Potential interference of spinal cord and sacral stimulators with cardiac implantable electronic devices: a systematic review.

Spinal cord stimulation (SCS) and sacral nerve stimulation (SNS) are neuromodulation therapies increasingly used for treatment-resistant chronic pain and urinary or fecal incontinence. Despite their benefits, concerns remain regarding their potential interference with cardiac implantable electronic devices (CIEDs), including permanent pacemakers (PPMs) and implantable cardioverter defibrillators (ICDs), potentially leading to inappropriate pacing or shocks. This systematic review aimed to assess documented interactions between these devices to guide clinical decision-making and enhance patient safety. A comprehensive search of PubMed, Embase, Scopus, Cochrane Library, and Web of Science was conducted for studies published up to November 2024. Eligible studies included adult patients with both SCS or SNS and CIEDs. Due to methodological heterogeneity, findings were summarized descriptively, and meta-analysis was not performed. The quality of the included studies was evaluated using Joanna Briggs Institute (JBI) critical appraisal tools. A total of 30 studies involving 119 participants were included. Among 107 patients with SCS, two instances of interference (1.86%) were reported: one with unipolar and one with bipolar configurations. In both cases, the interference was successfully managed through adjustments of stimulation parameters. No interference or adverse cardiac events were reported in 12 patients with concurrent SNS and CIEDs. The risk of interactions between SCS/SNS and ICDs/PPMs appears to be low and manageable with appropriate device programming and monitoring. Nevertheless, the absence of standardized monitoring protocols and methodological heterogeneity limits the generalizability of findings. Future research should focus on developing standardized protocols for assessing device compatibility to ensure safe integration of neuromodulation and cardiac therapies. Clinical trial number Not applicable.