Advances in radiofrequency ablation: mechanism of action and technology
Review Article | Palliative Medicine and Palliative Care for Serious or Advanced Diseases

Advances in radiofrequency ablation: mechanism of action and technology

Natalie H. Strand1, Jonathan M. Hagedorn2, Tyler Dunn1, Brooks Johnson1, Alaa Abd-Elsayed3, Stephen Covington1, John Freeman1, Azizat Dawodu1, Jillian Maloney1

1Department of Anesthesiology, Mayo Clinic, Phoenix, AZ, USA; 2Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA; 3Anesthesiology and Pain Management, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

Contributions: (I) Conception and design: NH Strand, J Maloney, A Dawodu; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Natalie H. Strand, MD. Department of Anesthesiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA. Email: Strand.natalie@mayo.edu.

Abstract: Radiofrequency ablation (RFA) is a minimally invasive treatment modality that utilizes high-frequency alternating current to destroy targeted tissues through thermal ablation. This manuscript provides an overview of the advancements in RFA, focusing on its mechanism of action and technological innovations. RFA technology was first introduced in the early 1900’s, and its use has expanded and evolved, especially in its current utility in the treatment of painful conditions. As the technology has evolved, new techniques, applications and modalities have expanded its use and improved its efficacy. RFA works by applying radiofrequency energy through specialized electrodes, leading to resistive heating and coagulation necrosis. Its advantages include precise tissue targeting, minimal invasiveness, reduced complications, and faster recovery compared to traditional surgical interventions. Technological advancements in RFA have led to improved treatment outcomes. Multi-electrode systems allow for larger ablation zones. Image-guided RFA improves treatment planning and minimizes damage to healthy tissues. Cooled-tip and perfusion electrodes address limitations such as heat sink effects, enhancing RFA’s efficacy in challenging anatomical regions. These developments have expanded RFA’s applications to liver tumors, lung tumors, renal tumors, cardiac arrhythmias, and chronic pain syndromes. In conclusion, RFA has emerged as a safe and effective thermal ablation technique. Understanding its mechanism of action and integrating advanced technologies have significantly enhanced treatment outcomes. Continued research and innovation in RFA hold immense potential for further improving patient care and outcomes.

Keywords: Pain; interventional pain; cancer pain; radiofrequency ablation (RFA)

Submitted Jun 20, 2023. Accepted for publication Apr 29, 2024. Published online Jul 05, 2024.

doi: 10.21037/apm-23-457

Introduction

Background

In the early 19th century, radiofrequency ablation (RFA) was introduced and developed as a novel treatment modality. Its use has continued to evolve and has application in several medical and surgical specialties, including interventional pain, cardiology, interventional radiology, neurology, neurosurgery, general surgery, orthopedic surgery, and oncology.

While its use in medicine is relatively new, RFA technology was first described in 1891 by d’Arsonval, who described the local increase of tissue temperature as radiofrequency (RF) waves were applied (1). By 1908 Edwin Beer, a urologist, was using high-frequency current through a cystoscope to obliterate bladder tumors. By the late 1920s, RF technology had been used to develop the Bovie knife, bringing RFA technology into modern medicine (2).

RFA employs a specialized catheter and probe with a distal electrode inserted into a target tissue. An alternating current of 400–500 kHz is passed from the electrode through the target tissue causing the water molecules adjacent to the tip of the electrode to vibrate. The vibration of molecules extends from the tip of the electrode outward and results in frictional energy deposition into the tissue. The amount of heat deposited in the tissue is proportional to the current’s strength, and the tissue’s resistance is inversely proportional to the 4th power of the distance from the tip of the needle (3). Heat production eventually leads to irreversible cell damage and cell death (coagulation necrosis).

Ideally, tissue is heated to at least 50° centigrade for 4–6 minutes. Notably, rapid increases in temperature and temperatures above 100° centigrade are avoided as they may lead to vaporization and charring of the tissue, leading to an insulating effect around the electrode (4). Numerous electrode design features are available including watered cooling, monopolar, bipolar, coil or expandable designs which all function to increase the volume of necrotic tissue achieved per unit time (5). In the clinical setting lesion temperatures around 80° centigrade for approximately 90 seconds are most commonly utilized.

In the 1930s, a German surgeon, Dr. Martin Kirschner described using a percutaneous electrode to lesion the trigeminal ganglion in patients suffering from trigeminal neuralgia (6). This marked the first known instance of utilizing directed thermal energy to treat a painful condition.

