ESWL in the Cardiac Patient

Instructor:

Lithotripsy Academy

Category:

Advanced

Last Update:

May 23rd, 2026

(0)

ESWL in the Cardiac Patient: Pacemakers, ICDs, Arrhythmias & ECG-Guided Safety

Managing cardiac patients during extracorporeal shock wave lithotripsy (ESWL) is one of the most critical—and often misunderstood—areas in modern urological practice. Variability in clinical decision-making across institutions has led to both overtreatment avoidance and unsafe execution.

This advanced course from Lithotripsy Academy provides a clear, evidence-based, and clinically practical framework for safely performing ESWL in patients with pacemakers, implantable cardioverter defibrillators (ICDs), and cardiac arrhythmias.

Understand the core physics of cardiac interaction in ESWL
Apply ECG gating to reduce arrhythmia risk
Use Cooper Classification (A, B, C) for clinical decision-making
Safely manage pacemakers (VVI, DDD, rate-responsive)
Implement correct protocols for ICD deactivation and reactivation
Handle patients with atrial fibrillation and ventricular ectopy
Apply pre-, intra-, and post-procedure protocols
Use a structured decision framework for safe ESWL execution

Topics of Course

Disclaimer
This course is designed for educational purposes only. It focuses on the concepts and clinical understanding of shockwave lithotripsy. All energy settings, system limits, and device-specific protocols must be followed as per the manufacturer’s recommendations. Lithotripsy Academy does not replace hands-on training or clinical judgment. Users are responsible for applying their own expertise and adhering to local guidelines and safety standards.

Disclaimer

01:11

Introduction: Understanding the Need for Cardiac Safety in ESWL
Managing patients with cardiac conditions during ESWL requires more than technical skill—it requires clear understanding, structured thinking, and clinical discipline. In this introductory section, we set the foundation for the entire course. You will explore why cardiac patients represent a unique challenge in shock wave lithotripsy, and why current practices across centers often vary widely—from unnecessary avoidance to unsafe execution

Core Physics of Cardiac Interaction in ESWL
Understanding cardiac safety in ESWL begins with understanding physics—not protocol. In this section, we explore how shock waves interact with the human body, and more specifically, how they influence cardiac physiology and implanted cardiac devices. These interactions are not random—they follow predictable physical and biological principles that directly determine clinical risk. You will learn how shock waves can mechanically stimulate myocardial tissue, leading to transient arrhythmias, and how they can generate electromagnetic signals that interfere with pacemakers and ICDs.

ECG Gating

Pacemaker Management: Principles and Cooper Classification
Pacemaker Management: Principles and Cooper Classification Pacemakers are not a contraindication to ESWL—but they require a structured, device-specific approach. In this section, you will understand the key principle that safe treatment depends on how the device behaves under shock wave exposure, not simply its presence. The Cooper Classification provides a practical framework to categorize pacemakers into risk groups and guide appropriate management. You will learn when it is safe to proceed with monitoring alone, when reprogramming is required, and when additional precautions or alternative strategies must be considered.

Practical Application: Managing Pacemaker Modes During ESWL
Understanding pacemaker classifications is only the first step. Safe and effective ESWL requires translating that knowledge into real-time clinical decisions based on how each device behaves during treatment. In this section, we focus on the three most relevant pacing modes encountered in practice—VVI, DDD, and rate-responsive systems—and how each should be managed during ESWL.

ICD Management during ESWL
ICD Management: What You Will Learn Learn how to safely manage patients with implantable cardioverter defibrillators during ESWL, including device risks, mandatory deactivation protocols, and essential intraoperative precautions.

Arrhythmia Patients during ESWL
Arrhythmia Patients: What You Will Learn Learn how to safely manage patients with cardiac arrhythmias during ESWL, including atrial fibrillation, ventricular ectopy, and rhythm-related challenges with ECG gating.

Protocol
Learn the complete pre-, intra-, and post-procedure protocol for safely performing ESWL in cardiac patients, including monitoring, device management, and sedation strategies.

Thank you
Disclaimer: This course is intended for educational purposes only. The information presented reflects current knowledge, clinical experience, and available evidence in the field of ESWL and cardiac device management. However, it should not be considered a substitute for professional medical judgment, institutional protocols, or specialist consultation. Lithotripsy Academy and the course authors do not assume liability for clinical outcomes resulting from the application of this information.

Student Ratings & Reviews

No Review Yet

Your Instructor

Lithotripsy Academy

Lithotripsy Academy is a dedicated educational platform focused on advancing knowledge and clinical practice in shockwave lithotripsy and urolithiasis management.

All courses on this platform are conceptualized, structured, and designed by Dr. Sameer Parmar, with over two decades of experience in shockwave lithotripsy. His work is centered on translating clinical experience, scientific evidence, and real-world practice into structured, practical learning.

Select courses are further enriched through collaboration with invited international faculty, bringing diverse clinical perspectives and global expertise into the learning experience.

Each course reflects a carefully curated blend of evidence-based guidelines and expert clinical insight, ensuring that learners gain not only knowledge, but also a deeper understanding of decision-making in real-world practice.

65 Students

13 Courses

This course is designed for healthcare professionals involved in ESWL who already have a clear understanding of basic urology and lithotripsy principles:
Urologists performing ESWL
ESWL operators and technicians
Clinical application specialists
Urology residents and fellows
This is an advanced-level course and is not intended for beginners without prior exposure to ESWL.

Share This Course

Contact Info

Follow On

Courses List