Safety and efficacy of radiofrequency ablation of benign thyroid nodules in patients with a history of implantable cardioverter defibrillators (ICDs), permanent pacemakers (PPMs), and implantable cardiac monitors (ICMs)

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Background: Radiofrequency ablation (RFA) has emerged as an effective, minimally invasive treatment option for benign thyroid nodules. However, safety in patients with cardiac implantable electronic devices (CIEDs) such as implantable cardioverter defibrillators (ICDs), permanent pacemakers (PPMs), and implantable cardiac monitors (ICMs) is unclear, given theoretical risks of electromagnetic interference (EMI). As the use of both RFA and CIEDs continues to increase, establishing evidence-based safety guidance for this population is essential. This study aimed to evaluate the safety of RFA for benign thyroid nodules in patients with CIEDs. Methods: This retrospective study included 7 patients with a history of ICDs, ICMs, or PPMs and benign thyroid nodules who underwent RFA. All CIEDs were interrogated both before and after the procedure. A magnet was placed over ICDs, and electrocardiogram (ECG) monitoring was performed to detect arrhythmias or mode switching. Outcomes included the incidence of post-RFA complications, including possible cardiac implant malfunctions and volume reduction rate (VRR) at 6 months. Results: The mean age of the patients was 72.1±12.5 years, with 71.4% of the patients being female. The mean VRR at 6 months was 73.8%±24.9%. No peri-procedural complications occurred, and no patient demonstrated clinically significant EMI, inappropriate sensing or pacing, arrhythmias, device resets, or structural lead damage. All patients tolerated the procedure without adverse events. Conclusions: RFA appears to be a safe and effective treatment for benign thyroid nodules in patients with a history of ICDs, ICMs, and PPMs. Our experience demonstrated the safety of RFA and supported its utility in this high-risk population when performing these procedures with appropriate monitoring.

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