Objective: To report outcomes regarding deep brain stimulation (DBS) hardware integrity and preservation of program settings in a Parkinson’s Disease (PD) patient with bilateral globus pallidus internus (GPi) DBS who underwent external cardioversion.

Background: Case reports in the literature suggest that patients with DBS can safely receive implantable cardioverter-defibrillator (ICD) shocks without significant effect on DBS function and vice versa. Just one published case reported resetting of the DBS device after ICD deployment. Nevertheless, there remains a paucity of literature regarding the effects of external cardiac defibrillation on DBS. According to DBS device manufacturer specifications, external defibrillation can cause damage to either the neurostimulator or to brain tissue itself. To mitigate risks of defibrillation, paddles should be maximally distanced, applied perpendicularly to the DBS system, and the lowest necessary current should be used. To our knowledge, there are only three case reports describing patients with DBS who underwent external defibrillation. In all cases, patients had internal pulse generators (IPGs) in the anterior chest wall. All three patients developed either IPG failure, electrode dysfunction, or brain tissue damage.

Method: Case report and literature review

Results: A 72-year-old woman with PD and bilateral GPi DBS programmed in bipolar mode and with IPG in the right abdomen suffered a witnessed cardiac arrest, requiring external defibrillation. After three rounds of cardiopulmonary resuscitation and deliverance of one shock, she achieved return of spontaneous circulation. One week after cardioversion, the patient’s DBS device was interrogated. There were no difficulties in IPG communication, indication of hardware compromise, or disruption of programming settings. Although no evidence of brain tissue damage was found on CT or MRI, clinical assessment for ongoing stimulation benefit was not possible due to patient’s decline and eventual death due to medical complications.

Conclusion: External defibrillation is often emergently indicated in cardiac arrest, yet there is limited understanding of its effect on hardware and software integrity in patients with DBS. In this case report, we describe a unique scenario of a patient with a DBS IPG placed in the abdomen – a location removed from standard defibrillator pad placement – whose DBS system was not affected by external defibrillation.

References: 1. Yamamoto T, Katayama Y, Fukaya C, Kurihara J, Oshima H, Kasai M. Thalamotomy caused by cardioversion in a patient treated with deep brain stimulation. Stereotact Funct Neurosurg. 2000;74(2):73-82. doi: 10.1159/000056466. PMID: 11251397. 2. Davis G, Levine Z. Deep Brain Stimulation Generator Failure due to External Defibrillation in a Patient with Essential Tremor. Stereotact Funct Neurosurg. 2021;99(1):38-39. doi: 10.1159/000510122. Epub 2020 Oct 16. PMID: 33070142. 3. Sobstyl M, Michałowska M, Fiszer U, Ząbek M. Deep brain stimulation failure due to external cardioversion in a patient with Parkinson’s disease. Neurol Neurochir Pol. 2017 Jul-Aug;51(4):324-330. doi: 10.1016/j.pjnns.2017.05.005. Epub 2017 May 30. PMID: 28587730. 4. Tavernier R, Fonteyne W, Vandewalle V, de Sutter J, Gevaert S. Use of an implantable cardioverter defibrillator in a patient with two implanted neurostimulators for severe Parkinson’s disease. Pacing Clin Electrophysiol. 2000 Jun;23(6):1057-9. doi: 10.1111/j.1540-8159.2000.tb00899.x. PMID: 10879397. 5. Obwegeser AA, Uitti RJ, Turk MF, Wszolek UM, Flipse TR, Smallridge RC, Witte RJ, Wharen RE Jr. Simultaneous thalamic deep brain stimulation and implantable cardioverter-defibrillator. Mayo Clin Proc. 2001 Jan;76(1):87-9. doi: 10.4065/76.1.87. PMID: 11155420. 6. Rosenow JM, Tarkin H, Zias E, Sorbera C, Mogilner A. Simultaneous use of bilateral subthalamic nucleus stimulators and an implantable cardiac defibrillator. Case report. J Neurosurg. 2003 Jul;99(1):167-9. doi: 10.3171/jns.2003.99.1.0167. PMID: 12854761. 7. Ooi YC, Falowski S, Wang D, Jallo J, Ho RT, Sharan A. Simultaneous use of neurostimulators in patients with a preexisting cardiovascular implantable electronic device. Neuromodulation. 2011 Jan;14(1):20-5; discussion 25-6. doi: 10.1111/j.1525-1403.2010.00314.x. Epub 2010 Nov 2. PMID: 21992157. 8. Karimi A, Conti JB, Beaver TM. Implantation of a cardiac resynchronization therapy defibrillator in a patient with bilateral deep brain stimulator: feasibility and technique. J Interv Card Electrophysiol. 2012 Dec;35(3):351-3; discussion 353. doi: 10.1007/s10840-012-9718-x. Epub 2012 Sep 26. PMID: 23011386. 9. Tsukuda S, Nishii N, Inoue Y, Sasaki T, Morita H, Ito H. A new approach for implantation of a cardiac resynchronization therapy-defibrillator in a patient with bilateral pectoral neurostimulation devices. HeartRhythm Case Rep. 2018 Jun 30;4(10):444-446. doi: 10.1016/j.hrcr.2018.06.009. PMID: 30364621; PMCID: PMC6197393. 10. Bader Y, Weinstock J. Successful implantation of a subcutaneous cardiac defibrillator in a patient with a preexisting deep brain stimulator. HeartRhythm Case Rep. 2015 Apr 1;1(4):241-244. doi: 10.1016/j.hrcr.2015.03.014. PMID: 28491558; PMCID: PMC5419417. 11. Tejada T, Merchant FM, El-Chami MF. Subcutaneous implantable cardioverter-defibrillator implantation in a patient with bilateral pectoral deep brain stimulators. HeartRhythm Case Rep. 2017 Dec 16;4(3):109-112. doi: 10.1016/j.hrcr.2017.12.005. PMID: 29707486; PMCID: PMC5918185. 12. Elliott M, Momin S, Fiddes B, Farooqi F, Sohaib SA. Pacemaker and Defibrillator Implantation and Programming in Patients with Deep Brain Stimulation. Arrhythm Electrophysiol Rev. 2019 May;8(2):138-142. doi: 10.15420/aer.2018.63.2. PMID: 31114689; PMCID: PMC6528032. 13. Medtronic. [Internet]. Medtronic Deep Brain Stimulation Therapy Implanted Neurostimulators: information for prescribers. Minneapolis, MN: Medtronic, Inc.; 2020 [cited 2021Mar14]. Available from: http://manuals.medtronic.com/content/dam/emanuals/neuro/M927893A_a_101_view.pdf

« Back to MDS Virtual Congress 2021

MDS Abstracts - https://www.mdsabstracts.org/abstract/successful-external-defibrillation-in-a-patient-with-bilateral-deep-brain-stimulation/