Radiofrequency Ablation

FAQ’s on  Radiofrequency Ablation

What is radiofrequency ablation?

 

Advances in medical technology have allowed physicians to treat patients with minimal damage to the tissues. These include minimally invasive techniques such as laparoscopic surgery, shock wave lithotripsy, and radiofrequency ablation. Procedures such as these are associated with better outcomes and patient satisfaction compared to traditional “open” surgical techniques.

Radiofrequency ablation (RFA) is a procedure that allows the physician to destroy tissues, such as for malignant tumors. The technology uses radiofrequency energy to heat up and ablate (i.e., destroy) the target tissues. The procedure is useful in the treatment of a wide variety of conditions.

How is the procedure done?

 

The procedure is an outpatient procedure and can be done under local anesthesia. The physician may opt to provide intravenous (IV) sedation to relax the patient. Sterile technique is employed: the needle injection site will be prepped with an antiseptic solution, and the surrounding area will be draped with sterile linen.

The operation begins when the needle-like probe is inserted through the skin. This is normally done under fluoroscopic (X-ray) guidance, however other guiding modalities such as computerized tomography (CT) scans and ultrasonography may be employed. The needle is inserted until the target area, and then high-frequency electrical energy is delivered to destroy the surrounding tissue. Months after the procedure, dead cells turn into a harmless scar.

 

The needle is then withdrawn, and the patient is kept under observation for 20 to 30 minutes before being sent to recovery.

What conditions can benefit from RFA?

 

Various conditions have been shown to benefit from RFA. These include, but are not limited to the following:

  • Cardiac arrhythmias – irregularities in the heart beat can be caused by dysfunctional cardiac tissues that misfire. These conditions include atrial flutter, atrial fibrillation, supraventricular tachycardia, among others. RFA has been effective in destroying the tissue responsible for the arrhythmia.
  • Varicose veins – RFA is used as a minimally invasive alternative to the traditional surgical technique.
  • Obstructive sleep apnea (OSA) – RFA has been shown to have use in the treatment of OSA, however, large-scale studies are still needed to prove its effectiveness and safety.
  • Pain management – chronic pain that is no longer responsive to more conservative interventions, such as oral pain medications, may be an indication for RFA. Conditions may include pain from malignancies and Complex Regional Pain Syndrome (formerly Reflex Sympathetic Dystrophy), among others. An initial diagnostic nerve block is done with a local anesthetic and/or a corticosteroid. If the diagnostic procedure provides pain relief, then long-term effects may be afforded through RFA of the same area.
  • Malignancies – RFA has been shown to be effective in destroying malignant tissue. Carcinomas and metastatic tissue can be destroyed via RFA, eliminating the need for surgery.

 

What are the risks for RFA?

 

RFA is normally well tolerated by most patients, and most report good outcomes. The procedure is generally safe, and has high success rates and low complication rates even in children and adolescents. However, there are always risks present with any medical procedure, and these include:

 

  • Infection of the surgical site
  • Bruising/Bleeding/Hematoma formation
  • Pain at injection site
  • Damage to surrounding muscles, nerves, tissues

 

There is usually some swelling and bruising at the site of treatment, however this usually resolves after a few days.

 

References

 

Boronyak SM, Merryman WD. In vitro assessment of a combined radiofrequency ablation and cryo-anchoring catheter for treatment of mitral valve prolapse. J Biomech. 2014 Jan 21. pii: S0021-9290(14)00052-9. doi: 10.1016/j.jbiomech.2014.01.021.

 

Hamer JF, Purath TA. Response of Cervicogenic Headaches and Occipital Neuralgia to Radiofrequency Ablation of the C2 Dorsal Root Ganglion and/or Third Occipital Nerve.

Headache. 2014 Jan 16. doi: 10.1111/head.12295.

 

Stavrakis S, Jackman WM, Nakagawa H, et al. Risk of Coronary Artery Injury with Radiofrequency Ablation and Cryoablation of Epicardial Posteroseptal Accessory Pathways within the Coronary Venous System. Circ Arrhythm Electrophysiol. 2013 Dec 23.