Guidelines for Urologists while Dealing with Patients having Pacemakers or ICDs


In urology practice, one often encounters patients with permanent pacemakers (PPMs) or implantable cardioverter defibrillators (ICDs). Doctors are often in a dilemma while performing procedures which create electromagnetic interference in these patients. This is because the safety or performance of these devices during electrosurgery, extracorporeal shock wave lithotripsy, magnetic resonance imaging, positron emission tomography and radiotherapy had not been properly evaluated earlier.
A new study, published online August 16, 2011 issue of "The Journal of Urology”, analyzed the results of all previous studies in this field to understand the use of PPMs and ICDs in urological practice and its implications. The study, conducted by Sarvpreet Singh Ubee, Vijay Kumar Kasi et al, has come up with several guidelines which will help urologists in dealing with patients with these devices, during certain surgical and diagnostic procedures.
Both PPMs and ICDs have been incorporated with several safety features like generator material changes, lead modification, and better sensing and pacing algorithms to reduce the effects of electromagnetic interference. In Europe, the pacemakers being currently used are compatible to magnetic resonance imaging. Urologists have to take extra precautions while dealing with patients with these devices for five different procedures. The procedures along with the recommended guidelines are:
Recommendations have been made for modifications in the device and in the methods of use during electrosurgery.
For extracorporeal shock wave lithotripsy, the patient’s cardiologist should be consulted prior to the procedure and the device should be re-programmed to single-chamber ventricular pacing with reduced sensitivity.
While performing positron emission tomography, the pulse generator and the lead area should be covered with lead to protect the device from ionizing radiation.
MRI is generally contraindicated. However, when absolutely necessary, it should be performed by doctors having adequate radiology and cardiology knowledge.
Such patients can undergo radiotherapy with standard precautions after careful planning.