Search Results (111)

This technical report presents a compelling case for the use of very-high-power, very-short-duration (VHPSD) radiofrequency ablation as a promising and efficient strategy for treating symptomatic premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT). The patient with frequent, symptomatic PVCs and a 24% burden underwent successful ablation using a 90 W/4 s recipe via the QDOT MICRO™ catheter. The procedure resulted in immediate and sustained elimination of PVCs, with only 4 s of ablation time, near-zero fluoroscopy, no complications, and no PVC recurrence at 6 months. VHPSD ablation, though originally developed for atrial fibrillation, demonstrated remarkable procedural efficiency, precision, and lesion efficacy in this case. Compared to standard power, long-duration (SPLD) ablation, VHPSD offers the potential to significantly reduce procedural time, minimize tissue edema, and lower complication risk, particularly advantageous in anatomically challenging areas or in situations where maintaining stable catheter contact for extended periods is difficult or unfeasible. This technical report suggests the transformative potential of VHPSD as a first-line ablation strategy for RVOT-PVCs, provided careful mapping and appropriate technique are used. It underscores the need for further prospective studies to validate its broader safety, efficacy, and role in PVC management, particularly in cases involving intramural origins. Full article

In this study, we provide a comparison of radiofrequency electromagnetic field exposure level maps as determined using two approaches: a broadband meter (NARDA EMR-300) equipped with an isotropic probe in the range of 100 kHz to 3 GHz, and a Personal Exposimeter (Satimo EME Spy 140) in the range of 88 MHz to 5.8 GHz. The aim of this research was to determine the necessary adjustments to the measurements made with personal exposimeters to obtain RF-EMF exposure maps equivalent to those made with broadband meters. We evaluated different possibilities to obtain the best equivalence of measurements between both devices. For this purpose, the datasets obtained in both cases were analyzed, as well as the possible correction factors. First, the possibility of establishing a single or double correction factor depending on the existence (or lack thereof) of a line of sight with respect to the base stations was analyzed by minimizing the average value of the error between the values of the broadband meter and the corrected values of the personal exposure meter. Due to the differences observed in the exposure maps, a second procedure was carried out, in which a genetic algorithm was used to determine the ratio between the measurements from both methods (the broadband meter and personal exposure meter), depending on the existence (or lack thereof) of a line of sight, and we compared the exposure maps generated using kriging interpolation. Full article

Electromagnetic hyper-sensitivity (EHS) and its causal link with radio-frequencies raise a major question of public health. In the frame of the clinical study DEMETER, 26 adult volunteers self-diagnosed as EHS-positive agreed to reply to a self-assessment questionnaire and to provide a skin biopsy sampling to establish a primary fibroblast cell line. The questionnaire and the biological data revealed, independently, 2 subsets of donors associated each with a low background, highly responsive (LBHR) and a high background, lowly responsive (HBLR) phenotype. A couple of subsets based on questionnaire data and based on the yield of spontaneous DNA double-strand breaks were found to be composed of the same donors at 64% identity. After exposure to X-rays, and application of anti-γH2AX, pATM, and MRE11 immunofluorescence, all the DEMETER fibroblasts (26/26) elicited a delayed radiation-induced ATM nucleoshuttling (RIANS). The use of RIANS biomarkers showed that the 2 phenotypes described above corresponded to DEMETER donors with a high risk of cancer (LBHR) or high risk of accelerated aging (HBLR). By exposing DEMETER cells to H₂O₂ followed by an antioxidative agent, we confirmed that EHS may be related to the management of DNA strand breaks. A preliminary molecular model of EHS inspired by the RIANS model was proposed. Full article

