Bipolar Radiofrequency Device Research Articles

Histopathological Evaluation of Bipolar and Microneedle Radiofrequency Energy on the Skin and Fat of the Abdominal Region of the Rat.

Radiofrequency (RF)-based devices are frequently used in plastic surgeries. In the current literature, no comparative experimental study has demonstrated the histological and immunological effects of these devices that are frequently used in the facial area. In this study, we investigated the histological and immunological effects of Bipolar RF (BodyTite) and Microneedle RF (Morpheus 8) devices in the rat abdominal region. 24 rats were used in this study. The rats were divided into four groups: group I: Control. In group II, BodyTite was applied to the abdominal region. Group III: Morpheus 8 was applied to the abdominal region. Group IV: Both Morpheus 8 and BodyTite were applied to the abdominal region. The histological and immunological features of the tissues in the groups were examined using light microscopy, and collagen formation and desmosome structures were examined using light microscopy. Collagens in Group II were thinner than those in the other groups. In addition, there were fewer vessels in Group III. The collagen scores were as follows: Group II:1.5; Group III:2; and Group IV:3. The VEGF scores were II:2.5, group III:2, and IV:3, respectively. The collagen score in group II and VEGF score in group III were significantly lower than those in the other groups. In addition, the bonds between desmosomes in group III were found to be looser using electron microscopy. Collagen morphology in groups III and IV was found to be similar to that in group I. The conclusion of comparison RF-based devices increased tissue regeneration and healing. The use of radiofrequency devices has increased in plastic surgery practice over the past two decades, particularly emerging as a unique alternative for non-surgical candidates. There is a lack of experimental studies concerning these commonly used devices in clinical practice.

A Computational Modeling Approach to Investigate the Influence of Hyperthermia on the Tumor Microenvironment.

The biophysical properties of the tumor microenvironment differ substantially from normal tissues. A constellation of features, including decreased vascularity, lack of lymphatic drainage, and elevated interstitial pressure, diminishes the penetration of therapeutics into tumors. Localhyperthermia within the tumor can alter microenvironmental properties, such as interstitial fluid pressure, potentially leading to improvements in drug penetration. In this context, multi-physics computational models can provide insight into the interplay between the biophysical parameters within the tumor microenvironment and can guide the design and interpretation of experiments that test the bioeffects of local hyperthermia. This paper describes a step-by-step workflow for a computational model coupling partial differential equations describing electrical current distribution, bioheat transfer, and fluid dynamics. The main objective is to study the effects of hyperthermia delivered by a bipolar radiofrequency device on the interstitial fluid pressure within the tumor.The system of mathematical expressions linking electrical current distribution, bioheat transfer, and interstitial fluid pressure is presented, emphasizing the changes in the distribution of the interstitial fluid pressure that could be induced by the thermal intervention.

Temperature Profile Measurement From Radiofrequency Nasal Airway Reshaping Device.

Nasal airway obstruction (NAO) is caused by various disorders including nasal valve collapse (NVC). A bipolar radiofrequency (RF) device (VivAer®, Aerin Medical, Sunnyvale, CA) has been used to treat NAO through RF heat generation to the upper lateral cartilage (ULC). The purpose of this study is to measure temperature elevations in nasal tissue, using infrared (IR) radiometry to map the spatial and temporal evolution of temperature. Experimental and computational. Composite porcine nasal septum was harvested and sectioned (1 mm and 2 mm). The device was used to heat the cartilage in composite porcine septum. An IR camera (FLIR® ExaminIR, Teledyne, Wilsonville, OR) was used to image temperature on the back surface of the specimen. These data were incorporated into a heat transfer finite element model that also calculated tissue damage using Arrhenius rate process. IR temperature imaging showed peak back surface temperatures of 49.57°C and 42.21°C in 1 and 2 mm thick septums respectively. Temperature maps were generated demonstrating the temporal and spatial evolution of temperature. A finite element model generated temperature profiles with respect to time and depth. Rate process models using Arrhenius coefficients showed 30% chondrocyte death at 1 mm depth after 18 s of RF treatment. The use of this device creates a thermal profile that may result in thermal injury to cartilage. Computational modeling suggests chondrocyte death extending as deep as 1.4 mm below the treatment surface. Further studies should be performed to improve dosimetry and optimize the heating process to reduce potential injury. Laryngoscope, 134:1063-1070, 2024.

