Cardiac Arrhythmias with External Fixed-Rate Signal Generators in Shock Wave Lithotripsy with the Medstone Lithotripter

Ganem, J; Carson, Culley C.

doi:10.1016/s0090-4295(97)00707-3

Cited by 22 publications

(14 citation statements)

References 23 publications

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“…20,22 Other studies have shown that there is a higher rate of dysrhythmias in patients with renal stones compared with ureteric stones. 13,14 Cardiac dysrhythmias can be induced in an animal model by focusing shockwaves at the apex of the heart. 23 These findings suggest that the location of the stone is an important predisposing factor in the development of CD and this supports the hypothesis that direct pressure stimulation of the myocardium contributes to CD during ESWL.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12] Such events have been documented at rates of 60% to 80% with early lithotripters and have led to the development of electrocardiogram (ECG)-gated shock wave delivery systems for management and prevention. 11,13,14 Although modern lithotripters have a lower incidence of CD during treatment, they still occur in up to 21% of patients depending on the device used. [13][14][15] Due to the increased treatment time required for ECG-gated lithotripsy, most procedures are performed at a fixed-rate putting patients at a higher risk of developing CD.…”

Section: Introductionmentioning

confidence: 99%

“…11,13,14 Although modern lithotripters have a lower incidence of CD during treatment, they still occur in up to 21% of patients depending on the device used. [13][14][15] Due to the increased treatment time required for ECG-gated lithotripsy, most procedures are performed at a fixed-rate putting patients at a higher risk of developing CD. 13,14 Most CD identified are benign, unifocal premature ventricular contractions (PVC), skinner and norman but severe multifocal PVC and supraventricular tachycardias can also occur.…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15] Due to the increased treatment time required for ECG-gated lithotripsy, most procedures are performed at a fixed-rate putting patients at a higher risk of developing CD. 13,14 Most CD identified are benign, unifocal premature ventricular contractions (PVC), skinner and norman but severe multifocal PVC and supraventricular tachycardias can also occur. 4,14,16 Almost all CD return to normal sinus rhythm following conversion to ECG-gated shock delivery and pose no intraoperative or postoperative consequences; consequently, the importance of preventing such events remains unknown.…”

Section: Introductionmentioning

confidence: 99%

“…13,14 Most CD identified are benign, unifocal premature ventricular contractions (PVC), skinner and norman but severe multifocal PVC and supraventricular tachycardias can also occur. 4,14,16 Almost all CD return to normal sinus rhythm following conversion to ECG-gated shock delivery and pose no intraoperative or postoperative consequences; consequently, the importance of preventing such events remains unknown. 15 The exact mechanism of abnormal cardiac activity during ESWL is poorly understood and consistent evidence on predisposing risk factors has not been established.…”

Section: Introductionmentioning

confidence: 99%

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Variables influencing the likelihood of cardiac dysrhythmias during extracorporeal shock wave lithotripsy

Skinner¹,

Norman²

2012

cuaj

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Introduction: Extracorporeal shock wave lithotripsy (ESWL) is a safe and effective treatment of upper urinary tract calculi. While serious side effects are rare, transient cardiac dysrhythmias (CD) may be associated with ESWL. The exact etiology of these events, which are often unpredictable, is poorly understood. Awareness of CD during ESWL and identification of risk factors for developing them could help clinicians predict and manage them safely and effectively. The current study examines selected variables to determine whether they may predispose individuals to developing CD during ESWL. Methods: We compared 16 patients who experienced CD during ESWL to 56 control patients. Cases and controls were compared with respect to several continuous and discrete variables, including age, pre-treatment heart rate, number of shocks received during treatment, energy setting of the lithotripter, gender, presence of a ureteric stent, previous ESWL and side being treated. Results: Cardiac dysrhythmias occurred more frequently in younger patients and in those being treated for right-sided stones. The other variables did not influence the likelihood of CD. All CD resolved promptly following conversion to electrocardiogram (ECG)-gating. Conclusion: Younger age and right-sided treatment predisposed individuals to developing CD during ESWL. Careful ECG monitoring should be performed during treatment. RésuméIntroduction : La lithotripsie extra-corporelle par ondes de choc (LECOC) est un traitement sûr et efficace pour les calculs des voies urinaires supérieures. Les effets secondaires graves sont rares, mais des dysrythmies cardiaques (DC) transitoires peuvent être associées à la LECOC. L'étiologie précise de ces manifestations souvent imprévisibles est mal établie. La reconnaissance d'une DC pendant la LECOC et des facteurs de risque de cette manifestation pourrait aider les cliniciens à en prédire la survenue et à traiter cette manifestation avec efficacité et en toute sécurité. L'étude présentée ici examine des variables sélectionnées pour déterminer si ces dernières peuvent prédisposer à la survenue d'une DC pendant une LECOC. Méthodologie : Nous avons comparé 16 patients ayant présenté une DC pendant une LECOC et 56 patients témoins. Les cas de DC et les témoins ont été comparés sur le plan de plusieurs variables continues et ponctuelles, dont l'âge, la fréquence cardiaque avant le traitement, le nombre d'ondes de choc reçues pendant le traitement, le niveau d'énergie établi pour le lithotriteur, le sexe, la présence d'une endoprothèse urétérale, le recours antérieur à une LECOC et le côté traité. Résultats : Les dysrythmies cardiaques ont été plus fréquentes chez les patients plus jeunes et les personnes traitées pour des calculs du côté droit. Les autres variables n'ont eu aucun effet sur la probabilité de survenue de DC. Toutes les DC se sont résorbées rapidement après conversion par synchronisation à l'électrocardiographie (ECG). Conclusion : Un âge moins avancé et un traitement du côté droit prédisposent les pat...

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