Objective: Since a few years rechargeable pacemaker technology is available in deep brain stimulation. This technical innovation becomes more and more important in clinical practice, particularly for patients with a need for high energy delivery. Unforeseen handling issues, however, may compromise its use in certain patients.

Methods: Over a period of ten years, 360 patients underwent deep brain stimulation for various indications. Rechargeable pacemakers are increasingly used upon replacement after battery depletion. Despite meticulous screening for suitability, we had to switch battery to non-rechargeable technology because of unforeseen technical difficulties in two patients.

Results: A 73-year-old man with a high cognitive performance with Parkinson’s disease, underwent bilateral deep brain stimulation in the internal globus pallidus. Pulse generators were replaced because of battery depletion in 2-year intervals. At the time of third replacement, it was decided to use rechargeable technology because of the relatively frequent need of pacemaker replacements. Two years later the patient requested to remove the pacemaker and reimplant a non-rechargeable once more because of increasing problems with handling of the recharger and inconvenience with the daily monitoring of the battery level. A 62-year-old woman underwent bilateral deep brain stimulation in the nucleus accumbens for alcohol addiction. She needed biennial pacemaker replacements, the pacemaker was replaced against a rechargeable device at the time of the second replacement. Two years later system malfunction was detected with fracture of the extension cable secondary to twiddler’s syndrome. The patient for the main part had had increased difficulties recharging the battery.

Conclusions: Rechargeable pacemaker undoubtedly are a step forward in providing standard of care medical treatment. Many patients stand to benefit from rechargeable technology, smaller devices and fewer replacement operations. However, with new technology we also have new requirements concerning technical capabilities and compliance. Although removal of a rechargeable device before end of service of the battery and replacement with a non-rechargeable pacemaker poses an undue economic burden, it may be the only solution under certain circumstances to guarantee the benefit of chronic stimulation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/rechargeable-pacemaker-technology-in-deep-brain-stimulation-a-step-forward-but-nor-for-everyone/