A few people have wondered if sacral neuromodulation might interfere with their cardiac pacemaker. The answer is no; the two are both entirely safe, even when used together, but let me elaborate a bit. Sacral neuromodulation (SNM) is considered safe for individuals with cardiac pacemakers because of their key mechanisms and safety measures. Both are types of pacemakers, but they act in different areas of the body.
How Do SNM And Cardio Pacemakers Work?
SNM involves delivering very low-voltage electrical pulses to the sacral nerves with an implanted lead and pulse generator. It’s used to treat urinary and fecal incontinence, non-obstructive urinary retention, and other pelvic floor disorders. The stimulation operates at low frequencies and does not directly interact with cardiac electrical activity.
A cardiac pacemaker, on the other hand, regulates heart rhythm by delivering electrical impulses to the nerve system of the heart when it detects bradycardia or arrhythmias. These devices are programmed to sense electrical activity and deliver stimulation only as needed.
Is There A Risk Of Electromagnetic Interference?
Historically, the concern with dual pacemakers was the potential for electromagnetic interference (EMI). But, this risk is mitigated in specific ways:
- Different electrode placement: SNM leads are implanted near the sacral nerves, far from the heart or pacemaker electrodes.
- Low-voltage stimulation: SNM delivers very low-intensity signals which do not travel far, significantly reducing the likelihood of interference.
- Modern technology: Pacemakers are increasingly designed with shielding and noise-detection algorithms to ignore non-cardiac signals.
Clinical Studies And Safety Evidence
Numerous studies have shown that SNM is routinely and safely used in patients with cardiac pacemakers or implantable cardioverter defibrillators. Research shows minimal overlap in frequency ranges. SNM typically operates at frequencies (e.g., 10-25 Hz) distinct from the signals used by pacemakers. Other studies show no significant impact on pacemaker functionality during SNM.
To ensure safety, the following steps are typically recommended for patients with a cardiac pacemaker who are considering SNM to treat incontinence:
- Pre-procedure evaluation to determine device compatibility, such as those from Axonics and Medtronic, which feature compatible SNM systems. This is also an opportunity to assess whether the pacemaker is functioning optimally before SNM implantation.
- Programming adjustments. During SMN implantation, SNM devices should be programmed at frequencies and amplitudes unlikely to overlap with pacemaker sensing. Device interactions are also tested to ensure the pacemaker does not detect or respond to SNM signals.
- Post-procedure monitoring for both devices during routine follow-ups to ensure continued compatibility and proper functioning.
Why SNM Is Safe In Practice
- Separation of systems: The physical and electrical separation of sacral neuromodulation and pacemaker systems minimizes interaction.
- Advancements in device technology: Both pacemakers and SNM systems are designed with EMI resistance in mind.
- Established clinical protocols: With proper evaluation, programming and monitoring, the risk of interference is negligible.
The Bottom Line
Sacral neuromodulation is safe for individuals with cardiac pacemakers because they offer distinct mechanisms of action, a low risk of electromagnetic interference, and feature advancements in device technology. Ensuring compatibility through proper testing and follow-up makes the combined use of these devices a viable and effective option for managing overlapping conditions. If you’re considering SNM to treat incontinence for yourself or a loved one, but worry about how it might affect an existing pacemaker, we’re happy to assure you that it isn’t an issue. Contact the team at Nevada Surgical today to learn more about SNM and how it can make a significant difference in quality of life.
