Extracorporeal shock wave lithotripsy in patient with cardiac pacemaker in an abdominal location: case report and review of the literature.

A 75-year-old man with complete heart block and a ventricular demand pacemaker with the generator in a left upper-quadrant subcutaneous pouch underwent extracorporeal shock wave lithotripsy (SWL) for a 2-cm proximal right ureteral calculus, receiving 2000 shocks at 24 kV. There was no damage or malfunction of the pacemaker, and the Dornier HM3 lithotripter had no difficulty sensing all paced ventricular complexes. The patient had excellent fragmentation of his calculus. Extracorporeal shock wave lithotripsy may be performed safely on patients with pacemakers directly in the path of the shock waves at maximal kilovoltage when appropriate peri-SWL guidelines are followed. Specifically, the treatment should be approved by a cardiologist knowledgeable about the patient and the pacemaker, and a cardiologist should be nearby with the equipment necessary to deal with any problems. Dual-chamber pacemakers should be reprogrammed to the single-chamber mode, and single-chamber rate-responsive devices should have the activity mode programmed off. Patients with the latter type of pacemaker implanted in the abdomen should not have SWL if the device will be close to F2.