title: Interaction between cardioverter defibrillator and enhanced external counterpulsation device.
abstract: BACKGROUND
  Potential interference between implanted cardiac devices and other medical instruments is an important concern. Therefore, we aimed to investigate the possible device interaction between implantable cardioverter defibrillators (ICDs) and external enhanced counterpulsation (EECP) treatment.
  
  
  METHODS
  Twenty-one patients with an implanted ICD or cardiac resynchronization therapy with defibrillator (CRT-D) were enrolled into the study. EECP had applied as two sessions of 5 minutes. Data from device interrogations before and after the first EECP session and during second EECP session were recorded and analyzed for signs of possible device interaction.
  
  
  RESULTS
  There was no sign of inappropriate sensing or noise during EECP session. There was no difference regarding electrode impedance, pacing, and sensing values before and after EECP. There was a statistically significant difference regarding heart rates during EECP therapy between rate response off and on modes (68.69 ± 5.92 beats/min and 90.32 ± 11.05 beats/min, respectively P = 0,001). In four patients with CRT-D and unipolar left ventricular pacing, counterpulsation could not be done because of QRS sensing problems.
  
  
  CONCLUSIONS
  EECP seems to be a safe treatment modality in patients with implanted ICD and CRT-D devices. It should be kept in mind that in those patients with CRT-D, rate responsive mode is on; inappropriate sinus tachycardia can be seen during EECP therapy. Also in patients with CRT-D using a unipolar sensing mode, problems of QRS complex sensing by the EECP may occur and, therefore, this effects synchronization and success of EECP therapy.
authors.affiliation: Department of Cardiology, Istanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery, Training and Research Hospital, Halkali, Istanbul, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Celik
authors.forename: Alper
authors.initials: A
authors.lastname: Aydin
authors.forename: Mustafa S
authors.initials: MS
authors.lastname: Yilmazer
authors.forename: Nedim U
authors.initials: NU
authors.lastname: Sarigul
authors.forename: Tayfun
authors.initials: T
authors.lastname: Gurol
authors.forename: Bahadir
authors.initials: B
authors.lastname: Dagdeviren
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications / Q000517:prevention & control*; D058406:Cardiac Resynchronization Therapy; D000075202:Contraindications; D017147:Defibrillators, Implantable; D004556:Electric Injuries / Q000209:etiology*; D004868:Equipment Failure; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome
keywords: EECP; enhanced external counterpulsation; heart failure; implantable cardioverter defibrillator