Safety of Paired Vagus Nerve Stimulation Implantation in the Presence of a Cardiac Pacemaker: A Case Report

Given advances in neuromodulation to improve health and function for those with chronic conditions, the implantation of vagus nerve stimulation (VNS) or other neuromodulation devices with existing cardiac devices, such as pacemakers in this report, presents unique challenges due to the safety concerns of potential device interactions or interference.

An 83-year-old man, 6 months postischemic stroke and upper extremity weakness, presented for surgical evaluation for the implantation of a Vivistim Paired VNS System to assist with stroke recovery. The patient had a history of myocardial infarction 3 years ago with subsequent dual chamber pacemaker implantation. We implemented a three-phase protocol that included worst-case test scenarios during preoperative and intraoperative testing and then long-term follow-up.

Use of a rigorous test protocol confirmed that VNS did not interfere with proper cardiac pacemaker operation. Preoperative testing, intraoperative testing, and a follow-up at 6 months confirmed the absence of potential safety events associated with device interactions.