Pacemaker and Defibrillator Implantation and Programming in Patients with Deep Brain Stimulation

Investigation of temperature variations on a Class-E inverter and proposing a compensation circuit to prevent harmful effects on biomedical implants

In this paper, a Class-E inverter and a thermal compensation circuit for wireless power transmission in biomedical implants are designed, simulated, and fabricated. In the analysis of the Class-E inverter, the voltage-dependent non-linearities of C_ds, C_gd, and R_ON as well as temperature-dependent non-linearity of R_ON of the transistor are considered simultaneously. Close agreement of theoretical, simulated and experimental results confirmed the validity of the proposed approach in taking into account these nonlinear effects. The paper investigated the effect of temperature variations on the characteristics of the inverter. Since both the output power and efficiency decrease with increasing temperature, a compensation circuit is proposed to keep them constant within a wide temperature range to enable its application as a reliable power source for medical implants in harsh environments. Simulations were performed and the results confirmed that the compensator enables significant improvements by maintaining the power and efficiency almost constant (8.46 ± 0.14 W and 90.4 ± 0.2%) within the temperature range of - 60 to 100 °C. Measurements performed at 25 °C and 80 °C with and without the compensation circuit were in good agreement with the theoretical and simulation results. The obtained measured output power and efficiency at 25 °C are equal to 7.42 W and 89.9%.

Effects of medically generated electromagnetic interference from medical devices on cardiac implantable electronic devices: A review

As cardiac implantable electronic devices (CIED) become more prevalent, it is important to acknowledge potential electromagnetic interference (EMI) from other sources, such as internal and external electronic devices and procedures and its effect on these devices. EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), respectively. This review analyzes potential EMI amongst CIED and left ventricular assist device, deep brain stimulators, spinal cord stimulators, transcutaneous electrical nerve stimulators, and throughout an array of procedures, such as endoscopy, bronchoscopy, and procedures involving electrocautery. Although there is evidence to support EMI from internal and external devices and during procedures, there is a lack of large multicenter studies, and, as a result, current management guidelines are based primarily on expert opinion and anecdotal experience. We aim to provide a general overview of PPM/ICD function, review documented EMI effect on these devices, and acknowledge current management of CIED interference.

Parkinson's Disease and Deep Brain Stimulation Have an Impact on My Life: A Multimodal Study on the Experiences of Patients and Family Caregivers

Parkinson’s disease (PD) has a large impact on patients’ physical and mental health, which also greatly affects their family caregivers. Deep brain stimulation (DBS) has emerged as an effective treatment for PD, but different authors have expressed their concerns about the potential impact of DBS on personality and identity. Our study aims at better understanding how patients and family caregivers experience life with PD and DBS, the impact of both on their personal and social lives, and their perception of the changes that have occurred as a result of the disease and the treatment. Our study applies a multimodal approach by means of narrative semi-structured interviews and drawings. Seven principal themes have been identified: “everyone’s Parkinson’s is different”, “changing as a person during the disease”, “going through Parkinson’s together”, “DBS improved my life”, “I am treated with DBS but I have Parkinson’s still”, “DBS is not perfect”, and “being different after DBS”. PD is perceived as an unpredictable and heterogeneous disease that changes from person to person, as does the effect of DBS. While DBS side-effects may have an impact on patients’ personality, behavior, and self-perception, PD symptoms and drug side-effects also have a great impact on these aspects.

Coexistence of deep brain stimulators and cardiac implantable electronic devices: A systematic review of safety

As the number of patients implanted with deep brain stimulation systems increases, coexistence with cardiac implantable electronic devices (CIEDs) poses questions about safety. We systematically reviewed the literature on coexisting DBS and CIED. Eighteen reports of 34 patients were included. Device-device interactions were reported in 6 patients. Sources of complications were extensively reviewed and cautious measures which could be considered as part of a standard checklist for careful consideration are suggested.

Deep Brain Stimulation Generator Failure due to External Defibrillation in a Patient with Essential Tremor

There exist only two case reports to date of open cardiac defibrillation with deep brain stimulator system (DBS) implantation. We report a 64-year-old male with DBS system in place for essential tremor who underwent cardiac defibrillation after cardiac arrest. Afterwards, his device impedances were all high and his tremor symptoms returned. Both problems resolved with implantation of a new generator and required no changes to the intracranial leads or extension cables. This is significantly different from the two previous reports. One included a significantly different DBS system relying on transcutaneous RF transmission and reported a lesioning effect after cardioversion. The other utilized a modern DBS system but reported damage to the generator and intracranial leads. We report that only the generator sustained damage, and that there were no intracranial changes that occurred.