Rotman Research Institute, Baycrest Health Science, Toronto, Canada; Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Chemin de la cote Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
Dept. of Cardiology, Jewish General Hospital, 3755 Chemin de la cote Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
Brain Stimul. 2020 Jan-Feb;13(1):89-95. doi: 10.1016/j.brs.2019.08.010. Epub 2019 Aug 17.
Studies investigating the therapeutic applications of transcranial direct current stimulation (tDCS) in the treatment of age-related neurodegenerative disease have been promising. However, exclusion criteria for these studies invariably disqualify patients implanted with internal cardiac pacemakers, citing safety concerns. Because the majority of cardiac pacemaker implantees are over 65, this criterion may limit candidacy for tDCS based research and/or treatment of age-related neurodegenerative disease.
OBJECTIVE/HYPOTHESIS: We will test the hypothesis that tDCS impacts pacemaker function. Strong electrical potentials, such as those generated by external defibrillators (∼500 V, ∼10 A), are known to occasionally damage pacemaker circuitry and software, but it seems unlikely tDCS would damage a pacemaker because it involves about 1/200th the energy (∼12 V, ∼2 mA) of an external defibrillator.
We delivered tDCS to seven participants (ages 70-92) with bipolar non-dependent pacemakers and subsequently collected data from the internal memory of the pacemakers to assess the tDCS signal detection, as well as alterations in mode switches, impedance levels, and pacing. Subsequently, similar assessments were carried out in participants who were pacemaker-dependent (ages 89-91).
After a review of the recordings, it was found that tDCS had no impact on the non-dependant, as well as the dependent, pacemakers. There were zero mode switches nor any impact on impedance levels.
Results in this small series of cases found no evidence that tDCS interferes with the function of the pacemakers and suggests tDCS can be delivered to patients equipped with a cardiac pacemaker. Further studies are needed to generalize these results to other pacemakers.
研究表明，经颅直流电刺激（tDCS）在治疗与年龄相关的神经退行性疾病方面具有治疗应用的潜力。然而，这些研究的排除标准无一例外地排除了植入内置心脏起搏器的患者，理由是存在安全隐患。由于大多数心脏起搏器植入者年龄都在 65 岁以上，这一标准可能限制了基于 tDCS 的研究和/或治疗与年龄相关的神经退行性疾病的候选人群。
目的/假设：我们将检验 tDCS 是否会影响起搏器功能这一假设。众所周知，强大的电场，如外部除颤器产生的电场（约 500V，约 10A），偶尔会损坏起搏器电路和软件，但似乎不太可能 tDCS 会损坏起搏器，因为它涉及的能量大约是外部除颤器的 1/200（约 12V，约 2mA）。
我们对 7 名（年龄 70-92 岁）具有双极非依赖性起搏器的参与者进行了 tDCS 治疗，随后从起搏器的内部存储器中收集数据，以评估 tDCS 信号检测以及模式切换、阻抗水平和起搏的变化。随后，对依赖起搏器的参与者（年龄 89-91 岁）进行了类似的评估。
在审查了记录后发现，tDCS 对非依赖性以及依赖性起搏器均没有影响。没有模式切换，也没有对阻抗水平产生任何影响。
在这项小型病例系列研究中，结果没有证据表明 tDCS 会干扰起搏器的功能，并表明可以向配备心脏起搏器的患者提供 tDCS。需要进一步的研究来将这些结果推广到其他起搏器。
