Department of Urology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom.
J Urol. 2011 Oct;186(4):1198-205. doi: 10.1016/j.juro.2011.02.2697. Epub 2011 Aug 16.
Pacemakers and implantable cardioverter defibrillators are widely used and often encountered in urology practices worldwide. Safety and performance during electrosurgery, extracorporeal shock wave lithotripsy, magnetic resonance imaging, positron emission tomography and radiotherapy are not clearly defined. We reviewed the literature on their use and implications in urological practice.
We performed a PubMed® search and all relevant articles were studied to understand the basic functioning of these devices along with the technological advances designed to reduce electromagnetic interference.
A modern permanent pacemaker is comprised of a generator and leads connecting to the atrial or ventricular myocardium with sensing and pacing functions. Implantable cardioverter defibrillators respond to episodes of ventricular tachycardia and fibrillation by discharging a defibrillating current. From a device perspective, several protective mechanisms have been developed in the permanent pacemaker/implantable cardioverter defibrillator to reduce the effects of electromagnetic interference. These involve generator material changes, lead modification, and better sensing and pacing algorithms. Magnetic resonance imaging compatible pacemakers have now been developed and are approved for use in Europe. From a urologist's perspective 5 procedures require the close monitoring of permanent pacemaker/implantable cardioverter defibrillator function. 1) For electrosurgery modifications in the device and in the methods of use have been recommended. 2) For extracorporeal shock wave lithotripsy the European Association of Urology provides some guidance with regard to patients with these devices. 3) During positron emission tomography the pulse generator and the lead area should be covered with lead to protect the device. 4) Magnetic resonance imaging is contraindicated but currently trials are under way for a new pacing system for safe use in the magnetic resonance imaging environment. 5) Patients can undergo radiotherapy with standard precautions but those with an abdominal permanent pacemaker/implantable cardioverter defibrillator require careful planning. Finally, implanted devices should have a full evaluation before and after the procedure.
Clear guidelines are essential given the rapid advances in technology to enhance patient safety. Magnetic resonance imaging should be avoided in patients without a magnetic resonance imaging compatible device. However, patients can undergo extracorporeal shock wave lithotripsy, radiotherapy and positron emission tomography as long as the device is not in the path.
起搏器和植入式心脏复律除颤器在全球范围内的泌尿科实践中广泛使用且经常遇到。在电外科手术、体外冲击波碎石术、磁共振成像、正电子发射断层扫描和放射治疗期间，其安全性和性能尚未明确界定。我们回顾了关于这些设备在泌尿科实践中的使用和影响的文献。
我们在 PubMed®上进行了搜索，并研究了所有相关文章，以了解这些设备的基本功能以及旨在减少电磁干扰的技术进步。
现代永久起搏器由一个发生器和连接到心房或心室心肌的导线组成，具有感应和起搏功能。植入式心脏复律除颤器通过释放除颤电流来响应室性心动过速和颤动发作。从设备角度来看，已经在永久起搏器/植入式心脏复律除颤器中开发了几种保护机制来降低电磁干扰的影响。这些机制包括发生器材料变化、导线修改以及更好的感应和起搏算法。现在已经开发出兼容磁共振成像的起搏器，并已在欧洲获得批准使用。从泌尿科医生的角度来看，有 5 种程序需要密切监测永久起搏器/植入式心脏复律除颤器的功能。1）对于电外科手术，已经推荐了设备和使用方法的修改。2）对于体外冲击波碎石术，欧洲泌尿外科协会提供了一些关于患有这些设备的患者的指导。3）在正电子发射断层扫描期间，脉冲发生器和导线区域应覆盖铅以保护设备。4）磁共振成像被禁用，但目前正在进行一项新的起搏系统试验，以确保在磁共振成像环境中的安全使用。5）患者可以接受标准预防措施的放射治疗，但腹部有永久起搏器/植入式心脏复律除颤器的患者需要仔细计划。最后，在进行程序之前和之后，应对植入设备进行全面评估。
鉴于技术的快速进步，增强患者安全性至关重要，因此需要明确的指南。在没有磁共振成像兼容设备的患者中应避免进行磁共振成像。然而，只要设备不在路径中，患者就可以进行体外冲击波碎石术、放射治疗和正电子发射断层扫描。
