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

Timothy Sowder,1 Dawood Sayed,1 Tyler Concannon,1 Scott H Pew,2 Natalie H Strand,2 Alaa Abd-Elsayed,3 Christopher S Wie,2 Daniel E Gomez Ramos,4 Ahmed M Raslan,5 Timothy R Deer6 1Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA; 2Department of Anesthesiology, Mayo Clinic, Phoenix, AZ, USA; 3Department of Anesthesiology, University of Wisconsin, Madison, WI, USA; 4Department of Neurology, Mayo Clinic, Phoenix, AZ, USA; 5Department of Neurological Surgery, Oregon Health and Science University, Portland, OR, USA; 6The Spine and Nerve Center of the Virginias, Charleston, WV, USACorrespondence: Timothy Sowder, Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS, 66160, USA, Tel +1-913-588-6670, Fax +1-913-588-3365, Email tsowder@kumc.eduAbstract: 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