In the early 1960s, Dr. Michael Rees developed a technique that he termed “Multiple Bilateral Percutaneous Rhizolysis” in which he would incise, what he believed to be, the facet joint nerve with a scalpel (7). His technique had excellent success rates and was adopted by physicians internationally (8).

Dr. C. Norman Shealy, neurosurgeon, adopted this rhizolysis technique in the mid-1970s, but his patients suffered an unacceptably high hematoma rate at the surgical site. Therefore, he introduced the use of a RFA instead of an incision with remarkable success. To aid in the proper placement of these RF electrodes he employed fluoroscopic guidance of cannulae placement; the birth of the current image-guided technique for RFA (8). By 1975, Shealy and colleagues reported good outcomes in a study of 207 patients undergoing percutaneous RFA of facet joint nerves for chronic pain (9).

Shealy went on to work with Radionics to develop the Shealy Rhizolysis Kit (SRK) for distribution. The kit utilized 14G spinal needles and 16G RF electrodes. While the technique was successful, it was necessary to be performed under general anesthesia at the hands of neurosurgeons, as patients didn’t tolerate the pain from electrode placement.

By 1976, Dr. Menno Sluijter developed a technique that utilized 18G, 20G and 22G electrodes. The use of finer electrodes allowed the procedure to be done under sedation and local anesthesia by anesthesia-trained pain physicians (8).

Following the success of Dr. Shealy, Dr. Nikolai Bogduk demonstrated that the nerves targeted by these ablations were the medial branch of the dorsal rami, and he fine-tuned and perfected the technique by specifically targeting the medial branch (10,11). His technique of “percutaneous lumbar medial branch neurotomy” is still in use today.

Two decades after that 1975 study by Shealy et al., the first double-blind, randomized trial reaffirmed the effectiveness of RFA in the treatment of chronic cervical pain following whiplash injury. This acted as a jumping point from which many studies have since reiterated the usefulness, effectiveness and safety of RFA for treating chronic pain of the spinal facet joint (6,12,13). Given the success of RFA utilization in facet joint denervation, its use in other joints has been growing. In the last two decades, its effectiveness in treating sacroiliac joint pain has been demonstrated (14,15). More recently, its application in treating chronic knee pain with lesioning of the genicular nerves has shown promising results (16). In the mid 1990’s, pulsed radiofrequency ablation (PRF) was introduced as a less destructive alternative to continuous radiofrequency ablation (CRF). PRF employs short, high-voltage bursts of RF current lasting 20 ms, with a subsequent “silent” phase of 480 ms that permits heat dissipation, typically maintaining the target tissue temperature below 42 °C. While it is hypothesized that PRF does not induce thermal lesions, there is research in rodent models demonstrating transient temperatures high enough to induce tissue injury, though magnitudes lower than CRF. Even so, PRF only causes transient endoneural edema (17).

The exact mechanism through which PRF provides pain relief without inflicting substantial heat-related tissue harm remains a subject of debate. A number of theories and hypotheses have been posited, including proposals that PRF’s electric fields can influence neuronal membranes, modify synaptic signaling, and significantly influence neuronal gene expression. The subject of PRF mechanism of action continues to be the subject of research (18).

Whether utilizing CRF or PRF, the goal of RFA is to maximize tissue disruption, but minimize tissue destruction. As such, the electrodes, energy generators, and needles continue to evolve to accomplish this objective.

Rational and knowledge gap

The need for new technology

Over the years, there have been changes in RFA technology that have led to improvement in the use of RFA to treat pain. The variety of probe sizes has grown considerably since the 1980s when the invention of the fine-gauge thermocouple electrode by E. R. Cosman Sr. enabled variously sized RF cannula to be electrified and monitored by a separate, universal, temperature-sensing RF electrode. Monopolar RF heat lesioning using a wide variety of sharp, bevel-tip cannula is currently the norm in interventional pain management (19). The change in probe sizes was one of the earlier changes made in RFA technology.

Temperature was initially thought to be the main mechanism of RFA. This in turn led to the creation of pulsed RFA which avoids neurodestructive temperatures. Although it used a relatively unchanged active tip design, the cooling system allowed for controlled enlarged lesions to be performed without inducing tissue charring (8).