Background: Catheter ablation is a first-line treatment for rhythm control strategies in patients with atrial fibrillation (AF), with different energy sources available, including pulsed-field ablation (PFA), high-power short-duration radiofrequency (HPSD RF), conventional radiofrequency (RF), and cryoballoon ablation. Limited evidence exists on how different ablation techniques affect patient-reported outcomes, such as patients’ quality of life (QoL) and perceived symptoms. This study aims to assess the impact of ablation energy sources on reported QoL and symptom perception after AF ablation. Methods: The study included 148 patients who underwent catheter ablation in different centers. Patients were divided into four groups according to the energy source used. Follow-up was conducted during the 6 months post-procedure. Patients were asked to complete a 20-item questionnaire evaluating quality of life, activity resumption, recovery process, perceived symptoms, and satisfaction. Comparative analyses were performed across energy groups, anesthesia types, and anesthetic drugs. Results: PFA patients reported the highest improvement in QoL scores compared to RF, HPSD RF, and cryoablation (p < 0.001). Activity resumption and symptom relief were significantly better in the PFA group compared to others (p < 0.001). Anesthesia type and anesthetic drug influenced QoL outcomes, with patients under general anesthesia showing higher QoL scores compared to deep sedation (p < 0.001). The energy source and anesthetic drug resulted in independent predictors of QoL improvement. Conclusions: Ablation energy source could impact patients’ perceived QoL and symptom relief after AF ablation. PFA demonstrated superior performance scores in QoL and symptom perception compared to other techniques. Anesthetic drugs also play a role in patient-reported outcomes and activity resumption. Full article

The cornerstone of ablative therapy for atrial fibrillation (AF) is pulmonary vein isolation (PVI). Whether PVI should be added with additional lesions in persistent atrial fibrillation (PerAF) or for any post-ablative recurrent AF is a matter of debate. Whatever the ablative strategy, it must determine the choice of energy source to achieve the most durable lesion sets with the least likelihood of complications. Radiofrequency (RF) is the most studied thermal ablation technique. It can be combined with high-density electroanatomic mapping and can be used for both pulmonary and extrapulmonary atrial ablation. Cryoenergy is at least as effective as radiofrequency for PVI; it is rapid, relatively safe, and has a steep learning curve. Therefore, it has been proposed as a first-line approach for PVI-only procedures. More recently, a non-thermal technique based on the application of pulsed direct current (Pulsed Field Ablation—PFA) has been introduced. PFA causes cell death by opening cell membrane pores (electroporation) without a significant increase in tissue temperature. It is fast and does not alter the extracellular matrix as thermal techniques do, although it ends up causing long-lasting, transmural lesions. Most importantly, it is relatively selective on cardiac myocytes and therefore potentially safer than thermal techniques. Some PFA systems can be combined with electroanatomic mapping systems. However, as of now, it appears that these ablation technologies should be considered complementary rather than alternative for a number of practical and theoretical reasons. Full article

Background/Objectives: Approximately 30% of women experience pelvic pain one year after vaginal delivery, and this increases to 50% during vaginal intercourse. Multimodal physiotherapy is the first-line treatment for myofascial pain of the pelvic floor muscles (PFM), often incorporating emerging technologies like radiofrequency, despite limited evidence supporting its use. The RASDOP study aims to (i) evaluate the effectiveness of multimodal physiotherapy combining therapeutic education, PFM training, and myofascial pain syndrome (MPS) management with or without radiofrequency, in reducing pain and improving sexual function postpartum; and (ii) explore the barriers and facilitators influencing adherence and perceived self-efficacy towards physiotherapy treatment in women with postpartum pelvic pain. Methods: This study employs a randomized clinical trial with a blinded examiner and two parallel groups, followed by a qualitative phenomenological study. A total of 124 postpartum women with pelvic pain (≥4 cm on the visual analogue scale) will be randomized into two groups: a multimodal physiotherapy group (therapeutic education, MPS treatment, and PFM training) and a radiofrequency + multimodal physiotherapy group (same treatment with additional non-ablative radiofrequency). Both groups will receive 12 supervised individual sessions. Assessments will be conducted pre- and post-intervention, and at 3-, 6-, and 12-month stages post-treatment. Primary outcomes include pain intensity and sexual function, while secondary outcomes involve PFM tone, strength, MPS presence, levator ani length, and distress caused by pelvic floor dysfunction. The qualitative study will utilize semi-structured interviews and focus groups analyzed thematically. Results: Radiofrequency is expected to enhance pain relief, sexual function, and PFM relaxation. Insights into adherence and barriers will aid in personalizing physiotherapy interventions. Conclusions: The RASDOP study will provide evidence on the safety and efficacy of radiofrequency in postpartum pelvic pain treatment and shed light on women’s experiences to improve therapeutic outcomes. Full article

