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Melvin M. Scheinman - One of the best experts on this subject based on the ideXlab platform.
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Comparison of high energy direct current and Radiofrequency catheter ablation of the atrioventricular junction
Journal of the American College of Cardiology, 1993Co-Authors: Jeffrey E. Olgin, Melvin M. ScheinmanAbstract:The goal of the study was to determine short- and long-term success and complications of Radiofrequency atrioventricular (AV) junction catheter ablation and to compare these with those of high energy direct current catheter ablation. Catheter ablation of the AV junction with Radiofrequency or direct current energy is an accepted treatment for drug-refractory supraventricular tachycardias. Few data are available on the long-term success and effects of Radiofrequency ablation or its comparison with direct current ablation. Fifty-four patients who underwent attempted AV junction ablation with Radiofrequency energy were followed up for a mean of 24 +/- 8.4 months. These patients were retrospectively compared with 49 patients who underwent attempted AV junction ablation with direct current energy and were followed up for a mean of 41 +/- 23 months. The early success rate at the time of discharge for Radiofrequency ablation was 81.5%, which was not statistically different from that for direct current ablation (85.7%). Fewer sessions were required to achieve complete AV block in the Radiofrequency group (1.05 +/- 0.23) (mean +/- SD) compared with the direct current group (1.21 +/- 0.41) (p = 0.02). Although overall complication rates were similar for both groups (9.3% in the Radiofrequency group and 8.2% in the direct current group), there was a trend toward more life-threatening early complications in those patients who received direct-current shocks (6.8%) than in those who underwent Radiofrequency ablation alone (2.3%) (p = 0.1). Early sudden death (one patient), early ventricular tachycardia (two patients) and cardiac tamponade (one patient) were seen only in those patients who underwent ablation with direct current energy, whereas pulmonary embolism (one patient) was the only early life-threatening complication in the Radiofrequency group. During follow-up, the rate of recurrence of AV conduction was the same (5%) for both the direct current and Radiofrequency groups. In the direct current group, one patient died suddenly 2 weeks after the procedure and another had a cardiac arrest due to ventricular tachycardia 6 h after the procedure. In the Radiofrequency group, two patients died suddenly at 11 and 7 months, respectively. Two patients, one who had unsuccessful Radiofrequency ablation and required direct current ablation, were resuscitated from ventricular tachycardia. Radiofrequency energy appears to be as efficacious as and perhaps safer than direct current energy for AV junction ablation.
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comparison of high energy direct current and Radiofrequency catheter ablation of the atrioventricular junction
Journal of the American College of Cardiology, 1993Co-Authors: Jeffrey E. Olgin, Melvin M. ScheinmanAbstract:Abstract Objectives. The goal of the study was to determine short- and long-term success and complications of Radiofrequency atrioventricular (AV) junction catheter ablation and to compare these with those of high energy direct current catheter ablation. Background. Catheter ablation of the AV junction with Radiofrequency or direct current energy is an accepted treatment for drug-refractory supraventricular tachycardias. Few data are available on the long-term success and effects of Radiofrequency ablation or its comparison with direct current ablation. Methods. Fifty-four patients who underwent attempted AV junction ablation with Radiofrequency energy were followed up for a mean of 24 ± 8.4 months. These patients were retrospectively compared with 49 patients who underwent attempted AV junction ablation with direct current energy and were followed up for a mean of 41 ± 23 months. Results. The early success rate at the time of discharge for Radiofrequency ablation was 81.5%, which was not statistically different from that for direct current ablation (85.7%). Fewer sessions were required to achieve complete AV block in the Radiofrequency group (1.05 ± 0.23) (mean ± SD) compared with the direct current group (1.21 ± 0.41) (p = 0.02). Although overall complication rates were similar for both groups (9.3% in the Radiofrequency group and 8.2% in the direct current group), there was a trend toward more life-threatening early complications in those patients who received direct-current shocks (6.8%) than in those who underwent Radiofrequency ablation alone (2.3%) (p = 0.1). Early sudden death (one patient), early ventricular tachycardia (two patients) and cardiac tamponade (one patient) were seen only in those patients who underwent ablation with direct current energy, whereas pulmonary embolism (one patient) was the only early life-threatening complication in the Radiofrequency group. During follow-up, the rate of recurrence of AV conduction was the same (5%) for both the direct current and Radiofrequency groups. In the direct current group, one patient died suddenly 2 weeks after the procedure and another had a cardiac arrest due to ventricular tachycardia 6 h after the procedure. In the Radiofrequency group, two patients died suddenly at 11 and 7 months, respectively. Two patients, one who had unsuccessful Radiofrequency ablation and required direct current ablation, were resuscitated from ventricular tachycardia. Conclusions. Radiofrequency energy appears to be as efficacious as and perhaps safer than direct current energy for AV junction ablation.