Combined Bipolar Radiofrequency and Non-Crosslinked Hyaluronic Acid Mesotherapy Protocol to Improve Skin Appearance and Epidermal Barrier Function: A Pilot Study.

Age-associated changes in epidermal hydration, pigmentation, thickness and cell renewal influence skin appearance and can lead to laxity, dryness and poor skin tone. The aim of this pilot study was to assess the synergistic effects of a new bipolar radiofrequency plus non-crosslinked hyaluronic acid (HA) mesotherapy protocol compared with radiofrequency alone on skin appearance and markers of epidermal function. This prospective, single-center, split-face pilot study recruited women aged 25-65 years with dryness and laxity of the facial skin defined by a trans-epidermal water loss (TEWL) value of ≥26 g/m2/h. Subjects were treated with a bipolar radiofrequency device on both sides of the face. This was immediately followed by needle hyaluronic acid (HA) treatment on one side of the face with 2.5 mL of a non-crosslinked HA. Photographic documentation, analysis of epidermal barrier function parameters, and high frequency (HF) ultrasound analysis were performed prior to treatment and at 28 days. Twenty female subjects with a mean age of 46 (range 29 to 54) years and dry and lax facial skin were included. TEWL was reduced and skin hydration improved to a greater extent with the combined radiofrequency plus mesotherapy protocol compared with radiofrequency alone (-5.8% vs. +3.9% and +23.1% vs. +1.0%, respectively). The combined protocol was also associated with greater improvements in melanin (-7.5% vs. -1.5%) and erythema values (-7.2% vs. +3.0%), respectively. Ultrasound measures of epidermal thickness and epidermal density were greater after the combined protocol compared with radiofrequency alone (12.0% vs. 5.6% and 57.7% vs. 7.1%, respectively). Both treatments were well-tolerated. The combined bipolar radiofrequency and HA mesotherapy protocol provided greater improvements in skin hydration, firmness and tone compared with radiofrequency alone. The combination treatment was also associated with greater epidermal thickness and density and increased keratinocyte differentiation suggesting a synergistic effect of both treatments on epidermal homeostasis and barrier function. Both treatments were well-tolerated and led to improvements in facial appearance.

Unilateral Biportal Endoscopy for Lumbar Spinal Stenosis and Lumbar Disc Herniation.

Unilateral Biportal Endoscopy for Lumbar Spinal Stenosis and Lumbar Disc Herniation.

Surgery results of Cox-Maze IV procedure in treatment for atrial fibrillation combined with valve disease at Cardiovascular Center, E hospital

Introduction: Atrial fibrillation is a major cause of stroke, heart failure, and sudden death and is often associated with valve disease. The Maze procedure using the unipolar and bipolar radiofrequency devices is often combined with valvular surgery, especially mitral valve, to treat atrial fibrillation.
 Method: Cross-sectional descriptive study; 40 patientsss were treated for atrial fibrillation by COX-MAZE procedure combined with heart valve surgery in 2020-2021 at Cardiovascular Center- E Hospital.
 Result: In 40 patients, 23 males (57.5%), 17 females (42.5%), mean age 53.6 ± 8.3 (36-68) years. Mean time to dêtct atrial fibrillation 3.27 (1-9) years. 05 cases (12.5%) were preopration stroke history. Mean left atrial diameter before surgery 49.2 ± 10.1 (21-70) mm, thrombus in left atrial appendage was 8 cases (20%). All patients had mitral valve disease, accompanied by aortic valve disease 4 cases (10%) and tricuspid valve regurgitation 13 cases (32.5%). 100% of patients underwent COX-MAZE procedure. The rates of free from AF and sinus recovery after surgery 31 cases (77.5%). 02 patients (5%) sinus node dysfunction and 04 patients (10%) atrioventricular block I-II degree but they did not require temporary pacemaker placement, and recovered in 1-3 weeks.
 Conclusion: The Maze procedure by unipolar devices alone and combination with bipolar devices are effective and safe in patient atrial fibrillation combined with valvular surgery, especially mitral valve surgery.