Magnesium-doped hydroxyapatite/chitosan composite coatings produced by the radio-frequency magnetron sputtering technique were exposed to 5 MeV electron beams of 8 and 30 Gy radiation doses in a linear electron accelerator. The surfaces of unirradiated layers are smooth, while the irradiated ones exhibit nano-structures with sizes that increase from 60 nm at a 8 Gy dose to 200 nm at a 30 Gy dose. Young’s modulus and the stiffness of the layers decrease from 58.9 GPa and 10 µN/nm to 5 GPa and 2.2 µN/nm, respectively, when the radiation doses are increased from 0 to 30 Gy. These data suggest the diminishing of the contribution of the chitosan to the elasticity of the magnesium-doped hydroxyapatite/chitosan composite layers after electron beam irradiation. The biological capabilities of the coatings were assessed before and after their immersion in RPMI-1640 cell culture medium for 7 and 14 days, respectively, and further cultured with a MG63 cell line (ATCC CRL1427) in Dulbecco’s Modified Eagle Medium supplemented with fetal bovine serum, penicillin–streptomycin, and L-glutamine. Thus, 1 µm spherical structures were developed on the surfaces of the layers exposed to a 30 Gy radiation dose and immersed for 14 days in the RPMI-1640 biological medium. The molecular structures of all the RPMI-1640 immersed samples were modified by the growth of a carbonated hydroxyapatite layer characterized by a B-type substitution, as Fourier Transform Infrared Spectroscopy revealed. The biological assay proved the increased biocompatibility of the layers kept in RPMI-1640 medium and enhanced MG63 cell attachment and proliferation. Atomic force microscopy analysis indicated the elongated fibroblastic cell morphology of MG63 cells with minor alteration at 30 Gy irradiation doses as a result of layer biocompatibility modifications. Full article

This paper presents the concept of a radiofrequency (RF) sensor designed to estimate the mass of the regolith acquired by a sampling device or excavator in planetary environments. The sensor utilizes a microstrip line with an open end as the sensing element, with the mass estimation based on measurements of the phase of the reflection coefficient (S11 of the scattering matrix) for the line immersed in the regolith. The Rotary Clamshell Excavator (RCE) was employed for the experimental evaluation of the sensor’s performance. The RCE successfully passed an environmental test campaign, demonstrating its suitability for future lunar missions. The test results indicate that the RF sensor can estimate the mass of the acquired regolith with reasonable accuracy, approximately 15%, making it a viable solution for rough mass estimation in sampling devices and excavators. Full article

Background/Objectives: Combination therapy with atezolizumab and bevacizumab (ATZ/BEV) is extremely effective and yields a high response rate in patients with hepatocellular carcinoma (HCC). In this study, the efficacy of adding locoregional therapy to ATZ/BEV in patients with stable disease (SD) HCC was investigated. Methods: One hundred five HCC patients who were treated with ATZ/BEV or lenvatinib (LEN) as first-line chemotherapy for unresectable HCC were evaluated on the basis of the modified RECIST criteria. SD patients whose initial antitumor effect was achieved received locoregional therapy, and the overall survival (OS) rate was assessed. Results: This study included 58 ATZ/BEV-treated participants and 47 LEN-treated participants. Twenty-eight SD patients (ATZ/BEV) and 20 SD patients (LEN) were identified. OS was significantly greater in ATZ/BEV-treated patients who also received locoregional therapy than in those who did not receive this additional therapy (p = 0.0343), whereas there was no difference between LEN-treated patients who also received locoregional therapy and those who did not. The locoregional therapy consisted of transcatheter arterial chemoembolization (TACE) and/or radiofrequency ablation (RFA). When assessing the add-on effect of TACE and/or RFA in the SD patients treated with ATZ/BEV, five patients were found to achieve CR. Conclusions: The addition of locoregional therapy, such as TACE/RFA, was found to affect SD patients. When a response is limited during ATZ/BEV therapy, it is important to consider the therapeutic option of adding locoregional therapy, as this additional treatment may contribute to improved prognosis via immune modulation. Full article

