Simultaneous use of bilateral subthalamic nucleus stimulators and an implantable cardiac defibrillator

Abstract

Bilateral electrical stimulation of the subthalamic nucleus is being used with increasing frequency as a treatment for severe Parkinson disease (PD). Implantable cardiac defibrillators improve survival in certain high-risk patients with coronary artery disease and ventricular arrhythmias. Because of concern about possible interaction between these devices, deep brain stimulation (DBS) systems are routinely disconnected before defibrillators are implanted in patients with PD and arrhythmia. The authors report on a patient with bilateral subthalamic stimulators who underwent successful placement of an implantable defibrillator. Testing of the devices over a wide range of settings revealed no interaction. The patient subsequently underwent multiple episodes of cardioversion when the ventricular lead became dislodged. There was no evidence of adverse neurological effects, and interrogation of the DBS devices after cardioversion revealed no changes in stimulus parameters. The outcome in this case indicates that DBS systems may be safely retained in selected patients who require implantable cardiac defibrillators.

Implantation of a Permanent Pacemaker in a Patient With Severe Parkinson's Disease and a Preexisting Bilateral Deep Brain Stimulator

“…Unfortunately, reports on this issue are limited. A small number of case reports, either about the implantation of bilateral deep brain stimulators in patients with Parkinson's disease and preexisting cardiac pacemakers, 5,6) or the implantation of a cardiac pacemaker/ICD in a patient with preexisting deep brain stimulators [7][8][9][10] are present in the literature. Whether or not their implantations in the same patient may cause electromagnetic interference is controversial; it has been reported that ICDs and cardiac pacemakers interfere with cellular telephones 11) and antitheft surveillance devices.…”

“…Actually, in one report, when the patient was told that his deep brain stimulator had to be permanently deactivated, the patient declined saying that he would rather risk sudden cardiac death than resume life with a disabling tremor. 7) In most of the reports, 5,[7][8][9] it was stated that testing during implantation showed that the neurostimulators did not affect the bipolar sensing of the ICD or pacemakers even when the stimulators were set to maximum limits. No interference was noted at any time during either the implantation or follow-up period, and both pacemakers and stimulators functioned well.…”

“…No interference was noted at any time during either the implantation or follow-up period, and both pacemakers and stimulators functioned well. Rosenow, et al 8) reported that after implantation of an ICD in a patient with a deep brain stimulator, testing of the devices over a wide range of settings revealed no interaction and the patient subsequently underwent multiple episodes of cardioversion with no evidence of adverse neurological effects, and interrogation of the DBS devices after cardioversions revealed no changes in stimulus parameters indicating that DBS systems might be safely retained in selected patients who required ICDs. On the other hand, only one of the reports stated that the ICD shock did affect the stimulators.…”

Introduction

“…With regards to this last statement, power consumption is obviously an important issue, and until this is addressed it is unlikely that, for example, pacemakers would be used to monitor the cardiovascular status as part of a body sensor network. Security and interference of these devices with each other, as well as with day-to-day technologies used by patients such as mobile phones, is a concern that has been noted and must be addressed [92]. The concern here is that interference may result in not only sensor malfunction, but also might affect implanted drug delivery systems and stimulators.…”

Biomedical applications of batteries

“…It used to be thought that deep brain stimulation (DBS) systems should be disconnected before cardiac defibrillators were implanted but a recent study has shown that DBS systems can be retained [48]. Optimisation studies to maximise battery life have been reported [49].…”