Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI 02903, USA.
Eur J Radiol. 2011 Sep;79(3):343-6. doi: 10.1016/j.ejrad.2010.04.004. Epub 2010 Apr 30.
To identify malfunction of implanted cardiac devices during or after thermal ablation of tumors in lung, kidney, liver or bone, using radiofrequency (RF) or microwave (MW) energy.
After providing written consent, 19 patients (15 men and 4 women; mean age 78 years) with pacemakers or pacemaker/defibrillators underwent 22 CT image-guided percutaneous RF or MW ablation of a variety of tumors. Before and after each procedure, cardiac devices were interrogated and reprogrammed by a trained cardiac electrophysiology fellow. Possible pacer malfunctions included abnormalities on electrocardiographic (EKG) monitoring and alterations in device settings. Our institutional review board approved this Health Insurance Portability and Accountability Act-compliant study. Informed consent for participation in this retrospective study was deemed unnecessary by our review board.
During 20 of 22 sessions, no abnormalities were identified in continuous, EKG tracings or pacemaker functions. However, in two sessions significant changes, occurred in pacemaker parameters: inhibition of pacing during RF application in one, session and resetting of mode by RF energy in another session. These changes did not, result in hemodynamic instability of either patient. MW ablation was not associated with, any malfunction. In all 22 sessions, pacemakers were undamaged and successfully reset to original parameters.
RF or MW ablation of tumors in liver, kidney, bone and lung can be performed safely in patients with permanent intra-cardiac devices, but careful planning between radiology and cardiology is essential to avoid adverse outcomes.
使用射频 (RF) 或微波 (MW) 能量，在肺、肾、肝或骨肿瘤的热消融过程中或之后，识别植入式心脏设备的故障。
在提供书面同意后，19 名患者（15 名男性和 4 名女性；平均年龄 78 岁）接受了 22 次 CT 引导下经皮 RF 或 MW 消融各种肿瘤的治疗。在每次治疗前后，经过训练的心脏电生理研究员都会对心脏设备进行询问和重新编程。可能出现的起搏器故障包括心电图 (EKG) 监测异常和设备设置改变。我们的机构审查委员会批准了这项符合《健康保险流通与责任法案》的研究。我们的审查委员会认为，参与这项回顾性研究的知情同意是不必要的。
在 22 次治疗中的 20 次中，连续的 EKG 描记或起搏器功能未发现异常。然而，在两次治疗中，起搏器参数发生了显著变化：一次治疗中 RF 应用期间起搏抑制，另一次治疗中 RF 能量重置模式。这些变化并未导致两名患者的血液动力学不稳定。MW 消融与任何故障无关。在所有 22 次治疗中，起搏器均未损坏，并成功重置为原始参数。
在有永久性心脏内设备的患者中，肝脏、肾脏、骨骼和肺部肿瘤的 RF 或 MW 消融可以安全进行，但影像学和心脏病学之间需要仔细规划，以避免不良后果。