Background/Objectives: Pulmonary vein isolation (PVI) using radiofrequency catheter ablation with contact force (CF)-sensing technology has improved long-term outcomes in patients with atrial fibrillation. This prospective randomized study aimed to assess the efficacy and safety of CF-sensing technology for additional left atrial (LA) linear ablation of persistent AF (PerAF). Methods: After PVI, anteromitral (AM) line and roof line ablation were performed using a CF-sensing catheter. Patients were randomly assigned to either the CF-sensing (CFS) group or the CF-blind control (Blind) group. The primary endpoint was atrial arrhythmia recurrence. LA late gadolinium enhancement (LA-LGE) MRI was conducted at baseline and 1-year follow-up for long-term lesion evaluation. Results: A total of 62 patients with drug-refractory PerAF were enrolled (mean age: 58 ± 10 years; 77% male). The success rates of AM and roof line block were 97% and 100% in the CFS group (n = 33) and 93% and 90% in the Blind group (n = 29). The time to achieve block was reduced in the CFS group (AM: 36 ± 22 vs. 48 ± 28 min, p = 0.068; roof: 19 ± 14 vs. 27 ± 15 min, p = 0.031). The maximum CF for safety endpoints was significantly lower in the CFS group (AM: 42 vs. 69 g, p < 0.001; roof: 33 vs. 49 g, p = 0.003). Full linear LA-LGE formation on 1-year MRI did not differ significantly between the groups (AM: 17 vs. 36%; roof; 29 vs. 24%, both p = NS). Kaplan–Meier estimates of AF/AT-free survival after ablation procedures were 63.6% in the CFS group and 58.6% in the Blind group (log-rank p = 0.837). Conclusions: In patients with PerAF, additional LA linear ablation following PVI using CF-sensing technology improved procedural safety and reduced the time needed to achieve conduction block. However, it did not significantly influence clinical outcomes or the formation of permanent full linear lesions. Full article

Background: Recurrences due to discontinuity in ablation lines are substantial after pulmonary vein isolation (PVI) with radiofrequency ablation for atrial fibrillation. Data are scarce regarding the durability predictors for very high-power short-duration (vHPSD, 90 W/4 s) ablation. Methods: A total of 20 patients were enrolled, who underwent 90 W PVI and a mandatory remapping procedure at 3 months. First-pass isolation (FPI) gaps, and acute pulmonary vein reconnection (PVR) sites were identified at the index procedure; and chronic PVR sites were identified at the repeated procedure. We analyzed parameters of ablation points (n = 1357), and evaluated their roles in predicting a composite endpoint of FPI gaps, acute and chronic PVR. Results: In total, 45 initial ablation points corresponding to gaps in the ablation lines were analyzed. Parameters associated with gaps were interlesion distance (ILD), baseline generator impedance, mean current, total charge, and loss of catheter–tissue contact. The optimal ILD cut-off for predicting gaps was 3.5 mm anteriorly, and 4 mm posteriorly. Conclusions: Biophysical characteristics dependent on generator impedance could affect the efficacy of vHPSD PVI. The use of smaller ILDs is required for effective and durable PVI with vHPSD compared to the consensus targets with lower power ablation, and lower ILDs for anterior applications seem necessary compared to posterior points. Full article

In this work results are presented on the evaluation of HAp, HApSr, HAp_CS, and HApSr_CS layers deposited on Ti substrates regarding L929 cell viability and cytotoxicity as well as antimicrobial activity against Staphylococcus aureus, in connection with their physicochemical properties. The HAp and HApSr layers generated by radio-frequency magnetron sputtering technique were further covered with chitosan by a matrix-assisted pulsed laser evaporation technique. During the plasma depositions, the Ti substrates were heated externally by a home-made oven above 100 °C. The HApSr_CS layers generated on the unpolished Ti substrates at 100 °C and 400 °C showed the highest biocompatibility properties and antimicrobial activity against Staphylococcus aureus. The morphology of the layer surfaces, revealed by scanning electron microscopy, is dependent on substrate temperature and substrate surface roughness. The optically polished surfaces of Ti substrates revealed grain-like and microchannel structure morphologies of the layers deposited at 25 °C substrate temperature and 400 °C, respectively. Chitosan has no major influence on HAp and HApSr layer surface morphologies. X-ray photoelectron spectroscopy indicated the presence of Ca 2p_3/2 peak characteristic of the HAp structure even in the case of the HApSr_CS samples generated at a 400 °C substrate temperature. Fourier transform infrared spectroscopy investigations showed shifts in the wavenumber positions of the P-O absorption bands as a function of Sr or chitosan presence in the HAp layers generated at 25, 100, and 400 °C substrate temperatures. Full article

