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Lithotripsy Academy Review Article

ESWL in the Cardiac Patient

Pacemakers, ICDs, arrhythmias, and the ECG-gating imperative

Author: Sameer Parmar
Article type: Clinical review and practical protocol
Topic: Shock wave lithotripsy, cardiac devices, rhythm safety

Abstract

Extracorporeal shock wave lithotripsy can be considered in selected cardiac patients when appropriate pre-procedure assessment, ECG monitoring, ECG-gated shock delivery, and device-specific precautions are applied.

Patients with permanent pacemakers, implantable cardioverter-defibrillators, cardiac resynchronization therapy devices, atrial fibrillation, or ventricular ectopy require structured assessment rather than automatic exclusion.

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Keywords: ESWL; shock wave lithotripsy; pacemaker; ICD; CRT; atrial fibrillation; ECG-gating; cardiac monitoring.

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Scientific Tables

Table A. Two-column scientific table.
Parameter Clinical meaning
ECG monitoring Continuous rhythm monitoring during ESWL in patients with cardiac history or implanted devices.
ECG-gating R-wave synchronized delivery to reduce rhythm disturbance risk.

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Table A. Two-column scientific table. (css in advance of this containor)
ParameterClinical meaning
ECG monitoringContinuous rhythm monitoring during ESWL in patients with cardiac history or implanted devices.
ECG-gatingR-wave synchronized delivery to reduce rhythm disturbance risk.

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Table B. Three-column decision table.
Device or conditionESWL feasibilityKey requirement
VVI pacemakerGenerally feasibleCardiology review, ECG monitoring, and safe focal-zone clearance.
ICDFeasible with strict protocolDeactivate tachytherapy, keep defibrillator available, and interrogate afterward.
Table B. Three-column decision table. (css in advance of this container)
Device or conditionESWL feasibilityKey requirement
VVI pacemakerGenerally feasibleCardiology review, ECG monitoring, and safe focal-zone clearance.
ICDFeasible with strict protocolDeactivate tachytherapy, keep defibrillator available, and interrogate afterward.
Table C. Four-column protocol table.
PhaseActionResponsible teamPurpose
Before ESWLConfirm cardiac history and device type.Urology / cardiologyIdentify rhythm and device risk.
During ESWLUse ECG monitoring and gated delivery.Urology / anesthesiaReduce arrhythmia risk.
After ESWLInterrogate device if present.Device clinicConfirm function and restore settings.
Table C. Four-column protocol table (css in advance of this container).
PhaseActionResponsible teamPurpose
Before ESWLConfirm cardiac history and device type.Urology / cardiologyIdentify rhythm and device risk.
During ESWLUse ECG monitoring and gated delivery.Urology / anesthesiaReduce arrhythmia risk.
After ESWLInterrogate device if present.Device clinicConfirm function and restore settings.

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