American Lithotripsy Society Patient Care Clinical Considerations


 

ISSUES FOR CONSIDERATION FOR SWL IN PATIENTS WITH PACEMAKERS

1. All patients should have cardiac clearance prior to the procedure.
- It is suggested that the pacemaker considerations be sent to the physician for his/her review to assure that all items are addressed.

2. Each patient should be individually evaluated for the need to have a cardiologist or physician knowledgeable in pacemaker management in the unit or on standby during the procedure.

3. A temporary pacemaker and magnet should be readily available if deemed necessary by the patient's cardiologist.

4. The pacemaker should be assessed before and after the procedure to verify that the programmed parameters have not been altered.

5. For Dual Chamber pacemakers:

a. Dual Chamber pacemakers should be reprogrammed to the VVI mode during shock wave lithotripsy.

b. In the DDD mode, an atrial pacing spike could trigger the lithotripter. If this occurs, the ventricular sensing channel could sense the resultant shock wave generator EMI and inhibit ventricular output.

6. For Rate Responsive [Piezoelectric] pacemakers:

a. The rate responsive feature should be programmed off.

b. Rate responsive pacemakers, with piezoelectric crystals, should be implanted in the chest to prevent the crystal from being shattered during treatment.

c. Abdominally implanted rate responsive pacemakers are at risk for damage during SWL.

 

(continued.)
7. Blast path issues should be considered when positioning the patient with regards to the location of the pacemaker

8. Continuous ECG monitoring of the patient should be provided throughout the procedure.

9. ECG shock wave gaiting with the lithotripter should be considered during the procedure. Delivering shock waves synchronously with the R waves of the ECG should help prevent any shock wave induced EMI from inhibiting the pacemaker pulse generator.

VERSION: March 8, 2001

 

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American Lithotripsy Society Patient Care Clinical Considerations

 

ISSUES FOR CONSIDERATION FOR SWL IN PATIENTS WITH PACEMAKERS

1. All patients should have cardiac clearance prior to the procedure.
- It is suggested that the pacemaker considerations be sent to the physician for his/her review to assure that all items are addressed.

2. Each patient should be individually evaluated for the need to have a cardiologist or physician knowledgeable in pacemaker management in the unit or on standby during the procedure.

3. A temporary pacemaker and magnet should be readily available if deemed necessary by the patient's cardiologist.

4. The pacemaker should be assessed before and after the procedure to verify that the programmed parameters have not been altered.

5. For Dual Chamber pacemakers:

a. Dual Chamber pacemakers should be reprogrammed to the VVI mode during shock wave lithotripsy.

b. In the DDD mode, an atrial pacing spike could trigger the lithotripter. If this occurs, the ventricular sensing channel could sense the resultant shock wave generator EMI and inhibit ventricular output.

6. For Rate Responsive [Piezoelectric] pacemakers:

a. The rate responsive feature should be programmed off.

b. Rate responsive pacemakers, with piezoelectric crystals, should be implanted in the chest to prevent the crystal from being shattered during treatment.

c. Abdominally implanted rate responsive pacemakers are at risk for damage during SWL.

 

(continued.)
7. Blast path issues should be considered when positioning the patient with regards to the location of the pacemaker

8. Continuous ECG monitoring of the patient should be provided throughout the procedure.

9. ECG shock wave gaiting with the lithotripter should be considered during the procedure. Delivering shock waves synchronously with the R waves of the ECG should help prevent any shock wave induced EMI from inhibiting the pacemaker pulse generator.

VERSION: March 8, 2001

 

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back to guidelines



American Lithotripsy Society
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Waltham, Massachusetts 02451
Telephone: (781) 895-9098
Fax: (781) 895-9088
email:
als@lithotripsy.org