Transcranial magnetic stimulation treatment in patients with traditional and leadless pacemakers: 10 cases

Transcranial magnetic stimulation (TMS) is an FDA-cleared treatment for several conditions including major depressive disorder, obsessive compulsive disorder and migraines. However, since its approval as a treatment for depression in 2008, many TMS user manuals and insurance guidelines still restrict access of patients with implanted cardiac pacemakers due to concern regarding how the magnetic pulses from the TMS coil could affect the pacemaker. Presented below are ten patients with various implanted cardiac pacemakers who were treated with TMS for depression: nine with unipolar treatment resistant depression, and one with treatment resistant depression in the context of bipolar disorder. None suffered adverse effects related to their cardiac pacemakers. TMS use in patients with pacemakers for depression needs to be reevaluated by manufacturers and insurance companies to improve patient access to a beneficial treatment option.