Use of a biventricular implantable cardioverter defibrillator in a patient with a neurostimulator: is it a safe combination?

The coincident use of neurostimulators and devices such as ICDs and pacemakers is increasing. This is because of the expanding indications for both devices. The manufacturers of ICDs caution against the combined use of ICDs and neurostimulators because of possible device interaction [1]. A 55-year-old woman was referred because of drug-refractory heart failure. In 2009, a neurostimulator (Synergy Versitrel, Medtronic, Inc, Minneapolis, Minnesota, USA) was implanted because of intractable back pain. She was admitted because of heart failure in the presence of dilating cardiomyopathy. Implantation of a biventricular implantable cardioverter defibrillator was indicated. A CRT-D (Consulta D234TRK, Medtronic, Inc, Minneapolis, Minnesota, USA) was implanted in the left pectoral region. Peri-procedural testing, with the ICD set to maximum sensitivity and the neurostimulator set to maximum therapeutic output, showed no interaction between the two devices (Fig. 1). A chest X-ray after the implantation showed adequate positioning of the leads (Fig. 2). The combination of cardiac resynchronisation therapy defibrillator and neurostimulators can be safe. However, extensive peri-operative testing is essential in preventing device interaction [1‐3].

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