Abstracts

RATIONALE: A 54-year old woman experienced an asystole during lead testing of the VNS in the operating room (OR). The device was left off, she underwent cardiac evaluation, and then under cardiac monitoring was uneventfully stimulated and remains on chronic stimulation. METHODS: The records of 3 other patients with bradycardia or asystoles during lead testing in the OR who subsequently underwent uneventful stimulation were reviewed. RESULTS: A 42 year old man with a static encephalopathy has been reported who after intial cardiac asystole was rechallenged with a gradual increase in intensity of the stimulus before leaving the OR. He was reported by Tatum et al. (Neurology 1999;52:1267-69). A 42 year old woman with intractable seizures, depression, diabetes, and hypertension experienced an asystole in the OR with subsequent stimulation initiated 2 weeks later. A 23 year old male with asystole in the OR has subsequently been chronically stimulated. CONCLUSIONS: Of the approximately 7000 patients world wide implanted with the VNS, 8 have been reported to experience an asystole during intraoperative lead testing at 1 mamp. Four of these patients were subsequently safely chronically stimulated while 4 were explanted. Manufacturers labeling recommends waiting 2 weeks after surgery before stimulation is initiated. Not all investigators agree. This review suggests that patients who experience bradycardia or asystole in the OR can safely undergo chronic stimulation and need not be immediately explanted.