Management of cardiac pacemaker in a patient with spinal cord stimulator implant

Spinal cord stimulation reduces pain of critical ischaemia in patients with severe inoperable coronary artery and peripheral vascular disease by increasing microvascular flow. Patients with cardiac pacemaker may be denied a spinal cord stimulator (SCS) implant because of the risk of compromising pacemaker function by inhibition or reversion to asynchronous noise-pacing mode. We describe the management of a patient with an SCS implant for lower limb ischaemia who required a pacemaker. We suggest that with modern pacemakers it is safe to implant a spinal cord stimulator simultaneously with a pacemaker provided adequate precautions are taken to prevent interdevice interference.