Management of Deep Brain Stimulators During Pacemaker Insertion
Yes, Deep Brain Stimulators (DBS) require specific programming and monitoring when a cardiac pacemaker is inserted to prevent potential electromagnetic interference between the two devices. 1
Pre-Procedure Evaluation
- Determine the type of DBS device, its programmed settings, and battery status before the pacemaker implantation procedure 1
- Assess whether electromagnetic interference is likely to occur during the planned pacemaker insertion procedure 1
- Consult with both the neurologist managing the DBS and the cardiologist to coordinate device management 2, 3
- Document the original indication for DBS placement and current stimulation parameters 4
Intra-Procedure Management
- Program the DBS to bipolar stimulation mode if possible to minimize potential interference with the cardiac device 5
- Maintain continuous ECG and pulse monitoring throughout the procedure 1
- Position the pacemaker generator at least 6 inches (15 cm) away from the DBS pulse generator to decrease the chance of interference during telemetry reprogramming 6
- Consider passing pacemaker leads on the contralateral side to the DBS extension wires when anatomically feasible 6
- Minimize use of electrocautery during the procedure; when necessary, use bipolar electrocautery systems rather than unipolar 1
- If unipolar cautery must be used, place the ground patch in a position that minimizes current flow through the DBS device 1
- Use short, intermittent bursts of electrocautery at the lowest possible energy levels 1
Post-Procedure Monitoring
- Test both devices after pacemaker implantation to ensure proper functioning 2, 5
- Program the cardiac pacemaker to bipolar sensing mode to minimize the risk of oversensing signals from the DBS 5, 3
- Monitor cardiac rhythm during initial DBS activation after pacemaker implantation 6, 5
- Perform formal device interrogation of both systems to verify absence of interference 2, 3
Long-Term Follow-Up Considerations
- Schedule regular follow-up visits to monitor both devices, with coordination between neurology and cardiology teams 1, 4
- Document any potential interactions between the devices in the patient's medical record 4
- Instruct patients to report any unusual symptoms that might indicate device interaction 1
- Ensure patients carry proper identification and information about both implanted devices at all times 1
Potential Complications and Their Management
- Be vigilant for potential resetting of DBS parameters following pacemaker testing or defibrillation 3, 7
- Monitor for changes in DBS effectiveness that might indicate interference from the cardiac device 5
- Watch for cardiac rhythm abnormalities that could suggest interference from the DBS 5
Clinical Evidence and Safety
- Multiple case series have demonstrated that patients can safely have both DBS and cardiac pacemakers with proper management 2, 6, 5
- Long-term follow-up studies (up to 48 months) have shown no significant adverse interactions between properly managed DBS and cardiac pacemaker systems 5
- One early case report noted a DBS reset after ICD shock, highlighting the importance of device checking after defibrillation 3
Despite theoretical concerns, with appropriate precautions and management, patients with DBS can safely undergo pacemaker implantation with minimal risk of device interaction.