Case Series
Simultaneous Use of Neurostimulators in Patients With a Preexisting Cardiovascular Implantable Electronic Device

https://doi.org/10.1111/j.1525-1403.2010.00314.xGet rights and content

Object

Neurostimulation is widely accepted for the treatment of refractory Parkinson’s disease, essential tremor, and chronic pain. The presence of a cardiovascular implantable electronic device (CIED) might be considered a contraindication for neurostimulators due to the possible interaction between the two devices. The purpose of this study is to report the feasibility and safety of concomitant use of neurostimulators and CIED, and to review surgical and clinical precautions needed to avoid possible interference between the two systems.

Methods

A retrospective institutional review board approved chart review of six patients having both a neurostimulator(s) and a CIED was performed. Diagnosis included Parkinson’s disease (two) and intractable pain (four). All implantable cardiac devices were set on bipolar sensing mode and bipolar stimulation was chosen for the neurostimulators. In general, both systems were implanted at sites seven inches apart. Electrocardiogram monitoring was observed throughout implantation. Patients were followed up for a mean period of 31.7 months (ranging from 14 to 67 months). An extensive chart review was done and cases from previous reports were compiled.

Results

In all six patients, no acute events occurred during surgery with no interaction or interference noted during implantation of the second device. Subsequent follow-up visits continued to exhibit a lack of interference between the two systems, including normal electrocardiogram studies. Both systems were noted to function at optimal levels. An extensive literature review revealed 57 unique cases previously published reporting the simultaneous use of neurostimulators and a CIED in the same patient. A table summarizing previously cited cases from the literature is provided.

Conclusion

The concomitant use of neurostimulator(s) and permanent pacemaker(s) can be safely performed. Permanent pacemaker should not be considered a general contraindication for neurostimulation therapy. Current literature lacks evidence to determine the safety of concomitant use of neurostimulator(s) and implantable cardioverter defibrillator(s).

Section snippets

INTRODUCTION

Neurostimulation represents a rapidly expanding domain in functional neurosurgery, comprising deep brain stimulations (DBS), spinal cord stimulation (SCS), and peripheral nerve stimulation. The common link in these fields is implantation of a neural pulse generator (NPG) and an electrode(s). With its wide acceptance, physicians will be faced with many unique circumstances related to device interactions. Simultaneously, with the increasing mean age of the general population in the USA and

CLINICAL MATERIAL AND METHOD

A retrospective institutional review board approved chart review of Thomas Jefferson University Hospital’s neurostimulation therapy program was undertaken. Six patients were identified to have both a neurostimulator system and a CIED. Diagnosis included Parkinson’s disease (two) and intractable pain (four). The mean age of these patients during implantation of the second system was 58 years (ranging from 45 to 70 years). Patients were followed up for a mean period of 31.7 months (ranging from

RESULTS

Our clinical experience involving six patients who have both a neurostimulator and a CIED showed no interaction between the two systems during implantation of the second device (Table 1).

All ICDs and PPMs were set on bipolar sensing mode and bipolar stimulation was chosen for the neurostimulators. In general, both systems were implanted at opposite sides of the patient’s body, at least seven inches apart. EKG monitoring was observed throughout implantation. A wide range of settings were tested

DISCUSSION

An extensive literature search revealed 57 unique published cases reporting the simultaneous use of neurostimulator(s) and CIED(s) in the same patient. We now report an additional six patients based on our clinical experience. Complications associated with the simultaneous use of both systems are rare.

CONCLUSION

Based on the multiple case reports, it is becoming increasingly evident that the simultaneous use of neurostimulators and PPM(s) is feasible. The presence of a preexisting PPM should not be considered as a general contraindication for neurostimulation therapy. However, due to lack of evidence in the literature, the safety of simultaneous use of neurostimulators and ICD(s) cannot be determined. There are many unique device interactions that may potentially occur. Further prospective studies with

Authorship Statements

Yinn Cher Ooi, Dr. Steven Falowski, Dr. Reginald Ho, and Dr. Dajie Wang designed and conducted the study, including providing patients, data collection, and data analysis. Yinn Cher Ooi prepared the manuscript draft with important intellectual input from Drs. Steven Falowski, Reginald Ho, Dajie Wang, Jack Jullo, and Ashwini Sharan. No funding was involved in this paper. Yinn Cher Ooi and Dr. Ashwini Sharan had complete access to study data. We would like to thank Dr. Ashwini Sharan for his

How to Cite this Article:

Ooi Y.C., Falowski S., Wang D., Jallo J., Ho R.T., Sharan A. 2010. Simultaneous Use of Neurostimulators in Patients With a Preexisting Cardiovascular Implantable Electronic Device. Neuromodulation 2011; 14: 20–26

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