Romanó M, Zucco F, Baldini M R, Allaria B
Department of Cardiology, S. Corona Hospital, Garbagnate Milanese, Italy.
Pacing Clin Electrophysiol. 1993 Aug;16(8):1639-44. doi: 10.1111/j.1540-8159.1993.tb01033.x.
Spinal cord stimulators are used to relieve pain associated with peripheral ischemia and angina pectoris. In patients with both permanent pacemaker (PPM) and a spinal cord stimulator (SCS), electromagnetic signals from the SCS may inhibit the PPM. A bipolar PPM configuration is preferred to minimize myopotential or electromagnetic interference but patients have safely had unipolar devices implanted. We report ten patients (six males and four females; median age 73.3 years) with both a SCS and a PPM implanted between 1987-1991. Intermittent interference with one PPM (Ela Medical Model Opus 3001) was noted after an increase in the output voltage of the SCS for continued clinical efficacy. Inhibition was output voltage dependent, and reversion to the noise mode was frequency dependent. Sensitivity to both could be managed by changing the pacemaker sensitivity. Interference with pacemaker function occurred if the SCS output was set above a voltage and pulse duration which resulted in a product of these values above 1.9-2 mVs. Seven VVI, one VDD, and two DDD PPM had been implanted. In five patients both PPM and SCS were unipolar. In two patients the SCS was bipolar and the PPM unipolar, in two patients a bipolar PPM was associated with a bipolar SCS and with one patient, a unipolar SCS. Multiprogrammable and/or bipolar PPMs should be implanted in a patient with a SCS to allow reprogramming of the PPM and to minimize the risk of inter-device interference. Inhibition of the PPM may occur at different SCS stimulation frequencies. The frequency at which inhibition occurs varies with different models of implanted pacemaker.
脊髓刺激器用于缓解与外周缺血和心绞痛相关的疼痛。对于同时植入永久性起搏器（PPM）和脊髓刺激器（SCS）的患者，SCS发出的电磁信号可能会抑制PPM。为了将肌电位或电磁干扰降至最低，首选双极PPM配置，但患者植入单极设备也较为安全。我们报告了1987年至1991年间植入SCS和PPM的10例患者（6例男性和4例女性；中位年龄73.3岁）。为了持续获得临床疗效而提高SCS输出电压后，发现其中一台PPM（伊拉医疗公司的Opus 3001型号）出现间歇性干扰。抑制作用取决于输出电压，而恢复到噪声模式则取决于频率。通过改变起搏器灵敏度可以控制对两者的敏感性。如果SCS输出设置高于某个电压和脉冲持续时间，导致这些值的乘积超过1.9 - 2 mVs，就会发生对起搏器功能的干扰。已植入7台VVI、1台VDD和2台DDD型PPM。5例患者的PPM和SCS均为单极。2例患者的SCS为双极而PPM为单极，2例患者的双极PPM与双极SCS相关，1例患者的SCS为单极。对于植入SCS的患者，应植入多程控和/或双极PPM，以便对PPM进行重新编程，并将设备间干扰的风险降至最低。PPM的抑制可能发生在不同的SCS刺激频率下。抑制发生的频率因植入起搏器的不同型号而异。