“A sea change occurred in the RF field around the adoption of the new ‘large volume lesion’ concept (50 mm3) for pain medicine procedures. Various new multi-tined cannula designs came to market, such as the Venom and Trident cannulae. More recent developments have focused on optimizing RF probe placement and targeting alternate structures, such as the facet joint capsule and terminal neural branches.” (8).

As mentioned in RFA: technological trends, challenges, and opportunities, the limitations of RF energy include inadequate lesion size for targets and collateral injury to structures, and there is still uncertainty about how best to deliver RF energy (20). One of the main roadblocks to more wide use of PRF is the lack of randomized control trials displaying its efficacy (17). This also highlights the larger ethical issues of randomized control trials in pain management due to the amorality of sham medications or placebos for patients experiencing pain.

Mechanism of action

The goal of RFA for the treatment of chronic pain is to create a thermal lesion to inactivate nociceptive pain pathways. RF describes the electromagnetic spectrum between 3 Hz and 300 GHz, and when applied to a patient’s tissue, this creates thermal ablation of a set amount of volume. The mechanism of thermal lesion creation is the result of RF currents passing through an RFA probe via a catheter which acts as the cathode of a closed electrical circuit when a grounding pad is applied to the patient. The current flows from the electrode through the target tissue causing the water molecules adjacent to the tip of the electrode to vibrate and results in frictional energy deposition into the tissue. The amount of heat deposited in the tissue is proportional to the current’s strength, and the tissue’s resistance is inversely proportional to the 4th power of the distance from the tip of the needle. The probe tip has a relatively small cross sectional area with high energy flux compared to the large cross sectional area of the grounding probe which results in tissue damage that is limited to the area around the probe tip (3).

In CRF, the lesion leads to cell death and coagulative necrosis of both cellular and acellular structures which histologically results in axonal degeneration and collagen fiber destruction of the endoneurium, perineurium and epineurium resulting in pain relief (21). Over a period of months reinnervation occurs due to Wallerian degeneration which is an inflammatory response for nerve regeneration leading to the return of the patient’s pain (22).

In PRF, the pain reducing mechanism is not clearly elucidated and it is thought that the destruction of neural elements is not the mechanism of action. It has been shown that temporary endoneurial edema occurs after treatment, but it returns to normal morphology by seven days post-treatment (23). It has been postulated that the electrical currents and magnetic fields lead to clinic improvement via altered gene expression, neuronal membrane function, and cytokine regulation (21,24). Additional studies are required to understand the mechanism of action.

Different ablation technologies

There is an array of RFA technologies, some historical, others that continue to be used. Current technologies include pulsed (non-thermal), conventional (thermal) both traditional and temperature regulated (cooled) with circulated water. CRF is the most common technique using an insulated cannula with an exposed metallic tip to deliver heat to the targeted nerve tissue. The tip of the needle is heated between 75–90 °C (17) and can be performed with monopolar or bipolar electrodes. Monopolar RF refers to current flow between a probe electrode and a return (dispersion) electrode or grounding pad placed on the skin’s surface adjacent to the lesion site. Bipolar RF refers to current flow between two probe electrodes without a grounding pad (19).

PRF is a technique that uses short bursts of RF energy to disable neural transmission. Common settings are 42 °C, 200 mA, 20 ms pulse, 120–240 s. This approach produces no tissue damage and may be useful for patients who have not responded to other treatments; however, it has been shown to be less durable and predictable in pain relief (17,24). There are few randomized controlled studies validating the use of PRF, but it offers a significant advantage in treating pain conditions in that it offers pain relief without the tissue destruction and motor side effects of CRF. PRF can be employed with minimal risk of producing sensory or motor loss and deafferentation syndromes (25). It’s application in pain syndromes not amenable to CRF is the subject of current research. Such syndromes include pain syndromes arising from the dorsal root ganglion, cutaneous nerves, trigeminal neuralgia (26), sphenopalatine ganglion for cluster headaches (27), occipital nerves for occipital neuralgia (28).

Water-cooled RFA uses a temperature regulated multichannel electrode (with circulated water) to deliver RF energy to the targeted tissue. This specialized electrode to prevent excessive tissue damage (charring) and creates a larger lesion (twice the diameter and eight times the volume over the traditional ablation lesion). (National Library of Medicine). A specialized needle is heated up to 140 degrees Fahrenheit but also cooled by a continuous flow of water. The water allows a regulated flow of current and also prevents the needle tip from being overheated (29).