Safety and feasibility of radiofrequency ablation using bipolar electrodes for aldosterone-producing adenoma: a multicentric prospective clinical study

Evaluation of feasibility and safety of percutaneous radiofrequency ablation using bipolar radiofrequency devices in a prospective multicenter cohort of patients with benign aldosterone-producing adenoma. A total of five institutions participated. CT-guided percutaneous RFA was performed for patients diagnosed as APA. The safety of the procedure was evaluated using the Common Terminology Criteria for Adverse Events. During the 84-day follow-up period, serial changes in plasma aldosterone concentration and plasma renin activity were measured. The percentage of patients with normalized hormonal activity after the procedure, was calculated with 95% confidence intervals. Forty patients were enrolled, and two patients were excluded for cerebral hemorrhage and no safe puncture root. In another patients, RFA was tried, but an intraprocedural intercostal arterial injury occurred. Consequently, RFA was completed in thirty-seven patients (20 men, 17 women; mean age, 50.4 ± 10.0 year). The tumor size was 14.8 ± 3.8 mm. The treatment success rate of the ablation was 94.6% (35/37), and a 2nd session was performed in 2.7% (1/37) patients. Grade 4 adverse events were observed in 4 out of 38 sessions (10.5%). The normalization of plasma aldosterone concentration or aldosterone-renin ratio was 86.5% (72.0–94.1: 95% confidence interval) on day 84. Percutaneous CT-guided RFA for APA using a bipolar radiofrequency system was safe and feasible with clinical success rate of 86.5% on day 84.

Minimally Invasive Approach to Skin Tightening of the Face and Body: Systematic Review of Monopolar and Bipolar Radiofrequency Devices.

Radiofrequency treatment is a relatively new and increasingly popular option for patients desiring skin tightening and an improvement in facial or body contour without undergoing an excisional surgical procedure. A systematic review of the literature was performed to investigate the safety and efficacy of monopolar and bipolar radiofrequency devices for facial and body rejuvenation. A computerized search of the MEDLINE database was performed for clinical studies investigating the use of monopolar and bipolar radiofrequency devices in facial and body rejuvenation. Data on the type of device, treated areas, number of patients, number of treatments, follow-up, complications, and outcomes were collected. The systematic review was performed in September of 2020. A total of 207 articles examined the use of radiofrequency technology for cosmetic purposes, and 23 articles remained after all inclusion and exclusion criteria were considered. Nine articles evaluated monopolar devices and five articles evaluated bipolar devices for treatment of the face. Three articles evaluated monopolar devices and six articles evaluated bipolar devices for treatment of various body areas. There is clinical evidence that monopolar and bipolar radiofrequency devices produce measurable improvement in skin laxity of the face and body with an acceptable complication profile. The majority of reported complications are minor and transient in nature; major complication rates are higher with the use of monopolar devices than with the use of bipolar devices.

Technique for Minimally Invasive Face and Neck Contouring with Bipolar Radiofrequency Devices.

Radiofrequency devices have grown in popularity as minimally invasive options for the treatment of skin laxity in the face and neck. These treatments are often combined with liposuction procedures to provide enhanced tissue contraction alongside the reduction in adiposity. Proper patient selection and intraoperative technique are crucial to achieving the desired outcomes in a safe manner. In this article, the authors discuss their indications and technique for the treatment of the face and neck with bipolar radiofrequency devices.