Heikki Hurri - One of the best experts on this subject based on the ideXlab platform.
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Radiofrequency denervation for neck and back pain a systematic review within the framework of the cochrane collaboration back review group
Spine, 2003Co-Authors: Leena Niemisto, Eija Kalso, Antti Malmivaara, Seppo Seitsalo, Heikki HurriAbstract:Study Design. Systematic review. Objective. To assess the effectiveness of Radiofrequency denervation for the treatment of musculoskeletal pain disorders. Summary of Background Data. There is a lack of effective treatment for chronic zygapophysiai joint pain and discogenic pain. Radiotrequency denervation appears to be an emerging technology, with substantial variation in its use. Methods. Original articles for this review were identified by electronically searching MEDLINE, PsycLIT, EMBASE, and the Cochrane Library to February 2002, hand-screening references, and consulting experts in the fieid. Two reviewers selected the randomized controlled trials that met the inclusion criteria, extracted the data. and assessed the main results and methodologic quality of the selected trials. Finally, qualitative analysis was conducted to evaluate the level of scientific evidence Results. Of seven relevant randomized controlled trials, six were considered to be high quality. The selected trials included 275 randomized patients, 141 of whom received active treatment. One study examined cervical zygapophysial joint pain; two. cervicobrachiai pain; three, lumbar zygapophysial joint pain; and one, discogenic low back pain. The sample sizes were smali, follow-up times short, and there were deficiencies noted in patient selection, outcome assessments, and statistical analyses. Conclusions. There is limited evidence that Radiofrequency denervation offers short-term relief for chronic neck pain of zygapophysiai joint origin and for chronic cervicobrachial pain, and confiicting evidence for its effectiveness for lumbar zygapophysial joint pain. There is limited evidence suggesting that intradiscal Radiofrequency may not be effective in relieving discogenic low back pain. Further high-quality randomized controlled triais are needed, with langer patient samples and data on long-term effects, for which current evidence is inconclusive.
B. Todd Sitzman - One of the best experts on this subject based on the ideXlab platform.
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Complications of Lumbar Facet Radiofrequency Denervation
Spine, 2004Co-Authors: Craig Kornick, S Scott Kramarich, Tim J Lamer, B. Todd SitzmanAbstract:Study Design. Retrospective. Objective. To assess the incidence of complications associated with fluoroscopically guided percutaneous Radiofrequency denervation of the lumbar facet joints. Summary of Background Data. Based on the results of previous efficacy studies, complications associated with facet joint Radiofrequency denervation procedures appear to be rare. No formal safety assessment for this procedure has been performed to date. Methods. We conducted retrospective chart reviews to identify complications that occurred within 8 weeks of facet joint Radiofrequency denervation procedures performed at the Mayo Clinic in Jacksonville during a 5-year period. Only procedures that included Radiofrequency electrode placement between The transverse process and the sacral ala were included. The chart of each patient was reviewed and adjudicated by a panel of 4 physicians before being classified as a complication. Results. Ninety-two patients received a total of 616 Radiofrequency lesions during 116 separate denervation procedures. An average of 5 ± 3 lesions were performed during each Radiofrequency denervation procedure. Six minor complications were identified, yielding a 1.0% overall incidence of minor complications per Radiofrequency site. Complications included: 3 cases of localized pain lasting more than 2 weeks (0.5%) and 3 cases of neuritic pain lasting less than 2 weeks (0.5%). No cases of infection, new motor deficits, or new sensory deficits were identified. Conclusions. Fiuoroscopically guided percutaneous Radiofrequency denervation of the lumbar facets is associated with an overall 1.0% incidence of minor complications per lesion site.