According to a comparison study in the Pain Physician journal by Cedeno et al., Comparisons of Lesion Volumes and Shapes Produced by a Radiofrequency System with a Cooled, a Protruding, or a Monopolar Probe, lesions obtained with cooled-RF ablation at a tip temperature of 60 °C and 150 s is significantly larger than lesions obtained with using either monopolar probes under typical conditions and lesions obtained through protruding the RF electrode outside the active tip (30). Other factors that appear to influence lesion size include the length of the active tip, electrode temperature, current density, active versus passive heat sinks, and duration of application of the RF current (24,30).

RF needles and electrodes

Various needle geometries are used in RFA such as the straight and curved needles (Table 1). The straight needle is the most common geometry used in RFA procedures. It consists of a single, straight electrode that is inserted into the targeted tissue. The lesion does not typically extend beyond the tip of the needle, placement of the needle is parallel with the desired target. The curved needle consists of an electrode with a single bend active tip (10–15°) to allow for more precise placement in tight or difficult-to-reach areas. Similar to straight needles, it must be placed in parallel with the target tissue.

Table 1

RF generators table with differences

Company Medtronic Boston scientific Stryker Avanos Abbott Diros
Latest product name Accurian G4 RF Generator MultiGen 2 Coolief RF IonicRF OWL URF-3AP RF
Number of channels 4 independent channels 4 independent channels 4 independent channels 4 independent channels 4 independent channels 4 channels with available multi-lesion adapter
Types of compatible electrodes Reusable stainless steel, reusable nitinol, single use stainless steel, enhanced (internally cooled) probes Disposable, reusable nitinol, reusable stainless steel, unified RF injection Reusable nitinol Disposable Disposable, reusable nitinol, reusable stainless steel, simplicity III disposable Disposable, re-usable (5, 10, 15, 20 cm)
Available electrode length (cm) 5, 10, 15 5, 10, 15, 20 5, 10, 15, 20 5, 7.5, 10, 15 5, 10, 15, 20 5, 10, 15, 20
Types of cannulae Curved blunt, curved sharp, straight sharp Straight sharp, curved sharp, curved blunt, SideKick 2 Straight, curved Curved sharp, curved blunt, straight sharp Curved, straight Sharp straight, sharp curved, blunt curved, blunt straight, RF trident cannulae
Lesioning type Monopolar, bipolar, cooled Monopolar, bipolar, pulsed RF Thermal and pulsed, DualWave technology Cooled, standard, pulsed and dual bipolar RF, transdiscal Monopolar, bipolar, pulsed, pulsed dose Monopolar, bipolar RF
Special features Internally cooled lesioning probe with introducer SideKick 2 produces 2× larger lesions 100 Watt system decreases warm up time “Simplicity” probe for SI joint ablation creates longer lesion “Trident” probe allows for perpendicular approach to medial branch nerve
References (31,32) (33-35) (36) (37) (38-40) (41)

RF, radiofrequency; SI, sacroiliac.

A cooled-tip electrode is designed with a small, water-cooled tip that reduces the risk of tissue damage and provides more precise control over the ablation process. This technology is particularly useful for procedures that require higher temperatures or longer ablation times. This technology is also useful for procedures that need larger lesion sizes due to anatomical variation, i.e., genicular nerves of knee joints, and is also useful for the lesions that are high risk for bone-needle interface, i.e., sacral lateral branches block for sacroiliac joint pain. The lesion in this type of technology extends beyond the tip of the needle and can be used in a co-axial fashion.

An expandable electrode is designed to expand or contract to fit the shape of the target tissue. Multiple tines are deployed from the electrode tip creating different geometrical shaped lesions that are large. This is advantageous as it is accomplished through a thin gauge shaft resulting in faster recovery and less pain during the procedure and is particularly useful for procedures that require more precise targeting of irregularly shaped or multi-level structures. This can be used in a “co-axial fashion”, similar to cooled, that does not require placement in parallel. Other needle designs include helical and cluster shaped needles, though these are not used in axial spine RFAs for pain relief.

Conclusions

Many advances have been made in RFA. From its development in the early 19th century to the most recent improvements with the development of PRF, it has made a profound impact not only in pain management but in other fields such as oncology and cardiology. There is still more room for new developments in terms of creating the most effective and safest method to perform RFA. As it is, the different technologies have their various benefits and detriments.

