Pulsed Radiofrequency Energy Research Articles

Non-pharmacological interventions of intermittent fasting and pulsed radiofrequency energy (PRFE) combination therapy promote diabetic wound healing

ObjectiveThis study aims to conduct an unbiased assessment of the synergistic effects of non-pharmacological Interventions of intermittent fasting and pulsed radiofrequency energy (PRFE) combination therapy on the facilitation of diabetic wound healing, while also exploring the underlying mechanisms. The findings of this research will provide a theoretical framework and innovative strategy for unconventional therapeutic interventions aimed at enhancing the healing process of diabetes-related wounds.MethodsIn vivo experiments involved the induction of diabetic models in C57 mice through streptozotocin injection. To simulate a combined therapeutic approach, diabetic mice underwent fasting on days 2 and 6, accompanied by twice daily PRFE applications for 8 days. In vitro experiments were conducted using a serum-free culture medium to replicate fasting conditions. The investigation encompassed wound healing rate, proliferation, migration, angiogenesis, oxidative stress, fibrogenesis, and sensory nerve growth through histological analysis and functional assessments in vivo. Additionally, this study utilized quantitative reverse transcription polymerase chain reaction (qRT-PCR), western blotting (WB), and immunofluorescence staining techniques to elucidate the potential mechanisms underlying the effects of intermittent Fasting and PRFE combination therapy in diabetic wound healing, both in vitro and in vivo.ResultsThe intermittent fasting and PRFE combination therapy demonstrated superior efficacy in enhancing diabetic wound healing compared to either treatment alone. It harnessed the respective strengths of individual therapies, fostering migration, mitigating oxidative stress, and enhancing fibrogenesis. Furthermore, the combination therapy manifested a synergistic effect in promoting proliferation, tube formation, angiogenesis, and sensory nerve growth.ConclusionThis study demonstrates that intermittent fasting and PRFE combination therapy enhance diabetic wound healing, effectively leveraging the strengths of both therapies and even yielding synergistic benefits. Moreover, it indicates the potential engagement of the P75/HIF1A/VEGFA axis in mediating these effects.

Real-world multicenter registry on a novel focal lattice tip catheter toggling between pulsed electric field and radiofrequency for atrial tachyarrhythmia ablation

Abstract Background Pulsed field ablation (PFA) has emerged as a novel non-thermal energy source for cardiac tissue ablation. A novel focal 9mm lattice tip catheter, namely Sphere-9 (Affera Inc), has recently received regulatory approval; the technology is part of a technology that allows the delivery of either pulsed electric field or radiofrequency energy and incorporates a proprietary 3D electroanatomical mapping system. Purpose To describe the first real-world, multicenter experience with the AfferaTM system. Methods Consecutive AF patients undergoing first-time or redo atrial tachyarrhythmia ablation with the AfferaTM system in two different centres between August and November 2023 were prospectively enrolled. PFA was always used to ablate the posterior left atrium, whereas anterior applications were performed using either radiofrequency energy (RF/PF strategy) or PFA (PF/PF strategy) based on operator's discretion. Data on first-pass pulmonary vein isolation (PVI) and posterior wall isolation (PWI), as well as success rate of extrapulmonary ablation were reported. Primary safety endpoint included any technology-related periprocedural complications. Results 46 patients (mean age: 67±10; 41.3% males, 60.8% non-paroxysmal AF) were included. 5 (10.8%) patients were in atrial flutter (AFlu) at the beginning of the procedure, whereas AF was the rhythm at presentation in 19 (41.3%) others. First-time PVI was performed in 37 (80.4%) patients, 68.4% of whom received concomitant PWI. PVI was performed with PFA-only in 27% of them. First-pass isolation was achieved in 97.3% and 100% of PVI and PWI cases, respectively. Additional lesions included an anterior or posterior mitral line (6 and 15 patients), CTI (4 patients) or substrate ablation in 3 patients. Evidence of first-pass line block was documented in 96.4% of patients. The remaining 9 (19.6%) patients had already undergone a previous ablation; remapping showed 27.7% of PVs requiring reisolation. PWI was performed in 88.9% of them, for the first time (75%) or due to reconnection (25%). Additional lesions included an anterior or posterior mitral line (3 and 3 patients) or CTI in 2 patients. Evidence of first-pass line block was documented in 100% of patients. In 3 AFlu patients, the arrhythmia was mapped and termination was achieved while performing an AML (2 patients) and CTI (1 patient). Procedural duration was 96.5±15.6 min for first time and 97.8±12.6 min for redo procedures. Mean left atrial dwelling and fluoroscopy times were 75.4±17.6 min and 7.36±2.1 min, respectively. No technology-related complications were documented. Conclusions AF ablation with the focal 9-mm lattice tip catheter Sphere-9 confirmed high efficacy and safety in a real-world population.

