Effect of Extracorporeal Shock Wave Lithotripsy on Implantable Cardioverter Defibrillator

Abstract

Extracorporeal shock wave lithotripsy (ESWL) is frequently used for nephrolithiasis of the upper urinary tract. Because of the powerful shock wave and electromechanical forces created, this therapy has been contraindicated in the patient with an implantable cardioverter defibrillator (ICD). To determine whether or not ESWL affects ICD devices, we subjected ten devices to a full course of ESWL. The devices were then returned to the manufacturer to undergo bench analysis, which revealed no abnormalities in function. Additionally, one device was placed in the pathway of the shock wave, resulting in a discharge of the device despite a frequency of ESWL of 100 shocks/min (well below the rate cutoff of that device). Manufacturer analysis of this device, likewise, revealed no abnormalities even though the device had been exposed to the focal point of the shock wave. We conclude that contralateral ESWL is not contraindicated for the patient with an ICD. We do, however, recommend a post-procedure evaluation to ensure appropriate function of the ICD.

Application of Radiofrequency Energy in Surgical and Interventional Procedures:

“…In the modern medical era a variety of techniques exist using sound waves or radiation for diagnostic and therapeutic purposes. Several authors could demonstrate that shock waves applied during extracorporeal shock wave lithotripsy (ESWL) have no influence on ICD function, even when the generators have been exposed to the focal point of the wave 2–4 . In contrast, diagnostic radiation (screening mammography) 5 and therapeutic radiation showed different modes of interference with pacemakers 6 and ICDs 7 depending on the integrated circuit (IC) technology of the devices.…”

New-Generation Lithotripters for Treatment of Patients with Implantable Cardioverter Defibrillator: Experimental Approach and Review of Literature

“…This results in fewer unfocused shockwaves in the patient's body. 17 The experience described by Venditti and his working group [11][12][13] refers only to urolithiasis on the right side, as with the HM3, focusing on a left kidney stone was quite difficult because only fluoroscopy was available, and the ICD could overshadow the kidney. As most of the new lithotripters favor dual imaging, it would not be a problem to focus a left kidney stone by ultrasound as ICDs can be implanted in the abdominal wall.…”

Laser surgery in a patient with Romano‐Ward (long QT) syndrome and an automatic implantable cardioverter defibrillator

“…This was previously not recommended in patients with an AICD because of the powerful mechanical and electromagnetic forces generated during treatment and the close proximity of the AICD to the focus of the shock waves [22]. However, recent studies conclude that ESWL can be performed safely in selected patients with modern AICDs, although the device should be shielded and a complete test should be performed on it after treatment [23].…”