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Gettings JV, Stowe RC. Deep Brain Stimulator (DBS) Artifact in the EEG of a Pediatric Patient. Clin EEG Neurosci 2024; 55:572-575. [PMID: 37611196 DOI: 10.1177/15500594231194958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
We report the first case of deep brain stimulator (DBS) artifact in the EEG of a pediatric patient. Our case is a 7-year-old male with bilateral globus pallidus interna (GPi) DBS for whom the EEG recorded a rhythmic 7.5 Hz theta activity on EEG related to DBS artifact. This artifact was also appreciated as a monochromatic invariable frequency band over 7.5 Hz on density spectral array (DSA). This rhythmic artifact may mimic an ictal pattern and should be recognized as artifact in order to avoid unnecessary treatment with anti-seizure medications (ASM).
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Affiliation(s)
- Jennifer V Gettings
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert C Stowe
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Sierra-Fernández CR, Garnica-Geronimo LR, Huipe-Dimas A, Ortega-Hernandez JA, Ruiz-Mafud MA, Cervantes-Arriaga A, Hernández-Medrano AJ, Rodríguez-Violante M. Electrocardiographic approach strategies in patients with Parkinson disease treated with deep brain stimulation. Front Cardiovasc Med 2024; 11:1265089. [PMID: 38682099 PMCID: PMC11047133 DOI: 10.3389/fcvm.2024.1265089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
Deep brain stimulation (DBS) is an interdisciplinary and reversible therapy that uses high-frequency electrical stimulation to correct aberrant neural pathways in motor and cognitive neurological disorders. However, the high frequency of the waves used in DBS can interfere with electrical recording devices (e.g., electrocardiogram, electroencephalogram, cardiac monitor), creating artifacts that hinder their interpretation. The compatibility of DBS with these devices varies and depends on factors such as the underlying disease and the configuration of the neurostimulator. In emergencies where obtaining an electrocardiogram is crucial, the need for more consensus on reducing electrical artifacts in patients with DBS becomes a significant challenge. Various strategies have been proposed to attenuate the artifact generated by DBS, such as changing the DBS configuration from monopolar to bipolar, temporarily deactivating DBS during electrocardiographic recording, applying frequency filters both lower and higher than those used by DBS, and using non-standard leads. However, the inexperience of medical personnel, variability in DBS models, or the lack of a controller at the time of approach limit the application of these strategies. Current evidence on their reproducibility and efficacy is limited. Due to the growing elderly population and the rising utilization of DBS, it is imperative to create electrocardiographic methods that are easily accessible and reproducible for general physicians and emergency services.
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Affiliation(s)
| | | | - Alejandra Huipe-Dimas
- Department of Medical Education, National Institute of Cardiology Ignacio Chávez, Mexico, Mexico
| | | | - María Alejandra Ruiz-Mafud
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
| | - Amin Cervantes-Arriaga
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
| | - Ana Jimena Hernández-Medrano
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
| | - Mayela Rodríguez-Violante
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
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Baldwin M, Palka S, Leppla D, Hollis B, Van Cott AC, Castellano JF. Unusual EEG Artifact in Patients with DBS. Clin EEG Neurosci 2022; 53:558-561. [PMID: 34859702 DOI: 10.1177/15500594211063710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Maria Baldwin
- Pittsburgh VA Medical Center, Pittsburgh, PA, USA.,6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sydney Palka
- 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Donna Leppla
- Pittsburgh VA Medical Center, Pittsburgh, PA, USA
| | | | - Anne C Van Cott
- Pittsburgh VA Medical Center, Pittsburgh, PA, USA.,6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Arafat T, Miron G, Strauss I, Fahoum F. Electrodiagnostic artifacts due to neurostimulation devices for drug resistant epilepsy. Epilepsy Behav Rep 2022; 20:100566. [PMID: 36276845 PMCID: PMC9583742 DOI: 10.1016/j.ebr.2022.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/11/2022] [Accepted: 09/25/2022] [Indexed: 11/24/2022] Open
Abstract
Neurostimulation devices for epilepsy commonly induce EEG and/or ECG artifacts. Neurostimulation-related artifacts are intermittent and could mimic ictal EEG changes or cardiac rhythm abnormalities. Clinicians should be aware of different EEG and ECG artifact patterns to accurately interpret test findings and avoid unnecessary diagnostics and treatment.