Pulsed High-Power Radio Frequency Energy Can Cause Non-Thermal Harmful Effects on the BRAIN.

High-power microwave applications are growing for both military and civil purposes, yet they can induce brain-related risks and raise important public health concerns. High-power sub-millisecond radio frequency energy pulses have been demonstrated to be able to induce neurological and neuropathological changes in the brain while being compliant with current regulatory guidelines' limits, highlighting the necessity of revising them.

Ultrastructural insights from myocardial ablation lesions from microsecond pulsed field vs radiofrequency energy

BackgroundUltrastructural findings immediately after pulsed field ablation (PFA) of the myocardium have not been described. ObjectivesThe purpose of this study was to elucidate ultrastructural characteristics and differences between microsecond PFA at the 1- and 4-hour timepoints after pulse delivery and to compare them to irrigated radiofrequency ablation (RFA) lesions. MethodsHealthy swine underwent endocardial PFA or RFA followed by necropsy. Discrete microsecond PFA and irrigated RFA lesions were created in the ventricles with a lattice tip ablation catheter. Lesions were delivered in a manner so as to allow sampling to occur 1 and 4 hours after ablation. All lesions were located at necropsy, and samples were carefully obtained from within the lesion core, lesion periphery, and adjacent healthy myocardium. Transmission electron microscopic assessment was performed after fixation using paraformaldehyde and glutaraldehyde. ResultsOne hour after microsecond PFA delivery, myocytes were noted to be significantly and uniformly disrupted. Clustered, misaligned, swollen mitochondria coupled with degenerating nuclei and condensed chromatin were visualized. These findings progressed over the subsequent few hours with worsening edema. Similar changes were seen with RFA but reduced in severity. However, there was prominent extravasation of red blood cells with occlusion of capillaries that was not seen in PFA. At the lesion periphery, an abrupt change in the degree of myocyte damage was observed with PFA but not RFA. ConclusionTransmission electron microscopy demonstrates evidence of widespread destruction of myocytes as early as an hour after PFA and corroborates known histologic features such as sparing of vessels and sharp lesion margins.

Detrusor nerve radiofrequency ablation (DENERA): Experimental study of safety and efficacy in an ovine model.

The subtrigonal perivesical nerve plexus contains a large proportion of the bladder's innervation. A transurethral radiofrequency ablation approach has successfully denervated this region to alleviate overactive bladder symptoms, with some urothelial heat injury. We report a novel transvaginal RFA device (DENERA) and assess its feasibility and efficacy in denervating the perivesical nerve plexus of in vivo sheep. In 14 adult female in vivo sheep, pulsed radiofrequency energy was applied transvaginally for three cycles of 4 min, maintaining the tissue temperature at 45°C, with 30 s of rest between each cycle. The control group (n = 4) was sacrificed without ablation, and various groups were sacrificed 1 week (n = 3), 4 weeks (n = 4), and 12 weeks (n = 3) after ablation. The bladder subtrigones were harvested then analyzed with H&E, S100, and TH immunostaining to quantify their neural density and neural vacuolization. The ablation procedure increased the neural vacuolization the most at 1 week and decreased the neural density the most at 4 weeks, with both variables displaying a significant change followed by a slight rebound towards baseline at 12 weeks. The H&E analysis showed that the needles penetrated deep into the subtrigonal detrusor muscle. The sheep recovered from the procedure with no complications or damage in the bladder wall or urothelium. This study shows that one DENERA treatment can cause subtrigonal denervation with some rebound afterwards and no complications. DENERA may become a promising OAB treatment option that can ablate the perivesical plexus without harming the urothelium.