Thoracoscopic AF ablation in situs inversus dextrocardia with interrupted inferior vena cava continuation in azygos vein

IntroductionSitus inversus totalis, dextrocardia with interrupted inferior vena cava, and azygos vein continuation concomitant with symptomatic atrial fibrillation requiring ablation. This case was deemed not suitable for percutaneous ablation due to anatomic variations and the lack of case reports in the literature.Methods and ResultsWe performed bilateral thoracoscopic epicardial ablation and epicardial left atrial appendage exclusion. The direct vision allowed for a complete box lesion set with bipolar radiofrequency device. Patient remained in sinus rhythm at the 12‐months follow‐up.ConclusionSurgical thoracoscopic epicardial ablation is safe and effective also in congenital defects. Multidisciplinary expertise can offer minimally invasive ablation treatments.

A Prospective Trial: Handsfree Thermoregulated Bipolar Radiofrequency for Face and Neck Contouring.

Background:The use of radiofrequency in aesthetic surgery has evolved significantly since it was first introduced in the early 2000s. Nonexcisional correction of the lower one-third of the face and neck has long been a challenging problem. The purpose of this prospective study was to assess the safety and efficacy of the first handsfree thermoregulated bipolar radiofrequency device for face and neck contouring.Methods:This prospective multicenter (New York, Nevada) IRB-approved study evaluated healthy candidates who desired noninvasive correction of their lower face and neck laxity. The primary objective of this study was to evaluate safety and soft tissue remodeling pretreatment and at 1-, 3-, and 6-months post last treatment. Assessment was made using blinded evaluators, 3D photographic analysis (Quantificare, France), and volumetric measurements. Investigator and subject assessments were obtained using a 0-4 point Likert scale.Results:A total of 34 patients completed both the cheek and chin applicator treatment series. Average age of patients was 38 (STD 3.4), BMI 27 (STD 2.2), average Baker Face & Neck classification 2.6 (STD 1.1), and average Fitzpatrick type 2.4 (STD 1.2). Mean treatment time was 41 min (STD 3.5) with a temperature of 42°C–43°C. Patient discomfort data were statistically very low based on t-test analysis. Satisfaction metrics measured at 1- and 3-month follow-up demonstrated a significant change in subject skin appearance, subject overall satisfaction, and investigator improvement perception. More patients were satisfied at the 3-month follow-up compared with the 1-month follow-up for all three measures. Volumetric data demonstrated an average change of −3.2 cm3 (STD ±1.2 cm3) per side for the cheek applicator and −4.1 (STD ±2.3) for the submental applicator. Of note there were cases where volume increases were noted that were believed to be related to soft tissue contraction.Conclusions:This is the first prospective study to evaluate a handsfree thermoregulated bipolar radiofrequency device for face and neck contouring. This device demonstrates a significant advance in the control and delivery of radiofrequency for aesthetic purposes. With a favorable safety and comfort profile, this device is able to concentrate thermal energy consistently at a depth that allows for fibroseptal network tightening to improve lower third of face and submental soft tissue contraction.

Effectiveness and side effects of bipolar radiofrequency to treat submental laxity.

Submental skin laxity becomes a common cosmetic problem with age. Bipolar radiofrequency is a new, non-invasive procedure. Unlike the LASER, the radiofrequency (RF) device has no specific chromophore absorption. Thus, the device can be used on any skin type. To evaluate the effectiveness and adverse effects of the bipolar RF for treatment of submental laxity and skin tightening. Twenty-two patients with submental laxity were treated with Forma™ on both sides of the submental area. The patients underwent four sessions every 2weeks for one and half months. Two blinded dermatologists evaluated the pre-treatment and post-treatment photographs at every visit. The three-dimensional photographs were recorded by Vectra® camera and determined the association. All 22 patients completed all the treatment sessions. The degree of improvement was statically significant after the third session based on the physical assessment scale and after the second session in terms of the submental laxity score. The fat volume reduction was statically significant from one week to six months from baseline. Almost all subjects developed transient erythema immediately after the treatment. No serious side effects were noted. The bipolar RF device is another potential choice for skin tightening due to its efficacy and safety profile. It can be used with any skin type and has few side effects.

