Attending Physician Greater LA VA Los Angeles, California, United States
Case Diagnosis: Radiofrequency ablation (RFA) of the pulmonary vein is a common interventional technique to restore sinus rhythm (SR) in patients with atrial fibrillation (afib). Effect of non-cardiopulmonary RFA on the heart rhythm in patients with arrhythmia is not well studied. Here we present a case of a patient with afib who spontaneously converted to SR during spine RFA.
Case Description: This is a male patient in his 80s with afib, non-ischemic cardiomyopathy, pulmonary hypertension, and sick sinus syndrome who underwent Metronic biventricular pacemaker placement. He was evaluated in the interventional pain clinic for back pain due to lumbar facet arthropathy and subsequently underwent lumbar L3-5 medial branch RFA. RFA was performed at each level with the needle tip temperature set to 80 degrees centigrade for 90 seconds. Same day pre-operative pacemaker interrogation demonstrated pt was in afib with complete heart block with slow ventricular escape, with afib burden of 16%. Post-operative pacemaker interrogation done right after his lumbar RFA demonstrated patient’s afib has converted to sinus during procedure with no tachyarrhythmia captured during the procedure. Patient tolerated procedure well without complications and reported improved pain at follow-up. Repeat pacemaker interrogation 4 months later demonstrated patient is back in afib.
Discussions: To our knowledge, this is the first case report presenting a patient who converted from afib to SR during a non-cardiopulmonary RFA. The use of RFA is based on the premise that transmission of radiofrequency waves near a local tissue causing tissue disruption. Our study suggests that RFAs may have effects in distant tissues, although may not be sustained.
Conclusions: RFA is a common interventional pain procedure utilized for facet-generated pain. Prior to performing this procedure, is important to consider its potential effect on patients’ implanted devices and consult appropriate specialties as needed.