Acknowledgments

Thank you to Barabara J. Weisser for administrative and academic support.

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine, for the series “Advances in Radiofrequency Ablation”. The article has undergone external peer review.

Peer Review File: Available at https://apm.amegroups.com/article/view/10.21037/apm-23-457/prf

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-23-457/coif). The series “Advances in Radiofrequency Ablation” was commissioned by the editorial office without any funding or sponsorship. A.A.E. served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Annals of Palliative Medicine from June 2022 to May 2024. He also serves as a consultant for Avanos and receives consulting fees. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. d'Arsonval MA. Action physiologique des courants alternatifs. CR Soc Biol 1891;43:283-286.
  2. O'Connor JL, Bloom DA, William T. Bovie and electrosurgery. Surgery 1996;119:390-6. [Crossref] [PubMed]
  3. Hong K, Georgiades C. Radiofrequency ablation: mechanism of action and devices. J Vasc Interv Radiol 2010;21:S179-86. [Crossref] [PubMed]
  4. Organ LW. Electrophysiologic principles of radiofrequency lesion making. Appl Neurophysiol 1976-1977;39:69-76. [PubMed]
  5. Gillams AR. The use of radiofrequency in cancer. Br J Cancer 2005;92:1825-9. [Crossref] [PubMed]
  6. McCormick ZL, Hurley R. The Evolution of Radiofrequency Denervation for Pain Indications. Pain Med 2021;22:1465-7. [Crossref] [PubMed]
  7. Bogduk N, Dreyfuss P, Govind J. A narrative review of lumbar medial branch neurotomy for the treatment of back pain. Pain Med 2009;10:1035-45. [Crossref] [PubMed]
  8. Russo M, Santarelli D, Wright R, et al. A History of the Development of Radiofrequency Neurotomy. J Pain Res 2021;14:3897-907. [Crossref] [PubMed]
  9. Shealy CN. Percutaneous radiofrequency denervation of spinal facets. Treatment for chronic back pain and sciatica. J Neurosurg 1975;43:448-51. [Crossref] [PubMed]
  10. Bogduk N, Long DM. The anatomy of the so-called "articular nerves" and their relationship to facet denervation in the treatment of low-back pain. J Neurosurg 1979;51:172-7. [Crossref] [PubMed]
  11. Bogduk N, Long DM. Percutaneous lumbar medial branch neurotomy: a modification of facet denervation. Spine (Phila Pa 1976) 1980;5:193-200. [Crossref] [PubMed]
  12. Engel A, Rappard G, King W, et al. The Effectiveness and Risks of Fluoroscopically-Guided Cervical Medial Branch Thermal Radiofrequency Neurotomy: A Systematic Review with Comprehensive Analysis of the Published Data. Pain Med 2016;17:658-69. [Crossref] [PubMed]
  13. Schneider BJ, Doan L, Maes MK, et al. Systematic Review of the Effectiveness of Lumbar Medial Branch Thermal Radiofrequency Neurotomy, Stratified for Diagnostic Methods and Procedural Technique. Pain Med 2020;21:1122-41. [Crossref] [PubMed]
  14. Patel N, Gross A, Brown L, et al. A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med 2012;13:383-98. [Crossref] [PubMed]
  15. Yin W, Willard F, Carreiro J, et al. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine (Phila Pa 1976) 2003;28:2419-25. [Crossref] [PubMed]
  16. Conger A, Cushman DM, Walker K, et al. A Novel Technical Protocol for Improved Capture of the Genicular Nerves by Radiofrequency Ablation. Pain Med 2019;20:2208-12. [Crossref] [PubMed]
  17. Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep 2008;12:37-41. [Crossref] [PubMed]
  18. Park D, Chang MC. The mechanism of action of pulsed radiofrequency in reducing pain: a narrative review. J Yeungnam Med Sci 2022;39:200-5. [Crossref] [PubMed]
  19. Cosman ER Jr, Dolensky JR, Hoffman RA. Factors that affect radiofrequency heat lesion size. Pain Med 2014;15:2020-36. [Crossref] [PubMed]