The fate of patients after failed epicardial ablation of atrial fibrillation

BackgroundMuch debate is still going on about the best ablation strategy—via endocardial or epicardial approach—in patients with atrial fibrillation (AF), and evidence gaps exist in current guidelines in this area. More specifically, there are no clear long-term outcome data after failed surgical AF ablation.MethodsSince June 2008, 549 surgical AF ablation procedures through a right minithoracotomy were performed at our institution. From 2008 to 2011, a unipolar radiofrequency device was used (151 patients), whereas from 2011 to 2020 a bipolar radiofrequency device was used (398 patients). Patients were scheduled for surgery on the basis of the following criteria: recurrent episodes of paroxysmal or persistent lone AF refractory to maximally tolerated antiarrhythmic drug dosing and at least one failed cardioversion attempt. Besides the recommended follow-up by the local cardiologist, starting from 2021, surviving patients were asked to undergo assessment of left ventricular function and to complete a questionnaire addressing quality of life and predisposing factors for recurrent AF.ResultsAt a mean follow-up of 77 months, the rate of AF recurrence was 20.7% (n = 114). On multivariate analysis, impaired left ventricular ejection fraction (58 patients, 51%, p = 0.002), worsening of European Heart Rhythm Association (EHRA) symptom class (37 patients, 32%, p = 0.003) and cognitive decline or depression (23 patients, 20%, p = 0.023) during follow-up were found to be significantly associated with AF recurrence.ConclusionsSurgical AF ablation through a right minithoracotomy is safe, but a better outcome could be achieved using a hybrid approach. Patients after initial failed surgical AF ablation show worsening of cardiac function, clinical status and quality of life at follow-up compared to patients with successful AF ablation.

Transvaginal radiofrequency energy for the treatment of urinary stress incontinence: A comparison of monopolar and bipolar technologies in both pre‐ and post‐menopausal patients

A study to compare the effect of two different radio frequency energy models (mono polar and bipolar) for the treatment of urinary stress incontinence. Retrospective chart review, which was conducted at 2 sites, 69 patients received treatment with a bipolar radiofrequency device. Out of those 69 patients, 13 patients received bipolar in conjugation with CO2 laser treatment, while 32 patients received monopolar frequency. The study protocol normally consists of three sessions of treatment. Each session was four weeks apart with a whole 6-month duration follow-up. Results were evaluated by urogenital distress inventory (UDI)-6 questionnaire before and after treatment. The bipolar group improved UDI-6 scores across time more so than did the monopolar group with some evidence suggesting that the bipolar radiofrequency treatment was more effective compared to the monopolar radiofrequency. Three months after treatment, the bipolar group UDI-6 values were lower than those of the monopolar group. Six months after treatment, the UDI-6 scores increased in both groups, suggesting decrease efficacy with time however, the bipolar group's UDI-6 scores were consistently lower than the monopolar group's scores. This study shows benefit of both monopolar and bipolar radiofrequency device in patients with stress urinary incontinence and mixed UI, with bipolar RF more efficacious than monopolar RF. More randomized prospective studies are needed to confirm these findings.

Catheter, surgical, or hybrid procedure: what future for atrial fibrillation ablation?

