Who performs radio frequency (RF) ablations?

Who Performs Radiofrequency Ablations

Radiofrequency (RF) ablation procedures are primarily performed by specialized physicians with specific training in interventional procedures, including electrophysiologists, interventional radiologists, pain management specialists, and neurosurgeons, depending on the anatomical location and purpose of the ablation.

Cardiac RF Ablations

• Cardiac Electrophysiologists: These specialists perform RF ablations for cardiac arrhythmias 1

  • Require specialized training in Clinical Cardiac Electrophysiology (CCEP)
  • Must complete ACGME-accredited fellowship training in cardiovascular disease followed by specialized training in CCEP
  • Need to demonstrate competence in performing diagnostic electrophysiologic testing before advancing to ablation procedures

• Training Requirements:

  • Must perform a minimum number of cases under supervision
  • For atrial fibrillation ablation, operators should have experience with at least 20 supervised transseptal punctures 1
  • Must be proficient in performing pericardiocentesis and managing potential complications
  • Should be familiar with intracardiac echocardiography and 3D mapping systems

Pain Management RF Ablations

• Pain Management Specialists: Typically perform RF ablations for chronic spine pain 1, 2

  • Commonly from backgrounds in anesthesiology or physical medicine and rehabilitation
  • Must have specialized training in interventional pain procedures

• Patient Selection Criteria:

  • Patients should have tried conservative measures for >6 weeks without relief
  • Require positive diagnostic blocks (≥80% pain relief) before proceeding to RF ablation 2
  • Procedures typically provide 6-12 months of relief and may need to be repeated

Oncologic RF Ablations

• Interventional Radiologists: Primarily perform RF ablations for tumors 1

  • Use imaging guidance (CT, MRI, or ultrasound) to precisely target tumors
  • Perform procedures for liver, kidney, and lung tumors

• Surgical Oncologists: May perform RF ablations during open surgical procedures 3

  • Often combine RF ablation with surgical resection for unresectable tumors
  • Use intraoperative ultrasound for guidance

Procedural Approaches

• Percutaneous: Performed by interventional radiologists or pain specialists

  • Minimally invasive, often outpatient procedure
  • Uses imaging guidance (fluoroscopy, CT, MRI, ultrasound)
  • Shorter hospital stays (average 1.8 days for percutaneous procedures) 3

• Surgical: Performed during open surgery or laparoscopy

  • Allows for direct visualization and combination with other surgical procedures
  • Intraoperative ultrasound can detect additional lesions not seen on preoperative imaging 3

Special Considerations

• Patients with Cardiac Implantable Electronic Devices (CIEDs):

  • Require special precautions due to potential electromagnetic interference
  • The RF current path should be kept as far away from the pulse generator and leads as possible 1
  • May need cardiology consultation before the procedure 4

• Safety Protocols:

  • Procedures should be performed under appropriate imaging guidance
  • For spine procedures, fluoroscopic guidance is standard 2
  • For tumor ablations, CT or ultrasound guidance is common 1

RF ablation is a specialized procedure requiring specific training and expertise. The physician performing the procedure should have appropriate credentials, experience with the specific type of ablation being performed, and the ability to manage potential complications.