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