The American Society of Pain and Neuroscience (ASPN) Guidelines for Radiofrequency Ablative Procedures in Patients with Implanted Devices

Abstract

Radiofrequency ablation (RFA) is a treatment modality used in interventional pain management to treat several conditions including chronic neck or back pain, sacroiliac joint pain, major joint pain, and pain from sites that can be isolated to a sensory nerve amenable to RFA. The goals of such procedures are to reduce pain, improve function, delay need for surgical intervention, and reduce pain medication consumption. As applications for RFA expand through novel techniques and nerve targets, there is concern with how RFA may impact patients with implanted medical devices. Specifically, the electrical currents used in RFA produce electromagnetic interference, which can result in unintentional energy transfer to implanted devices. This may also interfere with device function or cause damage to the device itself. As the number of patients with implanted devices increases, it is imperative to establish guidelines for the management of implanted devices during RFA procedures. This review aims to establish guidelines to assist physicians in the preoperative, intraoperative, and postoperative management of implanted devices in patients undergoing procedures using radiofrequency energy. Here, we provide physicians with background knowledge and a summary of current evidence to allow safe utilization of RFA treatment in patients with implanted devices such as cardiac implantable electronic devices, spinal cord stimulators, intrathecal pumps, and deep brain stimulators. While these guidelines are intended to be comprehensive, each patient should be assessed on an individual basis to optimize outcomes.

Keywords:

• radiofrequency ablation
• implanted medical devices
• cardiac implantable electronic device
• spinal cord stimulator
• intrathecal pump
• deep brain stimulator

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Dr Timothy Deer reports grants, personal fees from Abbott, during the conduct of the study; personal fees, Consultant, Stock Options, Research from Vertos, personal fees, Consultant, Stock Options from SpineThera, personal fees, Consultant, Stock Options, Research from Saluda, personal fees, Consultant, Stock Options from Nalu, Consultant, Stock Options from Cornerloc, personal fees, Consultant, Stock Options from Ethos, personal fees, Consultant, Stock Options, Research from SPR Therapeutics, personal fees from Medtronic, personal fees, consultant, Research from Boston Scientific, personal fees, Consultant, Stock Options, Research from PainTeq, personal fees from Tissue Tech, personal fees, Consultant, Stock Options from Spinal Simplicity, personal fees from Biotronik, Research from Mainstay, Research from Avanos, outside the submitted work; In addition, Dr Timothy Deer has a patent Abbott pending to pending The authors do not have any financial disclosures or other conflicts of interest to report.