The Effects of Extracorporeal Shock Wave Lithotripsy on Pacemaker Function

Twenty-two pacemaker pulse generators were exposed to shock waves of an extracorporeal shock wave lithotripter to assess the effects of the extremely high pressure transients on pacemaker function. The pulse generator and distal aspect of the lead were positioned 5 cm from the focal point of the lithotripter and 10 cm from each other. Pulse generator function was analyzed during shock wave delivery synchronized with pulse generator output, during shock waves at a rate faster than the escape rate, and after exposure to lithotripsy. During shock waves delivered synchronously with pulse generator output, only one of 22 pulse generators malfunctioned by intermittently reverting to the magnet rate. When subjected to shock waves at a rate greater than the escape rate, 50% of the pulse generators were inhibited by electromechanical interference from the lithotripter. Both bipolar and unipolar devices were affected. However, analysis after exposure to shock waves showed that none of the pacemakers was damaged or spuriously reprogrammed. In conclusion, cardiac pacemakers do not appear to be damaged or reprogrammed by exposure to extracorporeal shock wave lithotripsy. The likelihood of false inhibition appears to be very low if shock waves are delivered synchronously with the QRS.