Europace Advance Access originally published online on November 10, 2006
Europace 2006 8(12):1062-1063; doi:10.1093/europace/eul116
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ICD
Use of video capsule endoscopy in a patient with an implantable cardiac defibrillator
1 Department of Cardiovascular Medicine, Institute of Cardiology, Catholic University of the Sacred Heart, L.go Gemelli, 8, 00168 Rome, Italy; 2 Digestive Endoscopy Unit, Catholic University of the Sacred Heart, Rome, Italy
Manuscript submitted 20 March 2006. Accepted after revision 26 July 2006.
* Corresponding author. Tel: +39 0630154187; fax: +39 063055535. E-mail address: michelacasella{at}hotmail.com
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Abstract |
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Video capsule endoscopy (VCE) is a useful diagnostic tool in patients with unknown blood loss, particularly when there is a high suspicion of small bowel disease, but because of its use of radio frequency, it is relatively contraindicated in patients with a cardiac device. We report the case of a patient with an implantable cardiac defibrillator (ICD) who underwent VCE because of anaemia and previous surgery for colorectal cancer. Device interrogations were performed before and after the procedure. No interference between VCE and ICD was found. VCE is feasible and relatively safe in patients with ICDs.
Key Words: Defibrillator, Video capsule endoscopy, Interferences
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Introduction |
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The presence of implanted cardiac devices represents a relative contraindication for several external electromagnetic source applications because of potential interference.1
,2 Recently, wireless video capsule endoscopy (VCE) (Given M2A VCE Ltd, Yoqneam, Israel) with a digital radio frequency transmitter has become the gold standard for diagnosis of small bowel disease in patients with occult gastrointestinal (GI) bleeding and/or unexplained anaemia and for other disorders of the small intestine.3
We report a case of a patient with an implantable cardioverter defibrillator (ICD) who underwent VCE. Possible interference between the two devices was evaluated (either if the capsule interferes with correct ICD function or if the device interferes with the video capsule imaging).4
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Case report |
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A 72-year-old man presenting with severe normochromic normocytic anaemia came to our outpatient PM and ICD clinic to obtain consent to undergo VCE. His medical history revealed a right hemicolectomy for colorectal cancer without metastasis: 6 months later he underwent an oesophagogastroduodenoscopy and colonoscopy to investigate obscure GI bleeding, but both gave negative results. He was advised to have VCE to examine the small bowel.
The patient presented dilated idiopathic cardiomiopathy with recurrent episodes of congestive heart failure, poor ejection fraction of 25%, and a positive history of syncope and inducible sustained, poorly tolerated, ventricular tachycardia at EPS and, for this reason, received a dual chamber ICD (Medtronic, Minneapolis, MN, USA, GEM III 7275). Since then (3 years of follow-up), he has had no episode of heart failure or syncope, and no ICD shock was recorded from the device or reported by the patient.
VCE was considered for investigation of his GI problem, despite a concern over potential interference between the radio frequency emitted by the capsule and the ICD. The patient was admitted to our hospital to undergo Given M2A VCE.
VCE is composed of three fundamental parts: an ingestible M2A capsule endoscope, a recorder, and a workstation. The M2A capsule is the swallowable part, composed of a small capsule that contains a miniature video camera with a flash, a battery, a transmitter, and an antenna. The capsule acquires data at a rate of two pictures per second, approximately 50 000 images over 8 h and uses radio frequency to transmit them to a recorder unit located around the waist (
35–40 cm from the ICD). These images are downloaded on a computer and transformed into a video-movie, for the duration of 1 h, and examined by the endoscopist.3
On the day of the procedure, the ICD was interrogated, but no previous parameter or therapies were changed (Table 1), and then VCE preparation was started.
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During the procedure, vital signs and ECG were continuously monitored and ambulatory ECG monitoring was performed.
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Results |
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The patient remained asymptomatic, showing spontaneous sinus rhythm with phases of DDD pacing rhythm, from the beginning to the end of video endoscopy (almost 8 h). No arrhythmia or other adverse cardiac event was recorded and appropriate PM activity (50% atrial and ventricular DDD pacing) was observed during the procedure. At the end, a second ICD interrogation was obtained (Table 1): programmed parameters of ICD were not altered, and no interference was found between the capsule and the ICD function.
Reviewing the ambulatory ECG monitoring, phenomena such as sensing or pacing abnormalities were not observed. During VCE recording, no interference in terms of video quality, noises, or artefacts were noted.
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Discussion |
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Owing to the increasing number of patients with ICDs, it is frequent in clinical practice to be asked whether it is possible to perform special procedures in which an electromagnetic source is used. The decision to perform the procedure raises many safety concerns. VCE, an emerging diagnostic tool in the study of the GI tract, which uses radio frequency energy, may potentially interfere with correct function of implanted electrical devices such as PM and ICD. As previously reported, VCE appears to be safe in patients with an abdominal PM,2
and has been recently confirmed in five patients with an ICD.4
In our case report, the pacemaker function was not programmed to asynchronous mode unlike the previous case report presented in the literature,2 and no pacemaker malfunction in terms of inappropriate sensing or pacing features was recorded. ICD therapies were not switched off and no inappropriate interventions, artefacts, or malfunction of any kind was recorded from the device at the end of the procedure. Moreover, no interference or blank periods were observed on VCE and the endoscopic images were clear during the entire recording period. Furthermore, the frequency used for ICD transmission is 175 kHz (range 150–200 kHz), whereas the frequency used for the VCE is 430 MHz. These data support that, theoretically, there should be little chance of interference between the two devices.
Because experience in the use of VCE in patients with cardiac devices is still limited, caution must be maintained when such procedures are recommended. Despite its apparent feasibility and apparent safety in patients with device dependency, at this early stage, it is wise to perform VCE in such patients in a medical environment where possible dangerous interference might be appropriately handled.
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References |
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[1] Vanesio G, Maloney J, Rachidi R, et al. The effects of percutaneous catheter ablation on preexisting permanent pacemakers. Pacing Clin Electrophysiol 1990; 13: 1637–45.[Medline]
[2] Guyomar Y, Vandeville L, Heuls S, et al. Interference between pacemaker and video capsule endoscopy. Pacing Clin Electrophysiol 2004; 27: 1329–30.[CrossRef][Medline]
[3] Iddan G, Meron G, Glukhovsky A, et al. Wireless capsule endoscopy. Nature 2000; 405: 417.[Medline]
[4] Leighton JA, Srivathsan K, Carey EJ, et al. Safety of wireless video capsule endoscopy in patients with implantable cardioverter defibrillators. Am J Gastroenterol 2005; 100: 1728–31.[CrossRef][Web of Science][Medline]
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