Discussion to: Septal myectomy for hypertrophic obstructive cardiomyopathy using a pulsed radiofrequency energy soft tissue dissection instrument

Discussion to: Septal myectomy for hypertrophic obstructive cardiomyopathy using a pulsed radiofrequency energy soft tissue dissection instrument

PO-01-105 PRECLINICAL EVALUATION OF ACUTE AND CHRONIC CIRCUMFERENTIAL, LINEAR AND FOCAL PULSED FIELD ABLATION LESION SETS CREATED USING A “MAP & ABLATE” SPHERICAL MULTIELECTRODE ARRAY CATHETER

A multielectrode spherical array catheter (Globe PF System, Kardium Inc., Canada) capable of both cardiac mapping and ablation with either pulsed field (PF) or radiofrequency (RF) energy has been developed. To assess efficacy and safety of creating flexible PFA lesion sets. Healthy canines (n=12) underwent transeptal access under general anesthesia. Electroanatomic maps with ostial tags, contact maps based on blood flow detection, and animated voltage maps were created. PFA was delivered at two strengths (1.7 & 1.8kV)and two pulse train designs (6 x 1.5-2 sec pulse-time or 3 x 3-4 sec pulse-time) to isolate a minimum of 2 pulmonary veins (PVs) (∼1 application) and to create linear/focal lesions. Animals survived in acute (n=6; 3±1 days survival) and chronic (n=12; 30±3 days survival) cohorts. In the chronic cohort, a repeat electrophysiological study was performed followed by detailed necropsy. In 12 animals, all targeted PVs (25/25, 100%) were acutely and durably isolated (13/13,100%). Discrete ablation on the roof and on the posterior wall was also successful in all 12 animals. Phrenic activation was only seen at one ablation site in one animal in each cohort. All 12 animals completed their survival period and gross pathological analysis revealed contiguous pink to dark-red lesions and pale-homogenous lesions in the acute and chronic cohorts, respectively. No thrombus or char was observed on the catheter. Histology revealed mean transmurality rates of 95.7% and 91% for the 74 and 75 sections analyzed in the acute and chronic cohorts, respectively. The lesion mean depths were 3.0±1.8 and 1.6±0.9 mm in the acute and chronic cohorts, respectively. There were variable amounts of hemorrhage and a minimal to moderate acute inflammatory response in the acute cohort. In the 2/6 canines that underwent necropsy on day 4 (the other 4 underwent necropsy on day 2 or 3), fibroblast proliferation was noted in addition to the above findings. In the chronic group, the entire lesion was replaced with fibrous connective tissue. No ablation damage to extracardiac structures was found. There were no signs of thromboembolism in any downstream organs, including no brain infarcts. This multielectrode spherical array catheter can deliver pulsed field ablation to both isolate PVs and deliver extra-PV left atrial lesions. These data provide the basis for ongoing and future clinical trials.

Pulsed radiofrequency applied to the suprascapular nerve before rotator cuff tear arthroscopic repair: A prospective randomized clinical trial