BackgroundThe debate on the best treatment strategy for atrial fibrillation (AF) has expanded following the introduction of the so-called “hybrid procedure” that combines minimally invasive epicardial ablation with endocardial catheter ablation. However, the advantage of the hybrid approach over conventional epicardial ablation remains to be established.MethodsFrom June 2008 to December 2020, 609 surgical AF ablation procedures through a right minithoracotomy were performed at our institution. From 2008 to 2011, a unipolar radiofrequency (RF) device was used, whereas from 2011 to 2020 a bipolar RF device was used. In addition, between September 2016 and April 2017, 60 patients underwent endocardial completion of epicardial linear ablation. In 30 of these latter patients, surgical isolation of the Bachmann’s bundle (BB) was also performed. Starting from 2021, surviving patients at follow-up were asked to undergo electrocardiographic evaluation and left ventricular function assessment and to complete a questionnaire addressing quality of life and predisposing factors for recurrent AF.ResultsThe ablation procedure was completed in all patients. Upon discharge, 30 (4.9%) patients showed recurrence of AF, whereas the remaining patients (95.1%) were in sinus rhythm. All patients in whom a hybrid approach was used either with or without BB ablation were discharged in sinus rhythm. After a mean follow-up of 74 months, 122 (20%) patients developed recurrent AF, including 19.9% in whom a unipolar RF device was used, 21% in whom a bipolar RF device was used, 23% who had undergone a hybrid procedure without BB ablation and 3.3% who had undergone a hybrid procedure with BB ablation. On multivariate analysis, reduced left ventricular ejection fraction, worsening of European Heart Rhythm Association symptom class, and cognitive impairment or depression during follow-up were found to be significantly associated with AF recurrence.ConclusionsSurgical AF ablation through a right minithoracotomy is safe and may allow the creation of additional linear lesions, particularly in the BB. The placement of adjunctive linear lesions in the setting of a hybrid procedure can be more effective in reducing the risk for AF recurrence than isolated surgical ablation or hybrid ablation without the addition of further linear lesions, with no incremental risk to the patient.

A Computational and Experimental Study to Compare the Effectiveness of Bipolar Mode With Phase-Shift Angle Mode in Radiofrequency Fat Dissolution on Subcutaneous Tissue.

Radiofrequency (RF) energy exposure refers to a popular non-invasive method employed to generate heat in cutaneous and subcutaneous tissues. RF thermal stimulation of adipose tissue has been considered to cause adipocyte metabolism and enzymatic degradation of triglycerides into free fatty acids and glycerol. Bipolar mode (BM) has achieved extensive applications in clinical studies on RF fat dissolution, whereas BM has a less penetration depth than monopolar, result in a higher RF voltage that may be required to increase power to the deeper fat layer of the subcutaneous tissue, and improper power control may easily cause the skin layer to be thermally damaged. To tackle down the mentioned defect, a novel phase-shift angle mode (PM) was proposed in this study based on double-channel bipolar RF. By employing the finite element method (FEM) and performing the ex vivoexperiment, the effectiveness of BM was compared with that of PM in RF fat dissolution on subcutaneous tissue. In addition, this study attempted to develop reasonable phase-shift angles capable of achieving fat dissolution effects, while the RF energy of which would not cause the skin layer to be thermally damaged. Two electrode spacings (1 and 2 cm) were applied in BM (BM-1 cm and BM-2 cm, respectively), and six phase-shift angles (i.e., 30°, 60°, 90°, 120°, 150°, and 180°) were set in PM (i.e., PM-30°, PM-60°, PM-90°, PM-120°, PM-150°, and PM-180°). In addition, COMSOL was adopted to conduct a finite element analysis for achieving thermoelectric coupling. Ex vivo experiments were performed with a self-developed double-channel bipolar RF device, through which up to two adjustable phase-shift angle sinusoidal voltages could be generated. Such a device was isolated with a transformer and then connected to four electrodes with a 5 mm diameter contacting the ex vivo porcine abdominal tissue. Under the RF voltage amplitude of 30 V, and after 1800 seconds of RF heating, no thermally damaged area was formed in the tissue in BM-1 cm and BM-2 cm; in PM-30°, PM-60°, and PM-90°, thermally damaged areas were formed in the fat layer, while the skin layer was not located in the thermally damaged area.Moreover, the temperature in the thermally damaged area attributed to the mentioned three conditions may satisfy the requirement of fat dissolution temperature. Under the identical RF voltage and heating time, PM is easier to cause the fat layer of the subcutaneous tissue to be thermally damaged as compared with BM. Accordingly, PM may be enabled to achieve the fat dissolution effect under a relatively low RF voltage as opposed to BM, thus avoiding the possibility of thermal damage of the skin layer attributed to the use of higher RF voltage. In PM, different phase-shift angle significantly affects the electrical and thermal properties of RF energy applied on subcutaneous tissue; the phase-shift angle of RF voltage is likely to be regulated for fat dissolution effect, while the RF energy of which will not cause the skin layer to be thermally damaged.© 2021 Wiley Periodicals LLC.

