PO-04-010 USE OF A LEADLESS PACEMAKER WITH BILATERAL DEEP BRAIN STIMULATORS

Abstract

Deep brain stimulation (DBS) is a critical tool for the treatment of advanced, drug-refractory Parkinson’s disease using high-frequency stimulation of the subthalamic nucleus and globus pallidus internus. In patients with cooccurring needs for cardiac pacing, there is risk of electrical interference leading to oversensing. To minimize interaction, device manufacturers recommend a minimum distance of 6 inches between generators, which is not feasible with standard pacemaker (PPM) placement in the setting of bilateral DBS. In this case, we demonstrate leadless PPM placement in a patient with bilateral DBS and show absence of electrical interference with various DBS configurations and output. Demonstrate safety and efficacy of leadless pacemaker placement without electrical interference in patient with DBS n/a A 63 year-old female with history of Parkinson’s disease with bilateral DBS placement in 2015 presented with recurrent syncope. Patient was standing and washing dishes when she suddenly lost consciousness without prodrome. Telemetry demonstrated sinus rhythm with intermittent symptomatic junctional bradycardia. Transthoracic echocardiogram demonstrated normal ejection fraction with normal valve function. Reversible causes of syncope were ruled out and decision was made to implant a PPM. Given risk of interference with a standard PPM, a MICRA AV leadless PPM was implanted 4.8cm from the left DBS generator and programmed in VDD mode (Panel 1). To test for interference, bilateral DBS were programmed to unipolar stimulation with maximum output (5V at 135Hz and 2V at 185Hz). There was no evidence of noise or interference on MICRA AV EGM (Panel C) despite noise on surface ECG leads (Panel B). Patient’s symptoms improved with pacing and follow up device check showed no complications or interference. We demonstrate successful implant of a leadless PPM with AV synchrony (Micra AV) in patient with bilateral DBS. Despite placement less than 6 inches from DBS generators, there was no evidence of interference at maximum DBS voltage and frequency in both unipolar and bipolar configurations. Leadless PPM should be considered first line for patients with DBS, with appropriate pacing and absence of interference through a range of therapeutic outputs.