Background Methods Results Conclusions
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Villamar MF, Albuja AC. Waveform Window #50: A Novel Presentation of Deep Brain Stimulator (DBS) Artifact on Electroencephalogram (EEG) and Electrocardiogram (ECG). Neurodiagn J 2021; 61:104-109. [PMID: 34009102 DOI: 10.1080/21646821.2021.1909972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Kent Hospital, Warwick, Rhode Island
| | - Ana C Albuja
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Mruk M, Stroop R, Boergel J, Lang NM, Nakamura M, Lehrke R, Zawy Alsofy S. Neurostimulator-induced ECG artefacts: A systematic analysis. Clin Neurol Neurosurg 2021; 203:106557. [PMID: 33610952 DOI: 10.1016/j.clineuro.2021.106557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 01/11/2021] [Accepted: 02/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Deep brain stimulation (DBS) is known to interfere with electrocardiographic (ECG) examinations. In emergency situations, such electrical interferences can not only thwart ECG diagnostics, but even induce an ECG pattern that causes the emergency medical service to initiate inadequate or even harmful therapy. Aim of this prospective study was to evaluate factors influencing ECG interpretation in DBS and to evaluate the susceptibility of ECG criteria 'frequency', 'rhythm', 'regularity', 'QRS-configuration', and 'ST-segment' on neurostimulation. PATIENTS AND METHODS In 33 DBS patients (17 male, 16 female, mean age 64 years), limb-, 12 channel-, Nehb, and adhesive paddle-lead ECG were performed in activated (n = 33) and deactivated (n = 31) stimulation mode during outpatient follow-up examinations. The examinations were carried out using three different ECG devices (two portable emergency ECG-monitor/defibrillation/pacer-devices, one stationary hospital device), resulting in 4096 ECG leads. Statistics have been based on regression analyses and on a maximum likelihood estimation regression model. RESULTS Monopolar settings were found to be a relevant factor interfering significantly more often with ECG recording than bipolar parameters (p < 0.0001). Due to recurring movement artefacts, deactivation of bipolar stimulation might even significantly worsen ECG quality (p < 0.0001). Interpretability of 'rhythm' (β = -0.088, p = 0.03) and 'frequency' (β = -0.110, p = 0.02) revealed significant negative correlation to the applied neurostimulation voltage. Nehb lead yielded in highest ECG interpretability. CONCLUSION Bipolar neurostimulation mode barely affected the ECGs; furthermore, the suppression of motion artefacts by neurostimulation can improve ECG quality. If monopolar neurostimulation is required, at least, stimulation voltage should be as low as possible to obtain good stimulation results.
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Affiliation(s)
- Melanie Mruk
- Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Medicine, St. Barbara-Hospital, Hamm, Germany
| | - Ralf Stroop
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Department of Stereotactic Neurosurgery, St. Barbara-Hospital, Hamm, Germany.
| | - Jan Boergel
- Department of Internal Medicine, St. Barbara-Hospital, Hamm, Germany
| | - Norbert M Lang
- Department of Stereotactic Neurosurgery, St. Barbara-Hospital, Hamm, Germany
| | - Makoto Nakamura
- Department of Neurosurgery, Academic Hospital Cologne-Merheim, Cologne, Germany
| | - Ralph Lehrke
- Department of Stereotactic Neurosurgery, St. Barbara-Hospital, Hamm, Germany
| | - Samer Zawy Alsofy
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Department of Neurosurgery, St. Barbara-Hospital, Hamm, Germany
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Heard T, Coyne T, Silburn P. Deep Brain Stimulation in Patients With Concomitant Cardiac Pacemakers: A Case Series. Oper Neurosurg (Hagerstown) 2020; 17:549-553. [PMID: 30851040 DOI: 10.1093/ons/opz018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 02/03/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is a treatment modality increasingly utilized in the management of neurological and psychiatric conditions. Neurosurgical technical considerations and contraindications have yet to be thoroughly characterized in the literature. The patient population for DBS includes many elderly patients with multiple comorbidities who require treatments and investigations that expose them to electromagnetic fields of varying strengths and durations, including other implanted electromodulatory devices. OBJECTIVE To determine if clinically significant interference arises between DBS and cardiac pacemaker systems. METHODS Here we audited 8 patients, mean age 72, with cardiac pacemakers and DBS implanted from 2007 to 2015. We investigated details of their neurological and electrocardiological treatment and progress and sought evidence for interference between the two systems. RESULTS We found no evidence of DBS dysfunction, and only one case of abnormal pacemaker interrogation 2 yr post-DBS implantation was found, which was thought to be secondary to a medication issue rather than neuromodulation interference. CONCLUSION Our research reassures the clinician that pacemakers and DBS systems do not appear to affect one another and provides guidance on minimizing possibility of this.
