low- or high-risk, early-stage NMSC who prefer to avoid surgery. This large retrospective cohort study compared 2-, 4-, and 6-year freedom from recurrence in biopsy-proven NMSC lesions treated with IGSRT (n = 20,069 lesions) between patients aged < 65 years (n = 3158 lesions) and ≥65 years (n = 16,911 lesions). Overall freedom from recurrence rates were 99.68% at 2 years, 99.57% at 4 years, and 99.57% at 6 years. Rates did not differ significantly by age (p = 0.8) nor by sex among the two age groups (p > 0.9). There was a significant difference in recurrence among older patients when analyzed by stage (p = 0.032), but no difference by stage in younger patients (p = 0.7). For early-stage NMSCs, IGSRT is a clinically equivalent alternative to MMS and statistically significant in superiority to non-image-guided SRT. This study demonstrates that there is no significant effect of age on 2-, 4-, or 6-year freedom from recurrence in patients with IGSRT-treated NMSC. Full article

This study evaluates the long-term outcomes of minimally invasive mitral valve repair (MIMVR) in patients with degenerative mitral regurgitation, focusing on survival, mitral valve repair failure, and re-operation rates. A cohort of patients undergoing three primary repair techniques—quadrangular resection, edge-to-edge repair, and artificial chordae implantation—was analyzed using time-to-event methods. The overall survival rates at 1, 10, and 20 years were high and comparable among the techniques, indicating effective long-term benefits of MIMVR. However, freedom from recurrence of moderate mitral regurgitation (MR) ≥ 2 was significantly higher in the quadrangular resection and edge-to-edge groups compared to the artificial chordae group. No significant differences were observed for recurrent MR ≥ 3. Re-operation rates were low and similar across all techniques, underscoring the durability of MIMVR. Pre-discharge residual MR ≥ 2 was identified as a strong predictor of long-term repair failure. These findings confirm the effectiveness of MIMVR, with all techniques demonstrating excellent long-term survival and durability. Full article