RFA with pacer/defib

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paindoctor2014

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I am being told at one rural hospital and now a surgery center that I can’t longer do lumber rfa on patients with pacers.

I’ve done dozens of them in the past at both places. Place pad as far away etc.

What do you do precaution wise? Any literature I can provide?

Thanks
 
I'm interested in what people's real life practice patterns are in regard to pacemakers, ICDs, and patients who have both.
 
1 Up said:
I'm interested in what people's real life practice patterns are in regard to pacemakers, ICDs, and patients who have both.
Click to expand...
Personally never had an issue in the lumbar spine. I know don’t offer it in cervical. Don’t want no drama
 
clubdeac said:
Personally never had an issue in the lumbar spine. I know don’t offer it in cervical. Don’t want no drama
Click to expand...
In other words, if you have a patient with an AICD, you treat that as a contraindication to cervical RFA and won’t even consider it?
 
Gnarvin said:
In other words, if you have a patient with an AICD, you treat that as a contraindication to cervical RFA and won’t even consider it?
Click to expand...
Not anymore I won’t. I’ll just do IA facet injections. It’s not worth my time, risk and comfort

There was a time when it was. I was also doing cervical stim, SPG RFA, high cervical epidurals, kypho, and discograms

Now I stick to bread and butter procedures and make double what I did prior. Sleep better at night too
 
Gnarvin said:
In other words, if you have a patient with an AICD, you treat that as a contraindication to cervical RFA and won’t even consider it?
Click to expand...
AICD is different from pacer.

treat them differently.

for pacers, put a magnet on if lesioning above L3, and make sure current doesnt go across pacer, treat away.

for AICD, contact device rep and cardiologist.
 
Ducttape said:
AICD is different from pacer.

treat them differently.

for pacers, put a magnet on if lesioning above L3, and make sure current doesnt go across pacer, treat away.

for AICD, contact device rep and cardiologist.
Click to expand...
Only if above L3 if I’m understanding the guidelines correctly
 
i do plenty of cervical rfa with people who have aicd/pacemaker, just put the grounding pad far away, no issues, been doing this for years, not sure why everyone is scared; no interrogation, no magnet, nothing
 
buddababa said:
i do plenty of cervical rfa with people who have aicd/pacemaker, just put the grounding pad far away, no issues, been doing this for years, not sure why everyone is scared; no interrogation, no magnet, nothing
Click to expand...
Have had AICD discharge during cervical RFA. That’s why.

Now do anything thoracic and up bipolar if pacemaker. If AICD, bipolar even if lumbar just to be on the safe side.
 
as close as possible to the site but as far away a possible from the AICD.

issue with using AICD is that it might fire and give patient a shock, and in some cases- especially older AICDs - putting magnet on would reprogram it.
 
ASPN has put out a relatively detailed set of guidelines which have been somewhat useful:

pubmed.ncbi.nlm.nih.gov

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

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...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

In general, I will always communicate with Cardiology/EP to determine the indication and get contact info for the device rep to know the behavior of the device when applying a magnet and have an option for interrogation before or after the procedure. For patients that are pacer-dependent having this information is important and those with AICDs is well to be sure that magnet disables antitachycardia functions. Will always have EKG monitoring during the procedure to be able to see if the pacer is capturing/reacting to the RF. AICD firing is quite obvious, but I still have the EKG on just in case It fires and arrhythmia ensues.

For lumbar and genicular, it typically is not an issue so long as your grounding pad is close to your operative site. For cervical, I have a risk-benefit discussion with the patient and Cardiology to decide if we proceed with monopolar RF or do therapeutic MBB/intra-articular facet instead. I'm not too experienced with bipolar techniques, especially in cervical RFA, but would love to learn more if anyone has recommended resources.
 
Agree with above. If AICD cardiology consult and interrogate before and after. Most go into a non sensing mode with the proper instructions, usually magnet placement however this can be hard due to the positioning and taping of the magnet with movement possible and potentially an unintended sensing event.
 
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