1Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Chronic low back pain (CLBP) is a common problem all over the world and there are more and more patients with electronic device implantation. In recent decades, pulse radiofrequency (PRF) neuromodulation is considered a potentially effective therapy for CLBP, but there is still concern about safety when using it on patients with electronic device implantation. Here we provide with three successful cases of using PRF neuromodulation on patients with permanent pacemaker (PPM) implantation.
Patient 1 is an 88-year-old male who has PPM (mode unknown) for arrhythmia for many years. He underwent PRF (45V, 240 times, 42°C) for bilateral L4 and L5
radiculopathy three times; each time was done safely without sequela. Patient 2 is an 84-year-old female who has PPM(mode DDD) implanted in 2011/09 for sick sinus syndrome. She underwent PRF (60V or 45V, 240 times, 42°C) three times for fail back surgery syndrome and sciatica of bilateral L2; each time was done safely without sequela. Patient 3 is a 77-year-old female who has PPM (mode unknown) implanted in 2014/12 for sick sinus syndrome. She underwent PRF(50V, 120 sec, 42°C) once without sequela.
PRF had been considered to be contra-indicated for patients with PPM but without strong evidence. According to the physical features and neuromodulation mechanism of PRF, a current passes from an electrode to tissue and finally leaves from ground plate. It generates heat on the tip of the electrode, which causes thermal damage to target tissue and modulates the signals of neurotransmitters or inflammatory fators.
In our opinion, the reason why it is safe to use PRF on patients with PPM may due to the fact that the electrode is so far from the heart and PPM that the electric circuit does not pass through the heart and PPM. It is also possible that the energy.
Radiofrequency neuromodulation, analgesia, pacemaker, low back pain.
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