Is cardiac defibrillation contraindicated in patients with deep brain stimulation? A post-mortem case report

Deep Brain Stimulation (DBS) is increasingly applied for Parkinson's Disease. High energy supply needed for cardiac defibrillation (CD) in patients treated with DBS raises concern if it could lead to severe damage.

Objective: Does CD lead to damage of DBS-device or brain tissue?

Methods: A 63 year old Parkinsonian patient obtained bilateral DBS implants in the subthalamic nucleus (STN) in 2002 with good clinical effects. In 2004, CD with eight shocks, 360 joule each, was applied for ventricular fluttering resulting from myocardial infarction (MI). The patient died because of the MI and an autopsy was performed.

Results: The DBS pacemaker (Kinetra, Medtronic, USA) was set to factory delivery mode by the CD, but could be reprogrammed. The active parts of the electrodes were located in the STN and showed no damage. Only a slight gliosis in the close vicinity of the electrode tracks (Fig. 1) as well as hemosiderin deposits restricted to the areas of the electrode tips were encountered. But neither an acute haemorrhage nor necrosis was seen in the brain tissue which one would expect with energy flows induced by CD.

Conclusion: In this patient, no damage of the brain tissue or DBS implants by CD occurred. Patients with DBS should not be excluded from CD as part of a cardio-pulmonary resuscitation, but more data are needed to confirm the safety of CD in patients with DBS.