Cardiac Arryhythmias in Extracorporeal Shockwave Lithotripsy

Cardiac Arryhythmias in Extracorporeal Shockwave Lithotripsy
Title:Cardiac Arryhythmias in Extracorporeal Shockwave Lithotripsy
Author/Abstract:Rodolfo I. De Guzman, MD; Genlinus D. Yusi, MD; Roan J. Jocson, MD; Ernesto R. Castillo, MD; Kristine M. Bordaje, MD and Joseph Michael Jaro, MD

Department of Urology, National Kidney and Transplant Institute

Rationale: Cardiac arrhythmias in extracorporeal shockwave lithotripsy (ESWL) has been well documented worldwide with an overall incidence of <20%. Despite this fact, it is well regarded as a safe procedure and remains to be the treatment of choice for most renal and ureteral calculi. Objective: This study was done to document the incidence of cardiac arrhythmias in patients undergoing ungated ESWL at the National Kidney and Transplant Institute using the electromagnetic Dornier compact S lithotripter and determine its correlation to the patient's age, sex, size of the stone, location of the stone, laterality, number of shocks given and frequency of shock delivery. Materials and Methods: This is a cross-sectional study of 435 patients who underwent ESWL at the National Kidney and Transplant Institute from August, 2004 to July, 2005 with a normal preoperative ECG, no history of a diagnosed cardiac arrhythmia undergoing treatment and no artificial pacemaker. The main outcome was presence of arrhythmia during treatment. Treatment was stalled in patients nearing completion of their target number of shocks and was shifted to gated ESWL in patients with arrhythmias noted shortly after the start of treatment. Results: A total of 435 patients with a mean age of 45.6 + 14 were included. The overall incidence of cardiac arrhythmia was 34.5%. The incidence was higher in males (58.7%), higher in individuals above 45 years of age (46%), were more common with inferior calyceal stones (34.7%), higher in right-sided stones (55.3%), more common in stones < 1 cm (66.7%), higher when > 5000 shocks were delivered (54.7%) and with a delivery rate of 70-100 shocks/min (53.3%). Chi-square analysis showed a significant correlation between arrhythmia, stone size (p = 0.039) and laterality (p = 0.054). Logistic regression analysis was done with Odd's ratio at 95% confidence interval which revealed an increased risk of developing cardiac arrhythmias when treating patients with right-sided stones and an increase in stone size. Conclusion: The incidence of cardiac arrhythmias of patients undergoing ungated ESWL was 34.5%. A significant correlation was seen between the incidence of arrhythmias, stone size and laterality with patients having a greater risk of developing arrhythmias with right sided stones and an increase in stone size.

Key words: cardiac arrhythmias, extracorporeal shockwave lithotripsyq
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