From the Guidelines
Yes, sacral neuromodulation can typically be used in patients with cardiac pacemakers, but careful consideration and precautions are necessary. When implementing sacral neuromodulation in a patient with a cardiac pacemaker, it's crucial to consult with both the urologist and cardiologist to ensure proper device programming and compatibility. The sacral neuromodulation device should be programmed to use bipolar stimulation settings to minimize potential interference with the pacemaker. Additionally, the implantation procedure for the sacral neuromodulation device should be performed under fluoroscopic guidance to ensure adequate separation from the pacemaker leads. Some key points to consider include:
- The potential for electromagnetic interference between the devices, as discussed in the guidelines for cardiac pacing and cardiac resynchronization therapy 1
- The importance of minimizing unnecessary ventricular pacing, as highlighted in the 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities 1
- The need for careful monitoring and follow-up to detect any potential interactions between the devices, as recommended in the guidelines for device-based therapy of cardiac rhythm abnormalities 1 During follow-up visits, healthcare providers should monitor for any signs of device interaction, such as changes in pacemaker function or unexpected stimulation effects. Patients should be instructed to report any unusual symptoms or changes in the functioning of either device. It's also important to note that MRI compatibility may be affected when both devices are present, so alternative imaging modalities may need to be considered for future diagnostic needs. The rationale behind the compatibility of these devices lies in their different anatomical targets and stimulation parameters. Sacral neuromodulation primarily affects the sacral nerves, while cardiac pacemakers focus on the heart's electrical system. Modern medical devices are designed with electromagnetic shielding and programming options that allow for coexistence, provided proper precautions are taken, as supported by the guidelines for cardiac pacing and cardiac resynchronization therapy 1.
From the Research
Safety of Sacral Neuromodulation in Patients with Cardiac Pacemakers
- The use of sacral neuromodulation in patients with cardiac pacemakers has been studied in several case series, with no evidence of cross-interference or adverse interactions between the two devices 2, 3, 4.
- In these studies, patients with cardiac pacemakers underwent sacral nerve stimulation for urinary urgency, frequency, and urge incontinence, and all patients had a greater than 50% reduction in incontinence episodes during their test trial 2, 3.
- Postoperative programming of the sacral neuromodulation device was done under electrocardiogram monitoring by a cardiologist, and no interference was observed between the device and the cardiac pacemaker 3.
- The potential for cross-talk between cardiac pacemakers and sacral neuromodulation remains speculative, but available evidence suggests that sacral neuromodulation appears to be safe in the setting of cardiac pacemakers without cardioversion/defibrillation technology 4.
- Cardiologists should be familiar with extra-cardiac stimulators, including sacral neuromodulation devices, and potential issues that must be addressed when these patients undergo cardiac procedures 5.
- Proper precautions and guidelines should be followed to ensure safe and appropriate integration of sacral neuromodulation devices in clinical practice, including management in periprocedural settings such as general operating room recommendations, electrocautery, and implanted cardiac devices 6.