Gerbrand J. Groen - One of the best experts on this subject based on the ideXlab platform.
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Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain a randomized double blind sham lesion controlled trial
The Clinical Journal of Pain, 2005Co-Authors: Roelof M Van Wijk, Jos W M Geurts, Herman J Wynne, Edwin Hammink, Johannes T. A. Knape, Richel Lousberg, Erik Buskens, Gerbrand J. GroenAbstract:Objectives: Radiofrequency facet joint denervation procedures have been common practice for 2 decades in treatment of chronic low back pain. We designed this multicenter, randomized, doubleblind, sham treatment controlled trial to determine the efficacy of Radiofrequency facet joint denervation, as it is routinely performed. Methods: Inclusion criteria were low back pain, duration more than 6 months, and $50% Visual Analog Scale (VAS) reduction on diagnostic block. Exclusion criteria were prior Radiofrequency treatment, radicular syndrome, coagulopathies, specific allergies, cancer, and pregnancy. A total of 81 out of 462 patients were randomized to undergo Radiofrequency facet joint denervation or sham treatment. The first evaluation was carried out 3 months after treatment. Primary outcome was determined with a combined outcome measure comprising VAS, physical activities, and analgesic intake, from a twiceweekly recorded diary. Secondary outcome measures were the separate diary parameters, global perceived effect (complete relief, .50% relief, no effect, pain increase), and SF-36 Quality of Life Questionnaire. Results: There were no dropouts before the first evaluation. The combined outcome measure showed no differences between Radiofrequency facet joint denervation (n = 40; success 27.5%) and sham (n = 41; success 29.3%) (P = 0.86). The VAS in both groups improved (P , 0.001). Global perceived effect improved after Radiofrequency facet joint denervation (P , 0.05). The other secondary outcome parameters showed no significant differences. Relevant costs were evaluated. Discussion: The combined outcome measure and VAS showed no difference between Radiofrequency and sham, though in both groups, significant VAS improvement occurred. The global perceived effect was in favor of Radiofrequency. In selected patients, Radiofrequency facet joint denervation appears to be more effective than sham treatment.
Michael D Osborne - One of the best experts on this subject based on the ideXlab platform.
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Radiofrequency neurotomy for a patient with deep brain stimulators proposed safety guidelines
Pain Medicine, 2009Co-Authors: Michael D OsborneAbstract:Objective. To discuss the potential risks inherent to performing Radiofrequency procedures in patients with deep brain neurostimulators, and to propose safety guidelines. Design. Case report. Setting. Tertiary care teaching hospital. Subject. A 67-year-old male with intractable back pain due to advanced lumbar spondylosis, with a history of advanced Parkinson's Disease requiring two deep brain stimulators. Intervention. Radiofrequency neurotomy lumbar facet joints. Results. No atypical symptoms were reported during the procedure that would indicate iatrogenic injury from Radiofrequency effect on the deep brain neurostimulators. The subject's back pain was relieved by 70% for greater than 6 months bilaterally. Discussion. There are several theoretical concerns when using Radiofrequency therapies on patients with neurostimulators. Our patient did not experience any known adverse events during or subsequent to the procedure. This article presents our proposed safety guidelines for using Radiofrequency neurotomy on patients with deep brain stimulators. Conclusions. Radiofrequency medial branch neurotomy was performed on a patient with two deep brain stimulators with a satisfactory clinical outcome, and no adverse sequelae. Additional study is warranted regarding the safety and compatibility of brain neurostimulators and Radiofrequency interventions.