  20. Habibi M, Berger RD, Calkins H. Radiofrequency ablation: technological trends, challenges, and opportunities. Europace 2021;23:511-9. [Crossref] [PubMed]
  21. Choi S, Choi HJ, Cheong Y, et al. Internal-specific morphological analysis of sciatic nerve fibers in a radiofrequency-induced animal neuropathic pain model. PLoS One 2013;8:e73913. [Crossref] [PubMed]
  22. Dubový P. Wallerian degeneration and peripheral nerve conditions for both axonal regeneration and neuropathic pain induction. Ann Anat 2011;193:267-75. [Crossref] [PubMed]
  23. Podhajsky RJ, Sekiguchi Y, Kikuchi S, et al. The histologic effects of pulsed and continuous radiofrequency lesions at 42 degrees C to rat dorsal root ganglion and sciatic nerve. Spine (Phila Pa 1976) 2005;30:1008-13. [Crossref] [PubMed]
  24. Wray JK, Dixon B, Przkora R. Radiofrequency Ablation. Treasure Island (FL): StatPearls Publishing; 2024.
  25. Ahadian FM. Pulsed radiofrequency neurotomy: advances in pain medicine. Curr Pain Headache Rep 2004;8:34-40. [Crossref] [PubMed]
  26. Abd-Elsayed A, Kreuger L, Seeger S, et al. Pulsed Radiofrequency for Treating Trigeminal Neuralgia. Ochsner J 2018;18:63-5. [PubMed]
  27. Shah RJ, Dixon B, Padalia D. Sphenopalatine Ganglion Radiofrequency Thermocoagulation. 2024.
  28. Batistaki C, Madi AI, Karakosta A, et al. Pulsed Radiofrequency of the Occipital Nerves: Results of a Standardized Protocol on Chronic Headache Management. Anesth Pain Med 2021;11:e112235. [PubMed]
  29. Malik K, Benzon HT, Walega D. Water-cooled radiofrequency: a neuroablative or a neuromodulatory modality with broader applications? Case Rep Anesthesiol 2011;2011:263101. [Crossref] [PubMed]
  30. Cedeno DL, Vallejo A, Kelley CA, et al. Comparisons of Lesion Volumes and Shapes Produced by a Radiofrequency System with a Cooled, a Protruding, or a Monopolar Probe. Pain Physician 2017;20:E915-22. [Crossref] [PubMed]
  31. Accurian. Medtronic. Available online: https://www.medtronic.com/content/dam/medtronic-com/products/neurological/rfablation-nerve-tissue/documents/rfa-accurian-systemcomponents.pdf
  32. Accurian. Medtronic. Available online: https://www.medtronic.com/usen/healthcare-professionals/products/neurological/radiofrequency-ablation-nerve-tissue/accurian.html
  33. RF Electrodes. Boston Scientific. Available online: https://www.bostonscientific.com/en-US/products/nerve-radio-frequency-ablation/rfelectrodes.html
  34. RF Cannulae. Boston Scientific. Available online: https://www.bostonscientific.com/en-US/products/nerve-radio-frequency-ablation/rf-cannulae.html
  35. SideKick™ 2 Cannula. Boston Scientific. Available online: https://www.bostonscientific.com/en-US/products/nerve-radio-frequency-ablation/sidekick-2-cannula.html
  36. MultiGen 2. Stryker. Available online: https://www.stryker.com/us/en/portfolios/medical-surgical-equipment/image-guidedtherapies/radiofrequency-neurotomy.html
  37. COOLIEF* Cooled Radiofrequency. Avanos. Available online: https://avanospainmanagement.com/solutions/chronic-pain/cooled-radiofrequency-products/
  38. IonicRF. Abbott. Available online: https://www.ionicrf.com/healthcareprofessionals/
  39. IonicRF. Abbott. Available online: https://manuals.eifu.abbott/en/hcp/home.html
  40. IONICRF™ Generator Therapy. Available online: https://www.neuromodulation.abbott/us/en/healthcare-professionals/hcp-chronic-pain/ionic-rfgenerator.html
  41. OWL URF-3AP RF. Diros. Available online: https://dirostech.com/productdetails/3apmla-4-2/
Cite this article as: Strand NH, Hagedorn JM, Dunn T, Johnson B, Abd-Elsayed A, Covington S, Freeman J, Dawodu A, Maloney J. Advances in radiofrequency ablation: mechanism of action and technology. Ann Palliat Med 2024;13(4):1028-1034. doi: 10.21037/apm-23-457

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