Background: clinical studies have demonstrated the efficacy of pulsed radiofrequency (PRF) in treating many pain syndromes. PRF energy is delivered via a percutaneous needle under an image guide to reach the suprascapular nerve as it supplies more than 70% of the shoulder sensation. PRF was introduced as a non-destructive minimally invasive procedure in comparison with arthroscopic management of rotator cuff injury. However, there is a controversy regarding both measures in treating shoulder pain in rotator cuff injuries as standard methods. Objective: to evaluate the ability of PRF to produce shoulder pain relief by applying of PRF to the suprascapular nerve and measure the pain relief by VAS score at various time intervals prior to arthroscopic repair for rotator cuff injuries. The study should be in comparison with control group undergo arthroscopic repair without attacking of the suprascapular nerve by PRF. Methods: a prospective randomised controlled trial study including 40 patients divided as PRF or (P) group and control group (C) group equally. Each patient in our study whom their history and examination were fulfilled quietly including pain assessment by Visual Assessment Score (VAS). In The (P) group, a needle is inserted through a well-known point in the shoulder leading directly to the suprascapular notch (where the nerve is hooked above it) under image guidance. Radiofrequency waves at 2Hz of 20 milliseconds and 42 C in the pattern of three cycles each one lasting for 120 seconds. VAS score was assessed postoperatively for 7 time intervals starting from immediate postoperative (after arthroscopic repair) up to 3 months. Result: Pulsed radiofrequency produced dramatic progressive pain relief throughout our study time. In the 1st 48 hours, the VAS score dropped about 30% in (P) group with comparison to 22% in control group. At 3 months interval the VAS score was reduced by 45% from the preoperative period in comparison to 23% of the control group (P=0.000) Conclusion PRF is the safest, optimally invasive method to treat shoulder joint pain in rotator cuff injuries especially in unfitted patients for surgeries.

Hypertrophic Scars of the Hand: The Role of Electrophotobiomodulation Theory as a Recent Line of Treatment.

A more enduring strategy for the treatment of hypertrophic scars of the hand is still a challenge facing restorative dermatologists and plastic surgeons. Nonetheless, with the use of nonablative devices, intense pulsed light and different types of lasers have started to yield promising outcomes and are close to becoming an effective and dependable technique. The advances in radiofrequency energy have brought new life to optical-based frameworks. Radiofrequency current delivers an unadulterated heat effect according to the electrical response characteristics of each tissue. The purpose of this study was to assess the patient satisfaction, safety, and clinical efficacy of the use of electrophotobiomodulation (combined intense pulsed light and radiofrequency energy) in the treatment of postburn hypertrophic scars of the hand. This was a prospective clinical study that was performed on 56 patients who presented with postburn hypertrophic scars on the hands between March of 2013 and January of 2020. The clinical appraisal showed excellent results in 33 patients (58.9%), good results in 18 patients (32.2%), fair results in five patients (8.9%), and no poor results. The use of radiofrequency energy combined with intense pulsed light was effective for the treatment of hand scars on people with various skin tones. Therapeutic, IV.

Ki-67% Response to Pulsed Radio Frequency Energy on Chronic Wound Healing in Patients with Diabetic Foot Ulcer

Ki-67% Response to Pulsed Radio Frequency Energy on Chronic Wound Healing in Patients with Diabetic Foot Ulcer

Investigations Continue into Mysterious Illness Affecting U.S. Officials in Havana and Elsewhere

In late 2016, officials at U.S. and Canadian diplomatic posts in Havana, Cuba, began reporting a cluster of symptoms, including nausea, severe headaches, and dizziness, that came to be known as “Havana Syndrome.” The illnesses prompted the departure of U.S. personnel from Havana in 2017, and subsequent cases have been reported among personnel assigned to the U.S. consulate in Guangzhou, China and elsewhere. In recent months, three reports related to the illnesses and the government's response have become public. A Center for Disease Control (CDC) report examined medical records and produced a case definition. A National Academies for Sciences, Engineering, and Medicine (NASEM) standing committee considered possible causes, including “directed, pulsed radio frequency (RF) energy, . . . chemical exposures, infectious diseases and psychological issues,” and concluded that the symptoms were consistent with RF effects. Additionally, a recently declassified Accountability Review Board (ARB) report criticized the Trump administration's response to the illnesses in Havana. Amid reports of increasing cases, including some occurring in the United States, the Biden administration is attempting to determine the cause of the illness and has committed to support affected personnel.

