PD13-08 CHANGING PATIENT POSITION CAN ELIMINATE ARRHYTHMIAS DEVELOPING DURING SHOCK WAVE LITHOTRIPSY (SWL)

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2015PD13-08 CHANGING PATIENT POSITION CAN ELIMINATE ARRHYTHMIAS DEVELOPING DURING SHOCK WAVE LITHOTRIPSY (SWL) Tarek Alzahrani, Daniela Ghiculete, Kenneth Pace, and R.J. D'A. Honey Tarek AlzahraniTarek Alzahrani More articles by this author , Daniela GhiculeteDaniela Ghiculete More articles by this author , Kenneth PaceKenneth Pace More articles by this author , and R.J. D'A. HoneyR.J. D'A. Honey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1072AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES SWL has a low complication rate. While serious side effects are rare arrhythmias such as ventricular tachycardia may occur and require cessation of treatment. The etiology of these arrhythmias is poorly understood, but is most likely related to the relative position of the stone and the heart. This study examines the effect of rotating the patient 15 to 20 degrees when an arrhythmia occurs. METHODS 1369 patients were prospectively evaluated for arrhythmias during SWL. The initial patient position was dependent on the location of the stone and the size of the patient. Stones on either side may be treated with the patient flat supine. More frequently, the patients are rotated about 15 degrees with the opposite side to the stone elevated. With stones on the right the patient would be right posterior oblique (RPO) and for left sided stones left posterior oblique (LPO). If a sustained arrhythmia developed, treatment was held for 2 minutes and then recommenced. If the arrhythmia returned, as occurred in all 20 patients, the patient was rotated to the flat, RPO or LPO position, angling the shock wave away from the heart. RESULTS 20 patients developed significant arrhythmias during SWL. Arrhythmias occurred more frequently in patients with a lower BMI (P<0.01) and in those with right-sided stones (P=0.035). After rotation no further arrhythmias were seen in 13 patients. Gated ESWL was only needed in only 3 of the 20 patients after changing their position. CONCLUSIONS Changing the position of the patient by rotating the patient by 15 to 20 degrees may eliminate arrhythmias that develop during SWL allowing the continuation of the SWL treatment without the need to perform a gated SWL. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e264-e265 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarek Alzahrani More articles by this author Daniela Ghiculete More articles by this author Kenneth Pace More articles by this author R.J. D'A. Honey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...