Editorial Comment

No AccessJournal of UrologyAdult Urology1 Apr 2021Editorial CommentThis article comments on the following:Prostate Radiofrequency Focal Ablation (ProRAFT) Trial: A Prospective Development Study Evaluating a Bipolar Radiofrequency Device to Treat Prostate Cancer Nathan Perlis Nathan PerlisNathan Perlis Urologic Oncology, Sprott Department of Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001567.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 205(4), pp. 1098–1099 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyDec 14, 2020, 12:00:00 AMProstate Radiofrequency Focal Ablation (ProRAFT) Trial: A Prospective Development Study Evaluating a Bipolar Radiofrequency Device to Treat Prostate Cancer Volume 205Issue 4April 2021Page: 1098-1099 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Perlis Urologic Oncology, Sprott Department of Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Expand All Advertisement Loading ...

Review of the Safety of Bipolar Radiofrequency Ablation in Patients with Chronic Pain with Implantable Cardiac Rhythm Management Devices

Chronic pain, especially low back pain and hip pain, has been a growing public health concern that affects over 100 million Americans annually. Radiofrequency ablation (RFA) has distinct advantages over other chronic pain management modalities and its use has been increasing over the past decade. Among the growing population with comorbid conduction disorders and persistent pain, RFA and its potential interference with implantable cardiac devices is of concern.RFA is becoming a foundational element of persistent pain management and has been shown to be effective in a multitude of chronic pain syndromes. Cardiac implantable electronic devices (CIED), such as cardiac pacemakers or implantable cardioverter defibrillators, have been used in the treatment of cardiac conduction diseases for a number of decades. With our aging population, these diseases have increased in both incidence and prevalence. Chronic pain and cardiac conduction diseases are both common in our increasingly aging population. This study aims to determine if the literature supports the hypothesis that patients with CIEDs can safely use RFA with minimal to no interaction. Systematic assessment of literature with a modified approach with bipolar RFA. A narrative review with systematic assessment of the literature was carried out. In this review, we included randomized controlled trials (RCTs), open non-randomized control studies, prospective studies, retrospective studies, case series, and case reports. All types of radiofrequency utilized for pain management including pulsed and conventional were included. Outcome measures included interactions between the cardiovascular implantable electronic device (CIED) and radiofrequency ablation (RFA), adverse events, RFA efficacy in treating the pain using pain scores, and other complications. Our search criteria yielded 4 studies for inclusion, with inclusion of 33 patients and 71 bipolar radiofrequency for treatments. No adverse events or interactions occurred between the bipolar radiofrequency device and the implanted cardiac devices in any of these patients. Bipolar radiofrequency was utilized in all patients (n = 33). Overall there were no complications or malfunctions. Small sample size, narrative review. This study provides evidence that bipolar RFA can be safely used in patients with CIEDs for chronic pain provided that proper precautions are employed. Considerations for safe use are provided.

