Definition & Overview

Radiofrequency ablation (RFA) is a medical procedure that uses heat energy to destroy diseased or abnormal tissue. Other types of ablation therapies use laser beams (laser ablation) and extreme cold temperature (cryotherapy).

RFA involves inserting a probe into a small skin incision. The probe is then advanced to the targeted area where it delivers heat energy with the help of imaging tests.

RFA requires mild sedative or local anaesthesia. It is often an outpatient procedure. But in some cases, patients may need to stay in the hospital overnight. This may be the case if they need to be monitored for possible complications.

Who Should Undergo & Expected Results

RFA can be used to treat the following:

• Barrett’s oesophagus - RFA is used to destroy the diseased lining of the oesophagus that causes the condition.

• Cancer - RFA is used to treat cancer if surgery is not an option. This may be the case if the tumour is too close to a vital organ or the patient is too weak to undergo surgery. RFA can be used to treat small tumours and early-stage cancers. For the procedure, the probe is inserted into the abnormal growth through a small incision in the skin. The probe then delivers an electrical current that heats cancer cells to high temperatures. This causes them to die. Cancers that can be treated with RFA are lung, liver, kidney, bone, and prostate cancers.

• Arrhythmias - RFA can be used to destroy tissue that causes abnormal heart rhythms. It is an option if patients do not respond well to medications. Currently, ablation is the standard treatment for supraventricular tachycardia (SVT) and atrial flutter.

• Chronic pain - RFA is often used in treating chronic pain. It is used to destroy a part of the nerve tissue that sends pain signals to the brain.

• Obstructive sleep apnoea (OSA) - RFA is a safe treatment option for people with mild to moderate OSA. It can be used to change the shape of the tongue. It can also be used to cause scarring to the tissue that causes OSA.

• Varicose veins - Varicose veins are enlarged and swollen veins that often appear on the legs. RFA can be used to heat up and damage their walls so they will close off.

How Does the Procedure Work?

Patients with diseases or conditions mentioned above can discuss RFA with their doctor. If RFA is recommended, the doctor will proceed by explaining the procedure to the patient. It is important that the patient knows and understands its possible benefits as well as its risks and complications. All his or her questions must also be answered before the treatment is started.

For the procedure, the steps below are taken:

• The patient is connected to monitors. This is done to track his or her vital signs during the procedure.

• The patient is given local anaesthetic and mild sedative via an intravenous (IV) line. Because of this, he or she will not feel pain or discomfort during the procedure.

• The point of entry for the needle is cleaned and sterilised. This helps prevent infection.

• The needle is inserted into the skin. Using an MRI or a CT scan, the needle is then advanced to the target area. Once in place, a microelectrode is inserted through the needle.

• Energy is applied to the diseased or abnormal tissue. If needed, the needle is repositioned, and multiple ablations may be performed. This is done until all parts of the diseased tissue are destroyed.

• The needle electrode is then withdrawn. The IV line is also removed. The opening in the skin is then covered with a sterile dressing.

• The patient is then transferred to the recovery room.

• The patient is monitored for complications. He or she may need to stay in the hospital overnight.

• The pain caused by the procedure can be controlled with oral painkillers.

• The patient is then advised to get plenty of rest while recovering at home. He or she must wait for a couple of days before returning to his or her routine. The patient is not allowed to drive home.

Possible Complications and Risks

In general, RFA is a safe procedure. However, it has minor risks. These include:

• Infection at the site of injection.

• Pain - Pain after RFA is very common. It is treated with oral painkillers.

• Damage to surrounding healthy tissues.

• Flu-like symptoms. These go away on their own within a week.

• Bleeding, which usually resolves on its own. Severe bleeding is very uncommon.

References:

• Woodson BT, Nelson L, Mickelson SA, Huntley T, Sher A. A multi-institutional study of radiofrequency volumetric tissue reduction for OSAS. Otol H&N Surg. 125(4):303-311, 2001.

• Jarnagin WR. Radiofrequency ablation for liver tumors. In: Blumgart’s Surgery of the Liver, Biliary Tract and Pancreas. 5th ed. Philadelphia, Pa.: Saunders Elsevier; 2012

• El-Nashar SA, Hopkins MR, Creedon DJ, et al. Prediction of treatment outcomes after global endometrial ablation. Obstet Gynecol. Jan 2009;113(1):97-106. [Medline].