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Huang X, Jiang GJ. Magnetic resonance imaging interactions with a sacral neuromodulation system. Neurourol Urodyn 2021; 40:1862-1868. [PMID: 34487571 PMCID: PMC9290516 DOI: 10.1002/nau.24756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 11/08/2022]
Abstract
Aims Sacral neuromodulation (SNM) has successfully treated patients with functional urinary and/or bowel disorders for more than two decades. Historically, patients with the InterStim system (Medtronic) were contraindicated for Magnetic Resonance Imaging (MRI) scans. In 2012, Medtronic obtained Food and Drug Administration (FDA) approval for allowing 1.5 Tesla (T) MRI head scans. In September 2019, the Axonics System (Axonics) received FDA approval for 1.5 T full‐body MR Conditional labeling and then 3 T full‐body MR Conditional labeling in July 2020. In August 2020, Medtronic received 1.5 and 3 T full‐body MR Conditional labeling from the FDA for their new SNM systems (InterStim II and Micro devices with SureScanTM leads). With the advancements in MRI technology and availability of full‐body MRI eligible SNM systems, it is important for physicians to better understand MRI safety for these systems. Methods This paper explains the fundamentals of MRI physics, its interactions with active implantable medical devices (AIMDs), the subsequent potential safety hazards with emphasis on radio frequency (RF)‐related safety, and the risks associated with “Off‐label” scans, including abandoned and broken leads. Results MRI guidelines provided by the AIMD device manufacturer should be followed to ensure MRI scan safety and avoid any unnecessary risk to patients. Conclusions MRI guidelines provided by the device manufacturer are the best resource for guidance for performing safe MRI scanning. Specific conditions should be fully understood and generalizations on MRI safety claims based on partial analysis or case studies should be avoided.
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Pezzella A, McCrery R, Lane F, Benson K, Taylor C, Padron O, Blok B, de Wachter S, Gruenenfelder J, Pakzad M, Perrouin-Verbe MA, van Kerrebroeck P, Mangel J, Peters K, Kennelly M, Shapiro A, Lee U, Comiter C, Mueller M, Goldman HB. Two-year outcomes of the ARTISAN-SNM study for the treatment of urinary urgency incontinence using the Axonics rechargeable sacral neuromodulation system. Neurourol Urodyn 2021; 40:714-721. [PMID: 33508155 PMCID: PMC7986436 DOI: 10.1002/nau.24615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/17/2020] [Accepted: 12/31/2020] [Indexed: 11/07/2022]
Abstract
AIMS Sacral neuromodulation (SNM) is a guideline-recommended treatment with proven therapeutic benefit for urinary urgency incontinence (UUI) patients. The Axonics® System is the first Food and Drug Administration-approved rechargeable SNM system and is designed to deliver therapy for a minimum of 15 years. The ARTISAN-SNM study was designed to evaluate UUI participants treated with the Axonics System. Two-year follow-up results are presented. METHODS One hundred and twenty-nine UUI participants underwent implantation with the Axonics System. Therapeutic response rate, participant quality of life (QoL), and satisfaction were determined using 3-day voiding diaries, ICIQ-OABqol, and satisfaction questionnaires. Participants were considered responders if they had a 50% or greater reduction in UUI episodes post-treatment. As-treated and Completers analyses are presented. RESULTS At 2 years, 93% of the participants (n = 121 Completers at 2 years) were therapy responders, of which 82% achieved ≥ 75% reduction in UUI episodes and 37% were dry (100% reduction). Daily UUI episodes reduced from 5.6 ± 0.3 at baseline to 1.0 ± 0.2 at 2 years. Statistically significant improvements in ICIQ-OABqol were reported. All participants were able to recharge their device and 94% of participants reported that the recharging frequency and duration were acceptable. Participant demographics nor condition severity were correlated with clinical outcomes or recharging experience. No unanticipated or serious device-related adverse events occurred. CONCLUSIONS At 2 years, participants treated with the Axonics System demonstrated sustained safety and efficacy, high levels of satisfaction with therapy and recharging. Participant-related factors were not associated with efficacy or recharging outcomes, indicating the reported results are applicable to a diverse population.
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Affiliation(s)
| | - Rebecca McCrery
- Adult & Pediatric Urology & Urogynecology, Omaha, Nebraska, USA
| | - Felicia Lane
- University of California, Irvine, California, USA
| | - Kevin Benson
- Sanford Hospital, Sioux Falls, South Dakota, USA
| | | | | | - Bertil Blok
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, Edegem, Belgium
| | | | - Mahreen Pakzad
- Department of Urology, University College London Hospital, London, UK
| | | | - Philip van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | - Andrew Shapiro
- Chesapeake Urology Research Associates, Owings Mills, Maryland, USA
| | - Una Lee
- Virginia Mason, Seattle, Washington, USA
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Benson K, McCrery R, Taylor C, Padron O, Blok B, de Wachter S, Pezzella A, Gruenenfelder J, Pakzad M, Perrouin-Verbe MA, Van Kerrebroeck P, Mangel J, Peters K, Kennelly M, Shapiro A, Lee U, Comiter C, Mueller M, Goldman H, Lane F. One-year outcomes of the ARTISAN-SNM study with the Axonics System for the treatment of urinary urgency incontinence. Neurourol Urodyn 2020; 39:1482-1488. [PMID: 32339339 PMCID: PMC7384085 DOI: 10.1002/nau.24376] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/15/2020] [Indexed: 11/10/2022]
Abstract
Aims Sacral neuromodulation (SNM) is a guideline‐recommended treatment for voiding dysfunction including urgency, urge incontinence, and nonobstructive retention as well as fecal incontinence. The Axonics® System is a miniaturized, rechargeable SNM system designed to provide therapy for at least 15 years, which is expected to significantly reduce revision surgeries as it will not require replacement as frequently as the non‐rechargeable SNM system. The ARTISAN‐SNM study is a pivotal study designed to treat patients with urinary urgency incontinence (UUI). Clinical results at 1‐year are presented. Methods A total of 129 eligible UUI patients were treated. All participants were implanted with a quadripolar tined lead and neurostimulator in a single procedure. Efficacy data were collected using a 3‐day bladder diary, a validated quality of life questionnaire (ICIQ‐OABqol), and a participant satisfaction questionnaire. Therapy responders were defined as participants with ≥50% reduction in UUI episodes compared to baseline. Data were analyzed on all 129 participants. Results At 1 year, 89% of the participants were therapy responders. The average UUI episodes per day reduced from 5.6 ± 0.3 at baseline to 1.4 ± 0.2. Participants experienced an overall clinically meaningful improvement of 34 points on the ICIQ‐OABqol questionnaire. All study participants (100%) were able to recharge their device at 1 year, and 96% of participants reported that the frequency and duration of recharging was acceptable. There were no serious device‐related adverse events. Conclusions The Axonics System is safe and effective at 1 year, with 89% of participants experiencing clinically and statistically significant improvements in UUI symptoms.
