Shockwave Lithotripsy and Pacemakers: Experience with 20 Cases

Abstract

Lithotripsy treatment of urinary tract calculi initially excluded patients with cardiac pacemakers. Continued research and clinical study of patient outcomes has promoted a change in that initial concept. The Oklahoma Lithotripsy Center has successfully treated 20 patients with various types of pacemakers. No significant cardiovascular events occurred during treatment. Patients should be evaluated before the procedure by a cardiologist, and dual-chamber pacemakers should be reprogrammed to the single-chamber mode. Patients who cannot tolerate this should not undergo SWL. Rate-responsive pacemakers should be programmed to the non-rate-responsive (VVI) mode. The pacemaker should be at least 5 cm from the blast path. With these precautions and careful monitoring, SWL can be performed safely in most patients with pacemakers.

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

“…14 However, other investigators found no evidence that pacemakers are damaged or reprogrammed by exposure to shockwaves. 15,16 These results are not relevant any more, as new lithotripters have a completely different technical standard. One reason for a lower likelihood of mechanical damage is that new-generation lithotripters use a cushion instead of the waterbath for coupling.…”

Interference in Implanted Cardiac Devices, Part II

“…One device exhibited power-on-reset, one patient developed irregular heart rhythm if more than 22 kV was used, one device exhibited intermittent asynchronous operation, and one a 10beat/min increase in pacing rate with several extrasystoles. Albers et al 93 did not observe detrimental interactions in 20 pacemaker patients undergoing ESWL for urinary tract calculi. Safe ESWL has been reported in a patient with an abdominal contralateral early model ICD shielded with polyestyrene foam 94 and in a patient with an unshielded tiered-therapy ICD ipsilateral to the renal stone.…”

Complications of Extracorporeal Shock Wave Lithotripsy for Urinary Stones: To Know and to Manage Them—A Review

“…There is no documented relationship between the onset of arrhythmia and age, sex, cardiopathy, site, volume of the stone, onsite stent or nephrostomy, with or without anaesthesia, the number of shock waves, and the type of lithotripter [36]. Even those patients with pace makers may undergo an SWL with necessary precautions and cardiological supervision [37]. Although clinical and experimental data indicates that patients with aortic or renal aneurisms may be treated successfully, literature has reported some cases of breakage after an SWL [38].…”