Dissection using pulsed radiofrequency energy device (PlasmaBlade) is safe and efficient in experimental revision neuromodulation implant surgery

Background The use of functional neurosurgical implants has increased over the past 10 years. PlasmaBlade is an innovative electrosurgical appliance harnessing pulsed radiofrequency (RF) energy. Our aim was to assess the risk of damage to neuromodulation hardware during PlasmaBlade dissection. Materials and methods A simulated setting with chicken breast threaded with different hardware and PlasmaBlade used in three configurations. . Post dissection, the wires were inspected naked eye and under an operating microscope. The induced current was assessed contemporaneously using an oscilloscope. Results Five surgeons tested the PlasmaBlade at different generator settings. Sixty dissections were undertaken. No structural damage or induced current was identified at CUT 3/4, COAG 5. At CUT 6, COAG 5 and during dissection in a perpendicular orientation with prolonged hardware contact, opacification of insulation material occurred in 15/20 dissections. There was no dissolution of insulation even at this setting. On deviation from Medtronic advice, hardware damaged occurred if one was reckless with the PlasmaBlade. Conclusion When using the recommended settings and operational technique, PlasmaBlade dissection did not cause any damage to implant wiring/tubing in this simulated setting. This report seeks to add to clinical data suggesting PlasmaBlade is safe for dissection around deep brain stimulator (DBS), vagal nerve stimulator (VNS), and spinal cord stimulator (SCS) hardware.

Focal Pulsed Field Ablation for Pulmonary Vein Isolation and Linear Atrial Lesions: A Preclinical Assessment of Safety and Durability.

A novel ablation and mapping system can toggle between delivering biphasic pulsed field (PF) and radiofrequency energy from a 9-mm lattice-tip catheter. We assessed the preclinical feasibility and safety of (1) focal PF-based thoracic vein isolation and linear ablation, (2) combined PF and radiofrequency focal ablation, and (3) PF delivered directly atop the esophagus. Two cohorts of 6 swine were treated with pulsed fields at low dose (PFLD) and high dose (PFHD) and followed for 4 and 2 weeks, respectively, to isolate 25 thoracic veins and create 5 right atrial (PFLD), 6 mitral (PFHD), and 6 roof lines (radiofrequency+PFHD). Baseline and follow-up voltage mapping, venous potentials, ostial diameters, and phrenic nerve viability were assessed. PFHD and radiofrequency lesions were delivered in 4 and 1 swine from the inferior vena cava onto a forcefully deviated esophagus. All tissues were submitted for histopathology. Hundred percent of thoracic veins (25 of 25) were successfully isolated with 12.4±3.6 applications/vein with mean PF times of <90 seconds/vein. Durable isolation improved from 61.5% PFLD to 100% with PFHD (P=0.04), and all linear lesions were successfully completed without incurring venous stenoses or phrenic injury. PFHD sections had higher transmurality rates than PFLD (98.3% versus 88.1%; P=0.03) despite greater mean thickness (2.5 versus 1.3 mm; P<0.001). PF lesions demonstrated homogenous fibrosis without epicardial fat, nerve, or vessel involvement. In comparison, radiofrequency+PFHD sections revealed similar transmurality but expectedly more necrosis, inflammation, and epicardial fat, nerve, and vessel involvement. Significant ablation-related esophageal necrosis, inflammation, and fibrosis were seen in all radiofrequency sections, as compared with no PF sections. The lattice-tip catheter can deliver focal PF to durably isolate veins and create linear lesions with excellent transmurality and without complications. The PF lesions did not damage the phrenic nerve, vessels, and the esophagus.

Pulsed radiofrequency energy device (PEAK plasmablade™) and CustomBone® Cranioplasty: an appealing surgical rendez-vous

Background CustomBone® prosthesis is a widely recognized effective and successful technique for the reconstruction of cranial bone defects. Prior the cranioplasty implant, meticulous dissection within thick scar tissue is required. During this delicate surgical manoeuvre is vital to avoid damage to the skin flap itself and to the underlying cerebrovascular structures. We report our experience and potential applications of a novel, pulsed monopolar radiofrequency energy device (PEAK PlasmaBlade™, Medtronic plc). It reduced the incidence of post operativesubgaleal hematoma, the operative times and the intra operative blood loss following cranioplasty compared to the traditional scalpel and scissor dissection. Methods The authors present a one centre case series study to review the indications, safety and efficacy of the PEAK PlasmaBlade™ in adult patientsunderwent cranioplasty. Two surgical techniques for tissue dissection were compared: PEAK PlasmaBlade™ versus scalpel and scissor dissection (SSD). Treatment outcomes following each of these surgical approaches, relative to rate of post-operative subgalealhematoma formation, hospital admission, and operative times were compared. Results A total of 10 patients that had cranioplasty treatment were evaluated. In patients underwent scalp dissection with the PEAKPlasmaBlade™, we observed a reduction in the operative times, in the subgaleal hematoma formation and then in the hospital stay. Conclusion PEAK PlasmaBlade™ revealed to be a safe and effective device in tissues dissection for cranioplasty implant. It provided reduction of the rate of subgaleal hematoma formation, operating times and less potential risk to damage cerebrovascular structures.

