Arrhythmia during Extracorporeal Shock Wave Lithotripsy

Abstract

A prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12-lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right-sided and left-sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s. It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo-analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oximeter to be perfectly reliable for raising the alarm when depression of respiration and vaso-vagal reactions occur.

Atypical cardioversion in unstable arrhythmia caused by clavicle surgery

“…Although there are no comparable reports, other examples of accidental mechanically induced rhythm changes exist, e.g. for shock wave lithotripsy [2] , [3] and vascular guide-wires [4] . Thus, anesthesiologists should be aware for the possibility of mechanically induced malignant arrhythmias during intramedullary nailing of the clavicle, especially concerning critical ill patients.…”

Acoustic energy and cardiac electrophysiology: Ultrasonic cardiac pacing and novel shockwave ablation catheters

“…3 Multiple studies established a high incidence of arrhythmic events with first-generation urologic lithotripters. 10,15,16 However, this phenomenon reappeared with the introduction of S-IVL in the market in 2017 to treat calcified coronary lesions even though the penetration depth of SSW in tissue with S-IVL is only 3-7 mm. 17 The catheter of S-IVL has integrated lithotripters that deliver SSW circumferentially, selectively cracking coronary calcium.…”

“…Multiple studies established a high incidence of arrhythmic events with first‐generation urologic lithotripters 10,15,16 . In 1989, Ector and his Belgian colleagues performed Holter monitoring in 400 subjects undergoing different modes of ESWL: respiratory‐triggered, ECG‐triggered, and non‐triggered 10 .…”