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Affiliation(s)
| | - Rebecca McCrery
- Adult and Pediatric Urology and Urogynecology, Omaha, Nebraska
| | | | | | - Bertil Blok
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, Edegem, Belgium
| | | | | | - Mahreen Pakzad
- Department of Urology, University College London Hospital, Marylebone, London, UK
| | | | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | - Andrew Shapiro
- Chesapeake Urology Research Associates, Owings Mills, Maryland
| | - Una Lee
- Virginia Mason, Seattle, Washington
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Ong AA, O'Brien TX, Nguyen SA, Gillespie MB. Implantation of a defibrillator in a patient with an upper airway stimulation device. Laryngoscope 2015; 126:E86-9. [PMID: 26403681 DOI: 10.1002/lary.25683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2015] [Indexed: 11/07/2022]
Abstract
The patient is a 62-year-old man with continuous positive airway pressure-intolerant obstructive sleep apnea who was enrolled in a study for a hypoglossal nerve upper airway stimulation device (UAS). Nearly 2.5 years later, he was admitted to the hospital for unstable angina. Diagnostic workup revealed a prior myocardial infarction, an ejection fraction of 30% on maximal medical therapy, and episodes of nonsustained ventricular tachycardia. During hospitalization, the patient received an implantable cardioverter defibrillator (ICD). This is the first reported case of simultaneous use of a UAS and an ICD, and we report no untoward device interference between the two implantable devices.
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Affiliation(s)
- Adrian A Ong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Terrence X O'Brien
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Eastwood PR, Barnes M, Walsh JH, Maddison KJ, Hee G, Schwartz AR, Smith PL, Malhotra A, McEvoy RD, Wheatley JR, O'Donoghue FJ, Rochford PD, Churchward T, Campbell MC, Palme CE, Robinson S, Goding GS, Eckert DJ, Jordan AS, Catcheside PG, Tyler L, Antic NA, Worsnop CJ, Kezirian EJ, Hillman DR. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Sleep 2011; 34:1479-86. [PMID: 22043118 DOI: 10.5665/sleep.1380] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Reduced upper airway muscle activity during sleep is fundamental to obstructive sleep apnea (OSA) pathogenesis. Hypoglossal nerve stimulation (HGNS) counteracts this problem, with potential to reduce OSA severity. STUDY OBJECTIVES To examine safety and efficacy of a novel HGNS system (HGNS, Apnex Medical, Inc.) in treating OSA. PARTICIPANTS Twenty-one patients, 67% male, age (mean ± SD) 53.6 ± 9.2 years, with moderate to severe OSA and unable to tolerate continuous positive airway pressure (CPAP). DESIGN Each participant underwent surgical implantation of the HGNS system in a prospective single-arm interventional trial. OSA severity was defined by apnea-hypopnea index (AHI) during in-laboratory polysomnography (PSG) at baseline and 3 and 6 months post-implant. Therapy compliance was assessed by nightly hours of use. Symptoms were assessed using the Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Calgary Sleep Apnea Quality of Life Index (SAQLI), and the Beck Depression Inventory (BDI). RESULTS HGNS was used on 89% ± 15% of nights (n = 21). On these nights, it was used for 5.8 ± 1.6 h per night. Nineteen of 21 participants had baseline and 6-month PSGs. There was a significant improvement (all P < 0.05) from baseline to 6 months in: AHI (43.1 ± 17.5 to 19.5 ± 16.7), ESS (12.1 ± 4.7 to 8.1 ± 4.4), FOSQ (14.4 ± 2.0 to 16.7 ± 2.2), SAQLI (3.2 ± 1.0 to 4.9 ± 1.3), and BDI (15.8 ± 9.0 to 9.7 ± 7.6). Two serious device-related adverse events occurred: an infection requiring device removal and a stimulation lead cuff dislodgement requiring replacement. CONCLUSIONS HGNS demonstrated favorable safety, efficacy, and compliance. Participants experienced a significant decrease in OSA severity and OSA-associated symptoms. CLINICAL TRIAL INFORMATION NAME: Australian Clinical Study of the Apnex Medical HGNS System to Treat Obstructive Sleep Apnea. REGISTRATION NUMBER NCT01186926. URL: http://clinicaltrials.gov/ct2/show/NCT01186926.
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