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Affiliation(s)
| | | | - Peter Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, University of Queensland, Brisbane, Australia
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Hancu I, Boutet A, Fiveland E, Ranjan M, Prusik J, Dimarzio M, Rashid T, Ashe J, Xu D, Kalia SK, Hodaie M, Fasano A, Kucharczyk W, Pilitsis J, Lozano A, Madhavan R. On the (Non‐)equivalency of monopolar and bipolar settings for deep brain stimulation fMRI studies of Parkinson's disease patients. J Magn Reson Imaging 2018; 49:1736-1749. [DOI: 10.1002/jmri.26321] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/17/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ileana Hancu
- GE Global Research Center Niskayuna New York USA
| | | | | | | | | | | | | | - Jeffrey Ashe
- GE Global Research Center Niskayuna New York USA
| | - David Xu
- University Health Network Toronto ON Canada
| | | | | | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Division of Neurology University of Toronto Toronto Ontario Canada
- Krembil Research Institute Toronto Ontario Canada
| | | | | | - Andres Lozano
- University Health Network Toronto ON Canada
- Krembil Research Institute Toronto Ontario Canada
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Yeoh TY, Manninen P, Kalia SK, Venkatraghavan L. Anesthesia considerations for patients with an implanted deep brain stimulator undergoing surgery: a review and update. Can J Anaesth 2016; 64:308-319. [DOI: 10.1007/s12630-016-0794-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/06/2016] [Accepted: 12/08/2016] [Indexed: 11/25/2022] Open
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Guinand A, Noble S, Frei A, Renard J, Tramer MR, Burri H. Extra-cardiac stimulators: what do cardiologists need to know? Europace 2016; 18:1299-307. [DOI: 10.1093/europace/euv453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/23/2015] [Indexed: 01/25/2023] Open
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Cryoablation of an atrioventricular nodal reentrant tachycardia in a patient with an implanted deep brain stimulator. HeartRhythm Case Rep 2016; 2:258-260. [PMID: 28491683 PMCID: PMC5419761 DOI: 10.1016/j.hrcr.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Rudigwa P, Elakkumanan LB, Rajan SP, Prakash MVS. ECG artefacts mimicking atrial flutter in posterior fossa surgery. BMJ Case Rep 2015; 2015:bcr-2014-208617. [PMID: 26021382 DOI: 10.1136/bcr-2014-208617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
ECG artefacts are defined as abnormalities in the monitored ECG, which result from measurement of cardiac potentials on the body surface and are not related to the electrical activity of the heart. In the operation theatre, the use of various types of electrical equipment may interfere with ECG interpretation. We describe our experience with artefacts resembling atrial fibrillation when a nerve integrity monitoring device was used on a patient undergoing posterior fossa surgery for epidermoid tumour. These artefacts resemble serious arrhythmias and may result in unwanted interventions. To enable better identification of such artefacts, a 12-lead ECG should be considered as it will display rhythm in all the leads; while artefacts will present in only a few leads, true arrhythmia will be present in all the 12 leads. Our case report aims to increase awareness regarding ECG artefacts and to explain how to distinguish them from actual arrhythmias.
