A PROSPECTIVE-STUDY OF NON-ECG GATED ELEC TROCONDUCTIVE LITHOTRIPSY -HOLTER MONITORING DURING AN ALTERNANCE OF PERIODS WITH AND WITHOUT R-WAVE TRIGGERING
T. Flam et al., A PROSPECTIVE-STUDY OF NON-ECG GATED ELEC TROCONDUCTIVE LITHOTRIPSY -HOLTER MONITORING DURING AN ALTERNANCE OF PERIODS WITH AND WITHOUT R-WAVE TRIGGERING, Journal d'urologie, 102(5-6), 1996, pp. 195-198
Introduction : Electrohydraulic lithotripters use a R-wave triggering
system as episodes of cardiac arrhythmia were observed during early cl
inical experiments. This study was designed to assess the safety of no
n triggered shock wave treatments using an external fixed rate device
(120/min) on the Sonolith 4000 Plus (), a non bathtub electroconducti
ve lithotripter. Methods : Our study is the first prospective evaluati
on of non-EKG-gated lithotripsy where the patient under continuous Kel
ter monitoring served as his own control during a randomized alternanc
e of periods with or without R-wave triggering. This design allowed fo
r a direct comparison of the effect of EKG-gated and non-EKG-gated lit
hotripsy respectively. The sequence of the different periods was rando
mly assigned. The recordings were compared to a pre-treatment recordin
g, the cardiologist ignoring the randomization. Results : 25 consecuti
ve patients without cardiac history have been treated for urinary ston
es. Ventricular and supraventricular excitability disorders have been
noted in 7 patients, always during a non-EKG-triggered period. There w
as no correlation with stone location. No cardiac rhythm disturbances
have been observed during triggered periods in the 25 patients. Auricu
lar extrasystoles (0.1-0.5/min) were observed in 6 patients, and auric
ular couplets (0.5/min) in one. Ventricular extrasystoles were noted i
n 4 patients, and ventricular couplets in one. One patient had an asym
ptomatic non sustained ventricular tachycardia which resolved spontane
ously. No clinically significant disorder occurred. Treatment time and
analgesics requirements were reduced by non-EKG-triggering. Conclusio
ns : Non-EKG-triggering lithotripsy has a definite potential for cardi
ac disturbances, but appeared to be clinically safe in these patients
with no cardiac history.