Inhibition of a pacemaker during nerve stimulation for regional anaesthesia*

Abstract

Summary Electromagnetic interference is an important cause of pacemaker malfunction. We describe a case in which the use of a peripheral nerve stimulator at a pulse duration of 1 ms and a current of 1.4 mA led to complete but transient inhibition of a permanent pacemaker in a 73‐year‐old female who had undergone a total shoulder replacement.

Non-cardiac implantable electrical devices: brief review and implications for anesthesiologists

“…In this case, the use of a PNS with pulse duration of 1 ms led to complete but transient inhibition of a permanently implanted pacemaker. No inhibition was observed during nerve stimulation with pulse duration of 0.1 ms. 31 In the other case report involving the use of a nerve stimulator for supraclavicular block, there was no interference with the DBS and no resulting complication. 30 There are several safety precautions which should be considered during peripheral nerve blocks in patients with implantable electrical devices.…”

“…One involved the interaction with a cardiac pacemaker, and the other involved a non-cardiac implantable electrical device (DBS). 30,31 Englehardt et al reported a case of cardiac pacemaker malfunction with the use of a PNS. In this case, the use of a PNS with pulse duration of 1 ms led to complete but transient inhibition of a permanently implanted pacemaker.…”

Preventing pacemaker problems with nerve stimulators

“…The MASTER study did not involve UK hospitals and we do not feel that it has had the same impact on UK practice as you have found in New Zealand. Perhaps the survey being conducted by the Royal College of Anaesthetists on complications associated with neuraxial block in the UK will provide the information required for a balanced debate on the use of epidural analgesia [1]. Spinal opioids, ultrasound assisted regional blocks [2] and plexus or wound continuous infusions of local anaesthetic, all combined with newer surgical techniques may provide better and safer analgesia than can be achieved with an epidural.…”

“…Englehardt et al [1] report pacemaker 'malfunction' with the use of a peripheral nerve stimulator for placement and subsequent management of an interscalene catheter. They applied high-current output nerve stimulation across the chest and the lead system of a cardiac pacemaker, inducing a signal on the sensing circuit of the pacemaker.…”

“…A study cited by the authors argues against this assumption. Hadzic et al demonstrated that the electrical impedance between the stimulation needle (interscalene or femoral) and the return electrode subsequently placed on all four extremities, the umbilical region or even just 5 cm distal to the stimulation site did not change [1]. Thus the path and distribution of a current between two points in heterogeneous tissues such as our body are largely unknown.…”