Key result
Extracorporeal shock wave lithotripsy did not damage or reprogram 22 pacemaker pulse generators, though 50% experienced inhibition when shock waves were delivered faster than the escape rate.
Why the study?
Does exposure to extracorporeal shock wave lithotripsy affect the function of pacemaker pulse generators?
Does exposure to extracorporeal shock wave lithotripsy affect the function of pacemaker pulse generators?
Cardiac pacemakers are not damaged or reprogrammed by extracorporeal shock wave lithotripsy, and false inhibition is unlikely if shock waves are synchronized with the QRS.
Supports preclinical ESWL safety near pacemakers; leaves open prospective human confirmation before practice change.
Twenty-two pacemaker pulse generators were exposed to shock waves of an extracorporeal shock wave lithotripter to assess the effects of the extremely high pressure transients on pacemaker function. The pulse generator and distal aspect of the lead were positioned 5 cm from the focal point of the lithotripter and 10 cm from each other. Pulse generator function was analyzed during shock wave delivery synchronized with pulse generator output, during shock waves at a rate faster than the escape rate, and after exposure to lithotripsy. During shock waves delivered synchronously with pulse generator output, only one of 22 pulse generators malfunctioned by intermittently reverting to the magnet rate. When subjected to shock waves at a rate greater than the escape rate, 50% of the pulse generators were inhibited by electromechanical interference from the lithotripter. Both bipolar and unipolar devices were affected. However, analysis after exposure to shock waves showed that none of the pacemakers was damaged or spuriously reprogrammed. In conclusion, cardiac pacemakers do not appear to be damaged or reprogrammed by exposure to extracorporeal shock wave lithotripsy. The likelihood of false inhibition appears to be very low if shock waves are delivered synchronously with the QRS.
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Langberg et al. (1987) studied Pacemaker function (n=22). Extracorporeal shock wave lithotripsy was evaluated on Pacemaker function (malfunction, inhibition, damage, or reprogramming). Extracorporeal shock wave lithotripsy did not damage or reprogram 22 pacemaker pulse generators, though 50% experienced inhibition when shock waves were delivered faster than the escape rate.
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