The purpose of this study is to evaluate the treatment safety of thermal ablation compared to surgical treatment of T1a tumors (small renal masses) at a high-volume center. We conducted an observational single-center study based on data collected form the National Swedish Kidney Cancer Register (NSKCR) between 2015 and 2021. In total, 444 treatments of T1a tumors were included. Patients underwent surgery (partial or total nephrectomy) or ablative treatment—radiofrequency ablation (RFA) or microwave ablation (MWA). Patient characteristics were retrieved from patient records, and tumor complexity was estimated from pre-interventional CT scans. The odds ratio (OR) of suffering from a severe surgical complication following ablative treatment was estimated using a logistic regression model adjusted for age, BMI, ASA physical status classification, smoking status and RENAL nephrometry score. The frequency of severe surgical complications was 6.3% (16/256 treatments) after surgical intervention and 2.1% (4/188 treatments) following ablative treatment. Our primary hypothesis that ablative treatment is associated with a lower risk of severe surgical complications is supported by the results (OR 0.39; 0.19–0.79; p = 0.013). When adjusting for age, smoking status, ASA score, BMI score and RENAL nephrometry score, we see an even greater difference between the two groups (OR 0.34; 0.17–0.68; p = 0.002). Our study was limited by the differences in patient and tumor characteristics between the two compared groups and the study design. If oncological outcomes are found to be comparable, ablative treatment should be considered as a first-line treatment for all small renal masses. Full article

Global Navigation Satellite System (GNSS) technology supports all phases of maritime navigation and serves as an integral component of the Automatic Identification System (AIS) and, by extension, Vessel Traffic Service (VTS) systems. However, the accuracy of standalone GNSS is often insufficient for specific operations. To address this limitation, various regional and local-area solutions have been developed, such as Differential GNSS (DGNSS), Satellite Based Augmentation Service (SBAS) and Real Time Kinematic (RTK) techniques. A notable development in this field is the recent introduction of the Galileo High-Accuracy Service (HAS), which saw its initial service declared operational by the European Commission (EC) on 24 January 2023. Galileo HAS provides high-accuracy Precise Point Positioning (PPP) corrections (orbits, clocks and signal biases) for Galileo and GPS, enhancing real-time positioning performance at no additional cost to users. This article presents the results of the first Galileo HAS testing campaign conducted at sea using a buoy-laying vessel temporarily equipped with a Galileo HAS User Terminal. The results presented in this Article include accuracy and position availability performance achieved using the Galileo HAS User Terminal. The article also highlights challenges posed by high-power radio-frequency interference, which likely originated from the Long-Range Identification and Tracking (LRIT) system antenna on board the vessel. Furthermore, the article provides additional assessments for different phases of navigation, demonstrating better performance in slow-motion scenarios, particularly relevant to mooring and pilotage applications. In these scenarios, values for horizontal accuracy reached 0.22 m 95% and 0.13 m 68% after removing interference periods. These results are in line with the expectations outlined in the Galileo HAS Service Definition Document (SDD). Full article

Catheter ablation to perform pulmonary vein isolation (PVI) is established as a mainstay in rhythm control of atrial fibrillation (AF). The aim of this review is to provide an overview of current practice and future perspectives in AF ablation. The main clinical benefit of AF ablation is the reduction of arrhythmia-related symptoms and improvement of quality of life. Catheter ablation of AF is recommended, in general, as a second-line therapy for patients with symptomatic paroxysmal or persistent AF, who have failed or are intolerant to pharmacological therapy. In selected patients with heart failure and reduced left-ventricular fraction, catheter ablation was proven to reduce all-cause mortality. Also, optimal management of comorbidities can reduce AF recurrence after AF ablation; therefore, multimodal risk assessment and therapy are mandatory. To date, the primary ablation tool in widespread use is still single-tip catheter radiofrequency (RF) based ablation. Additionally, balloon-based pulmonary vein isolation (PVI) has gained prominence, especially due to its user-friendly nature and established safety and efficacy profile. So far, the cryoballoon (CB) is the most studied single-shot device. CB-based PVI is characterized by high efficiency, convincing success rates, and a beneficial safety profile. Recently, CB-PVI as a first-line therapy for AF was shown to be superior to pharmacological treatment in terms of efficacy and was shown to reduce progression from paroxysmal to persistent AF. In this context, CB-based PVI gains more and more importance as a first-line treatment choice. Non-thermal energy sources, namely pulsed-field ablation (PFA), have garnered attention due to their cardioselectivity. Although initially applied via a basket-like ablation tool, recent developments allow for point-by-point ablation, particularly with the advent of a novel lattice tip catheter. Full article