P29 Dissection using pulsed radiofrequency energy device (PlasmaBlade) is safe round implanted neuromodulation hardwares

ObjectivesTo assess risk of damage to implanted neuromodulation hardware’s during dissection using the pulsed radiofrequency energy device (PlasmaBlade) in a simulated setting.DesignSimulated experiment.MethodsA simulated setting with fresh chicken breast threaded with different hardwires and PlasmaBlade in three configurations. Multiple substrates (wires), operators and observations were used representing typical hardware encountered in a functional neurosurgery service. Post dissection, the wires are inspected naked eye and under operating microscope. Induced current was assessed contemporaneously. A simple risk of physical and physiological damage is estimated.ResultsFive surgeons, of various grades, tested the PlasmaBlade at different CUT and COAG settings. Sixty dissections were undertaken. There was no structural damage and no induced current identified when PlasmaBlade was used at manufacturer recommended settings. At higher settings than would normally be used (CUT 6, COAG 5), there was opacification of insulation material of some wires (in 15 of 20 dissections; 75%), There was no dissolution of insulation even at this setting. Surgeons appreciated visibly lesser collateral damage to tissue and lesser smoke in the operative field using PlasmaBlade compared to conventional diathermy.ConclusionsWhen used at recommended settings, PlasmaBlade dissection did not cause any damage to implant wiring or tubing in this simulated setting. This report seeks to add to clinical data suggesting PlasmaBlade dissection is safe for dissection around DBS, SCS, VNS, ITB hardware.

Skeletonized internal thoracic artery harvesting: a low thermal damage electrosurgical device provides improved endothelial layer and tendency to better integrity of the vessel wall compared to conventional electrosurgery

BackgroundElectrosurgery is fundamental to the precise, fast and bloodless preparation of internal thoracic artery grafts in cardiac surgery. The PEAK PlasmaBlade is a monopolar electrosurgical device that uses pulsed radiofrequency energy to generate a plasma-mediated discharge along an insulated electrode, creating a cutting edge while the blade stays near body temperature. The aim of this study is to compare the histological samples, cardiac computed-tomography of graft patency, and clinical outcomes of patients after off-pump coronary artery bypass grafting with preparation of the internal thoracic arteries by a conventional electrosurgical device and the PlasmaBlade.MethodsIn twenty subjects one internal thoracic artery was prepared with PlasmaBlade and the other artery with a conventional electrosurgical device. Histological samples were evaluated for three factors for potential graft failure: endothelial damage, integrity of the vessel wall and adventitial hemorrhage. Five samples per artery were evaluated by a novel scoring method based on the exposed circumference of the histological sample (“0”: 0%, “1”: 1–25%, “2”: 26–50%, “3”: 51–75%, “4”: ≥76% of the circumference). The Wilcoxon signed ranks test for mean scores within subjects was performed. Six-month-follow up by cardiac computed tomography for evaluation of graft patency was completed in 16 patients.ResultsHistological results demonstrated significantly less endothelial damage after PlasmaBlade (83% vs 60%, absolute: 75/90 vs. 53/89 samples with score “0–1”, p = 0.04). PlasmaBlade samples demonstrated a tendency to better wall integrity (72% vs. 54%, absolute: 64/89 vs. 47/87 samples with score “0–1”, p = 0.32). There were no differences in endothelial bleeding (PlasmaBlade 46% vs. electrosurgery 53%, absolute: 41/88 vs. 48/90 samples with score “0–1”, p = 0.63). Computed tomography confirmed non-inferiority of the PlasmaBlade to conventional electrosurgery with a patency rate of 94%.ConclusionHistologically, internal thoracic arteries harvested with PlasmaBlade demonstrate a more intact endothelial layer and a tendency to better wall integrity. Computed tomography of graft patency speaks for non-inferiority to conventional electrosurgery. PlasmaBlade may be preferable to conventional electrosurgery, if further follow-up confirms patency of internal thoracic arteries.Trial registrationNCT03510026, registered 4th April 2018 (retrospectively registered).