The effectiveness of the combined use of RF therapy and laser technology in the correction of involutive changes in the skin of the face

Bipolar radio-frequency devices have all the theoretical prerequisites for use in combination with phototechnologies, while the properties of electro-optical synergy are manifested.
 Material and method. The study included 125 patients aged 40 to 50 years. Depending on the therapy, patients were divided into 4 groups and subgroups A and B, depending on the identified predictors of the effectiveness of laser therapy.
 The results of the study. After applying the combined methods, a more significant improvement in the quality characteristics of the skin was noted: an increase in skin moisture in the 1A group, the corneometry index increased by 24.6%, in the 1st group by 28.3%, in the 2A group by 38.9%, in the 2B group by 37.3%, in the 3A group by 29.1%, in the 3B group by 27.5%, in the 4A group by 38.8%, in the 4B group by 38.8%; an increase in skin elasticity in group 1A, the Ua/Uf indicator increased by 13.2%, in group 1B by 13.9%, in group 2A by 27.9%, in group 2B by 29.0%, in group 3A by 14.9%, in the 3B group by 14.6%, in the 4A group by 28.2%, in the 4B group by 28.2%, which was accompanied by a more pronounced decrease in the severity of wrinkles according to profilometry. The use of laser therapy (an erbium or neodymium laser) and microneedle RF therapy contributes to a more significant restoration of the epidermal-dermal structure of the skin, which is confirmed by ultrasound data: the microrelief has improved by more than 3 times compared with monotherapy, the thickness of the dermis is 2.2 times and acoustic density 1.7 times.
 Conclusions. Combined methods, to a greater extent than mono-laser therapy, contribute to improving the quality of life of patients according to the dynamics of the LHC index, which decreased in groups 1 and 3 by an average of 47.1% and 44.4% versus 57.8% and 64.3% in 2 and 4 groups, while there was a significant difference in the values of the index of HSCI in groups A and B (p 0.01). In accordance with the VAS and GAIS indicators, the optimal effect after a course of therapy with preservation of the results after 1 year was achieved in 25/12.5% of patients in group 1A, in 46.7/33.3% in group 1B, 7/37.5% of patients of group 2A, 78.6/71.4% of patients of group 2B, 33.3/20.0% of patients of group 3A, 50.0/25% of patients 3B groups, 58.8/58.8% and 75.0/75.0% in patients 4A and 4B of the group, respectively, which indicates the high efficiency of the combined methods and the persistence of the results.

A novel internal cold circulation radiofrequency-assisted device for liver transection

Purpose To evaluate the safety and efficacy of a new internal cold circulation bipolar radiofrequency compared with Habib-4X bipolar radiofrequency device in the resection of liver tumors. Methods A total of 85 patients with hepatocellular carcinoma who received radiofrequency-assisted liver resection from February 2017 to January 2020 were retrospectively enrolled in our study, in which 45 patients received the new internal cold circulation bipolar radiofrequency (New-RF) and 40 patients received Habib-4X bipolar radiofrequency (Habib-4X). Primary outcome measures were the speed of liver transection, the width of coagulation tissue, hemorrhage volume, blood transfusion rate, and operation time. Results The baseline characteristics of patients in the New-RF and Habib-4X groups had no significant difference (p > 0.05). Compared to Habib-4X, the New-RF had a faster average speed of liver transection (4.81 ± 1.20 cm2/min vs 3.64 ± 1.08 cm2/min, p < 0.001), a narrower width of coagulation tissue (1.42 ± 0.23 cm2 vs 1.81 ± 0.20 cm2, p < 0.001), a less operation time (55.04 ± 16.12 min vs 64.02 ± 15.09 min, p = 0.010), a lower rate of needle path bleeding (13.3% vs 35.0%, p = 0.019), and a lower carbonization rate of electrode needle (22.2% vs 77.8%, p < 0.001). Hemorrhage during the transection (85.0 ml vs 105.0 ml, p = 0.438) and hemorrhage per square centimeter (3.28 ± 0.86 ml/cm2 vs 3.60 ± 1.12 ml/cm2, p = 0.141) in the New-RF group were smaller than those in Habib-4X group with no significant difference. Conclusion The new internal cold circulation bipolar radiofrequency was a safe and efficacious auxiliary device for liver resection with a faster speed of resection, lower carbonization rate of electrode needle, and more precise range of coagulation.