Simultaneous use of neurostimulators in patients with a preexisting cardiovascular implantable electronic device.

Object: Neurostimulation is widely accepted for the treatment of refractory Parkinson's disease, essential tremor, and chronic pain. The presence of a cardiovascular implantable electronic device (CIED) might be considered a contraindication for neurostimulators due to the possible interaction between the two devices. The purpose of this study is to report the feasibility and safety of concomitant use of neurostimulators and CIED, and to review surgical and clinical precautions needed to avoid possible interference between the two systems.

Methods: A retrospective institutional review board approved chart review of six patients having both a neurostimulator(s) and a CIED was performed. Diagnosis included Parkinson's disease (two) and intractable pain (four). All implantable cardiac devices were set on bipolar sensing mode and bipolar stimulation was chosen for the neurostimulators. In general, both systems were implanted at sites seven inches apart. Electrocardiogram monitoring was observed throughout implantation. Patients were followed up for a mean period of 31.7 months (ranging from 14 to 67 months). An extensive chart review was done and cases from previous reports were compiled.

Results: In all six patients, no acute events occurred during surgery with no interaction or interference noted during implantation of the second device. Subsequent follow-up visits continued to exhibit a lack of interference between the two systems, including normal electrocardiogram studies. Both systems were noted to function at optimal levels. An extensive literature review revealed 57 unique cases previously published reporting the simultaneous use of neurostimulators and a CIED in the same patient. A table summarizing previously cited cases from the literature is provided.

Conclusion: The concomitant use of neurostimulator(s) and permanent pacemaker(s) can be safely performed. Permanent pacemaker should not be considered a general contraindication for neurostimulation therapy. Current literature lacks evidence to determine the safety of concomitant use of neurostimulator(s) and implantable cardioverter defibrillator(s).