Thomas Jefferson University Hospital, Pennsylvania, PA 19107, USA.
Neuromodulation. 2011 Jan;14(1):20-5; discussion 25-6. doi: 10.1111/j.1525-1403.2010.00314.x. Epub 2010 Nov 2.
Neurostimulation is widely accepted for the treatment of refractory Parkinson's disease, essential tremor, and chronic pain. The presence of a cardiovascular implantable electronic device (CIED) might be considered a contraindication for neurostimulators due to the possible interaction between the two devices. The purpose of this study is to report the feasibility and safety of concomitant use of neurostimulators and CIED, and to review surgical and clinical precautions needed to avoid possible interference between the two systems.
A retrospective institutional review board approved chart review of six patients having both a neurostimulator(s) and a CIED was performed. Diagnosis included Parkinson's disease (two) and intractable pain (four). All implantable cardiac devices were set on bipolar sensing mode and bipolar stimulation was chosen for the neurostimulators. In general, both systems were implanted at sites seven inches apart. Electrocardiogram monitoring was observed throughout implantation. Patients were followed up for a mean period of 31.7 months (ranging from 14 to 67 months). An extensive chart review was done and cases from previous reports were compiled.
In all six patients, no acute events occurred during surgery with no interaction or interference noted during implantation of the second device. Subsequent follow-up visits continued to exhibit a lack of interference between the two systems, including normal electrocardiogram studies. Both systems were noted to function at optimal levels. An extensive literature review revealed 57 unique cases previously published reporting the simultaneous use of neurostimulators and a CIED in the same patient. A table summarizing previously cited cases from the literature is provided.
The concomitant use of neurostimulator(s) and permanent pacemaker(s) can be safely performed. Permanent pacemaker should not be considered a general contraindication for neurostimulation therapy. Current literature lacks evidence to determine the safety of concomitant use of neurostimulator(s) and implantable cardioverter defibrillator(s).
神经刺激广泛用于治疗难治性帕金森病、原发性震颤和慢性疼痛。由于两种设备之间可能存在相互作用，因此存在心血管植入式电子设备 (CIED) 可能被认为是神经刺激器的禁忌症。本研究的目的是报告同时使用神经刺激器和 CIED 的可行性和安全性，并回顾为避免两种系统之间可能发生干扰而需要的手术和临床注意事项。
对六名同时拥有神经刺激器和 CIED 的患者进行了回顾性机构审查委员会批准的图表审查。诊断包括帕金森病（2 例）和难治性疼痛（4 例）。所有植入式心脏设备均设置为双极感应模式，并选择双极刺激用于神经刺激器。通常，两种系统都安装在相隔七英寸的位置。整个植入过程中都进行心电图监测。患者平均随访 31.7 个月（范围为 14 至 67 个月）。进行了广泛的图表审查，并汇编了以前报告的病例。
在所有六例患者中，手术过程中均未发生急性事件，在植入第二台设备时未发现相互作用或干扰。随后的随访继续显示两种系统之间没有干扰，包括正常的心电图研究。两种系统均被认为功能处于最佳水平。广泛的文献综述显示，先前已发表了 57 例独特病例报告，这些病例报告在同一患者中同时使用神经刺激器和 CIED。提供了一个总结以前文献中引用案例的表格。
可以安全地同时使用神经刺激器和永久起搏器。永久性起搏器不应被视为神经刺激治疗的一般禁忌症。目前的文献缺乏确定同时使用神经刺激器和植入式心脏复律除颤器安全性的证据。