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Affiliation(s)
- Priya Rudigwa
- Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
| | | | - Sakthi P Rajan
- Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
| | - M V Satya Prakash
- Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
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Mindermann T, Maurer D. Delayed diagnosis of myocardial infarction due to deep brain stimulation. Acta Neurochir (Wien) 2013; 155:1679-80. [PMID: 23580111 DOI: 10.1007/s00701-013-1702-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 03/26/2013] [Indexed: 11/24/2022]
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Nandedkar SD, Sheridan C, Bertoni S, Hiner BC, Barkhaus PE. Deep brain stimulator artifact in needle electromyography: effects and distribution in paraspinal and upper limb muscle. Muscle Nerve 2013; 47:561-5. [PMID: 23463685 DOI: 10.1002/mus.23636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2012] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Deep brain stimulators (DBS) have become a more widespread treatment option for individuals with centrally mediated movement disorders. Such devices are expected to create artifact in standard needle electromyographic (EMG) recordings. METHODS Five subjects with DBS were studied with standard concentric needle electrode EMG in paraspinal and upper limb muscles. RESULTS All subjects showed EMG artifact directly related to, and corresponding with, the DBS unit settings. The artifact was very prominent in all paraspinal muscles, although the amplitude was less in lumbar compared with cervical levels. With a large ground electrode next to the insertion site, the artifact was sufficiently small to allow standard EMG examination of upper limb muscles. CONCLUSIONS The DBS artifact is so prominent in paraspinal muscles that it will not allow standard EMG examination for diagnostic purposes such as radiculopathy. The artifact itself can easily be distinguished from pathological insertional and spontaneous activity.
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Desmaizières M, Alhéritière A, Adnet F, Lapostolle F. A “crenel” ECG pattern related to deep brain stimulation treatment for Parkinson's disease. Resuscitation 2012; 83:e199-200. [DOI: 10.1016/j.resuscitation.2012.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022]
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Kanagaratnam L, Lee A, Whalley D, Figtree GA. Overcoming artifacts and fears: electrophysiology study and radiofrequency ablation in a Parkinsonian patient with supraventricular tachycardia and a brain neurostimulator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 36:e1-3. [PMID: 21883310 DOI: 10.1111/j.1540-8159.2011.03204.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 04/15/2011] [Accepted: 05/23/2011] [Indexed: 11/29/2022]
Abstract
With the ageing of the population and expanding use of deep brain stimulation in the treatment of various neurological and neuropsychiatric conditions, there will be an increasing number of patients with these devices who present with cardiac conditions necessitating electrophysiology studies (EPS). However, neurostimulator devices have been shown to cause significant artifacts on electrocardiography recordings. We present the case of a 53-year-old Parkinsonian woman with a brain neurostimulator device who underwent a successful EPS with radiofrequency ablation.
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Affiliation(s)
- Logan Kanagaratnam
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
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Rose NGW, Mostrenko M, McMaster J, Honey CR. Severe agitation following deep brain stimulation for parkinsonism. CAN J EMERG MED 2011; 13:279-83, E11-2. [PMID: 21722545 DOI: 10.2310/10.2310/8000.2011.110001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The use of deep brain stimulation has become increasingly common for the treatment of movement disorders, including Parkinson disease. Although deep brain stimulation is generally very successful in alleviating the extrapyramidal symptoms of Parkinson disease, side effects can occur. This case report describes a patient presenting to the emergency department in a state of extreme aggression 3 days after a change in the parameters of his bilateral subthalamic nucleus stimulator. We review the complications of deep brain stimulation relevant to the emergency physician and provide some practical information on stimulator adjustment in an emergency.
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Affiliation(s)
- Nicholas G W Rose
- Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
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Sommerfield D, Hu P, O’Keeffe D, McKeatinga K. Caesarean section in a parturient with a spinal cord stimulator. Int J Obstet Anesth 2010; 19:114-7. [DOI: 10.1016/j.ijoa.2009.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 05/19/2009] [Accepted: 08/25/2009] [Indexed: 12/17/2022]
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Lu G, Yang F, Taylor JA, Stein JF. A comparison of photoplethysmography and ECG recording to analyse heart rate variability in healthy subjects. J Med Eng Technol 2009; 33:634-41. [DOI: 10.3109/03091900903150998] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Poon C, Irwin M. Anaesthesia for deep brain stimulation and in patients with implanted neurostimulator devices. Br J Anaesth 2009; 103:152-65. [DOI: 10.1093/bja/aep179] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Blomstedt P, Jabre M, Bejjani BP, Koskinen LOD. Electromagnetic Environmental Influences on Implanted Deep Brain Stimulators. Neuromodulation 2006; 9:262-9. [DOI: 10.1111/j.1525-1403.2006.00068.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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