Echocardiography-Guided Radiofrequency Ablation for Cardiac Tumors

Abstract

Background: Patients with cardiac tumors may present challenges for surgical resection due to poor clinical condition. Echocardiography-guided transapical radiofrequency ablation for cardiac tumors (TARFACT) potentially offers a less invasive palliative therapy option.

Objectives: This study aimed to evaluate the safety and efficacy of TARFACT.

Methods: Five patients with cardiac tumors (mucinous liposarcoma, myocardial hypertrophy with inflammatory cell infiltration mass, fibrous tissue tumor hyperplasia, myocardial clear cell sarcoma, and cardiac rhabdomyoma) were included. All patients underwent TARFACT and were assessed with electrocardiogram, echocardiographic imaging, biochemical analysis, and pathological confirmation.

Results: The median follow-up for all patients was 9 (range 4-12) months. Three surviving patients were alive at their last follow-up (9, 12, and 12 months, respectively), whereas 2 patients with late-stage tumors survived 6 months and 13 months after TARFACT, respectively. After TARFACT, all patients showed significant reductions in tumor size: the mean length decreased from 6.7 ± 2.0 cm to 4.7 ± 1.8 cm (P = 0.007); and the mean width decreased from 5.0 ± 2.1 cm to 2.5 ± 0.7 cm (P = 0.041). NYHA functional class also improved: median (IQR) decreased from 3.0 (1.5) to 2.0 (1.0) (P = 0.038), Peak E-wave on echocardiography showed a mean increase from 64.4 ± 15.7 cm/s to 76.6 ± 18.6 cm/s (P = 0.008), and NT-pro BNP levels had a median (IQR) reduction from 115.7 (252.1) pg/mL to 55.0 (121.6) pg/mL (P = 0.043).

Conclusions: TARFACT is a novel palliative treatment option for cardiac tumors, reducing accessible tumors and improving clinical symptoms in a preliminary group of patients. (Cardiac Tumors Interventional [Radio Frequency/Laser Ablation] Therapy [CTIH]; NCT02815553).

Keywords: cardiac tumors; transapical radiofrequency ablation for cardiac tumors TARFACT; tumor debulking ablation.

Graphical abstract

Central Illustration

Echocardiography-Guided Transapical Biopsy and Radiofrequency Ablation for Cardiac Tumors Echocardiography-guided transapical biopsy and radiofrequency ablation of cardiac tumors. The arrowhead indicates the insertion of the biopsy needle into the cardiac tumor, and star indicates the tumor. Debulking of cardiac tumors by transapical radiofrequency ablation for cardiac tumors (TARFACT) can improve NYHA functional class. The arrow indicates the cardiac tumor. LV = left ventricle; RA = right atrium; RV = right ventricle.

Figure 1

Imaging Evaluation of Cardiac Tumors for TARFACT (A) Echocardiography showed the size and location of cardiac tumors. (B) Pre-procedure myocardial contrast echocardiography (MCE) was used to evaluate the vasculature of the tumors. (C) Cardiac computed tomography (CT) was performed to obtain comprehensive anatomic information of the heart. (D) Positron emission tomography (PET)/CT scans showed various levels of glucose metabolism in cardiac tumors. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle; TARFACT = echocardiography-guided transapical radiofrequency ablation for cardiac tumors; Tu = tumor.

Figure 2

Echocardiography-Guided TARFACT Procedure (A) Cardiac tumors were reassessed by echocardiography before TARFACT. (B) Percutaneously cardiac intratumor biopsy was performed, and images are shown here are at 200× magnification after hematoxylin and eosin staining. (C) The radiofrequency needle was percutaneously inserted into the tumors, guided by color Doppler guidance to avoid vascular injury. The arrowhead indicates the needle in the cardiac tumor through the guide frame. (D) Ablation of the cardiac tumor was performed. The bright echo signal, indicated by the arrowhead, represents the ablation area. (E) After tumor ablation, contrast echocardiography was used to assess whether the ablation range was adequate. (F) At a median (IQR) of 9 (8) months after TARFACT, the cardiac tumor demonstrated a reduction in size. Abbreviations as in Figure 1.

Figure 3

Changes in Length and Width of Tumor Size in Individual Patients (A) The tumor length continuously decreased in all patients after the procedure. (B) The tumor width continuously decreased in all patients during follow-up.