Novel Application of Pulsed Radiofrequency Energy Device (PEAK Plasmablade) in Neurosurgical Reconstructive Surgery

Novel Application of Pulsed Radiofrequency Energy Device (PEAK Plasmablade) in Neurosurgical Reconstructive Surgery

Comparative assessment of pulsed electromagnetic fields (PEMF) and pulsed radio frequency energy (PRFE) on an in vitro wound healing model

Comparative assessment of pulsed electromagnetic fields (PEMF) and pulsed radio frequency energy (PRFE) on an in vitro wound healing model

Use of Pulsed Radiofrequency Energy Device (PEAK Plasmablade) in Neuromodulation Implant Revisions.

Battery replacement or revision surgery for neuromodulation implants is conventionally performed using sharp dissection. Meticulous dissection within thick scar tissue is vital to avoid damage to surrounding lead(s), which could result in more extensive revision surgery. Traditional electrosurgery devices are contraindicated as the emitted energy can be transferred to the hardware, resulting in implant or tissue damage with severe consequent complications. We report our experience and potential applications of a novel, pulsed monopolar radiofrequency energy device (PEAK PlasmaBlade, Medtronic PLC, Minneapolis, Minnesota, USA), which facilitates dissection around implants without the risk of damaging or transmitting energy through the system. We conducted a 2-center retrospective study to review the indications, safety, and efficacy of the PlasmaBlade in 57 cases requiring either neuromodulation system replacement or revision. Deep brain stimulator (DBS) battery replacements were undertaken in 45 cases, 8 vagal nerve stimulator battery revisions, 2 intrathecal baclofen system revision, 1 DBS extension revision, and 1 DBS scar revision around the cranial portion of the lead. All cases proceeded without adverse event or damage to lead/generator and with a subjective and objective impression of significant time savings. Average operating times for battery replacements were reduced from 37 to 26 minutes (P= 0.015). In our experience, the PlasmaBlade is safe to use in revising/replacing neuromodulation implants. We observed no damage or transmission of energy to the implants or leads; additional advantages of the system include reduced operating times, less damage to surrounding tissue, and the potential to facilitate revision procedures in awake patients under local anesthesia.

Treatment of recalcitrant port-wine stains (PWS) using a combined pulsed dye laser (PDL) and radiofrequency (RF) energy device

Pulsed dye laser (PDL) is the treatment of choice for port-wine stains (PWS). Some PWS are recalcitrant to this modality. A number of reasons for PDL treatment resistance have been described, including inadequate heat generation. We evaluated PDL combined with radiofrequency (RF) energy into a single device to target larger and deeper blood vessels and overcome PDL resistance. This was an open-label, prospective, single-center investigation of a novel device combining RF energy with PDL conducted to treat recalcitrant PWS. Ten patients with 11 recalcitrant PWS were enrolled. Each PWS was divided into 5 treatment areas: PDL alone, RF alone, PDL+RF, RF+PDL, and untreated control. Patients underwent a maximum of 6 treatments, scheduled 4 to 6weeks apart with follow-up evaluation at 4 and 12weeks after the final treatment. Colorimetry and standardized digital photography were performed at all visits. Lesional biopsy specimens were collected for selected patients. Areas treated with RF followed by PDL and PDL followed by RF showed the greatest improvement based on blinded review of digital photographs, reaching statistical significance (P value<.05) at the 12-week follow-up evaluation when compared with baseline. Adverse events, including purpura, erythema, edema, scabbing, crusting, and blistering, resolved without sequelae; a small residual scar was noted in 1 patient. Small sample size and short follow-up period are limitations. Combined RF/PDL technology is promising for the treatment of recalcitrant PWS.