scs trial and pacemaker...

[Jcm800]

have one tomorrow. St. Jude SCS, Guidant (msp) pacer. I plan to have the pacer rep there, monitor during the trial. This is all i can really think of to do, any other suggestions. This is situation came up a few years ago, and this is what we did, worked ok.

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[painstop]

The technical answer would be to have the rep interrogate the PPM and place external pads on the patient in the event of a dangerous arrythmia/bradycardic episode. In reality, if the rep tells you that placing a magnet over the PPM site puts it in asynchronous mode then you should be okay with that in case of trouble and just leave the PPM alone. If the pt is pacer dependent, I would probably go with the former. Obviously, make sure the grounding pad is as far away from the PPM insertion site as reasonably possible.

have one tomorrow. St. Jude SCS, Guidant (msp) pacer. I plan to have the pacer rep there, monitor during the trial. This is all i can really think of to do, any other suggestions. This is situation came up a few years ago, and this is what we did, worked ok.

 

[ParaVert]

There should be no problem with the trial. The concern is either with use of cautery for implant, or with RF communication from programmer to implanted IPG. A trial utilizes no RF communication (at least a St. Jude trial doesn't, Bos Sci would be different story). Trial away, dude.

Correct me if I'm wrong...

 

[lonelobo]

Only done one with a pacemaker,

but my reps gave me same info as ParaV

 

[facets]

Oh no, I've been lied to again. I thought you couldn't do a stim in anyone with a pacer or ACD?

 

[Neuromodulator]

have one tomorrow. St. Jude SCS, Guidant (msp) pacer. I plan to have the pacer rep there, monitor during the trial. This is all i can really think of to do, any other suggestions. This is situation came up a few years ago, and this is what we did, worked ok.

Pacemaker is fine, ICD is NOT. We make sure that we are trialing with the same company that patient has used for PM. It keep things simpler and reps communicate with each other to make sure they show up ontime. We let the cardiologist know. PM reps are available throughout. I have done trials on 14-15 patients with PMs, never had one issue. ICDs at present are a 'contraindication'.

 

[oreosandsake]

Can anyone point me in the direction for literature on this topic? Specifically, protocols for precautions... types of pacemaker vs types of SCS?

thanks

 

[NOSfan]

Can anyone point me in the direction for literature on this topic? Specifically, protocols for precautions... types of pacemaker vs types of SCS?

thanks

Here you go.....

Medtronic: https://professional.medtronic.com/pt/neuro/scs/ind/index.htm

St. Jude: http://www.poweroveryourpain.com/safety/SCSSafety

Boston Scientific: http://www.controlyourpain.com/prescription-information/precision-spectra-prescriptive-information/

 

[emd123]

FWIW- I just discussed this exact thing with one of my patient's electrophysiologists last week. He strongly recommends "no" to stim in any of his AICD patients. I brought up the bipolar settings and all the precautions and he didn't care. He said the sensing on the acids is set so sensitive, to pick up super low voltage vfib that he thought there's still risk of the AICD picking up a false vfib mimic signal, that he tells all his patients that if they get a stim he cannot rule out it falsely shocking them. He also said for pacemakers, there are still circumstances where a stim could trigger Asystole, despite the precautionary settings though much less likely sense the sensing is set with a higher threshold. I happen to know this guy personally too, and he's solid. Also, he's not just cards, he's electrophysiology. He says the only exception would be if the patient says they'd rather die than not have the stim, if their pain was that life altering they were willing to risk it.


From Medtronic: pages 5, 6 and 8

http://hbotechblog.files.wordpress.com/2011/07/medtronicneurostimulation.pdf

 

[jettavr6]

Trialed about 15 patients with pacers in place. Best to match the pacer with the same brand of SCS to keep it simple.

 

[clubdeac]

Wondering if things have changed. Got a patient with a dual chamber pacemaker that has failed two decompressions and was referred for SCS trial. His cardiology NP says it's ok to do. What's the consensus these days?? Ok?