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Suhail Arain S, Cretnik A, Huemer M, Attanasio P, Nagel P, Landmesser U, Hardt J, Sidhu K, Tscholl V, Roser M. Risk of occurrence of electromagnetic interference from the application of transcutaneous electrical nerve stimulation on the sensing function of implantable defibrillators. Europace 2023; 25:euad206. [PMID: 37487241 PMCID: PMC10365842 DOI: 10.1093/europace/euad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief. But electrical TENS currents are also a source of electromagnetic interference (EMI). Thus, TENS is considered to be contraindicated in implantable cardioverter-defibrillator (ICD) patients. However, data might be outdated due to considerable advances in ICD and cardiac resynchronization therapy (CRT) filtering and noise protection algorithm technologies. The aim of this pilot safety study was to re-evaluate the safety of TENS in patients with modern ICDs. METHODS AND RESULTS One hundred and seven patients equipped with 55 different models of ICD/CRT with defibrillators from 4 manufacturers underwent a standardized test protocol including TENS at the cervical spine and the thorax, at 2 stimulation modes-high-frequency TENS (80 Hz) and burst-mode TENS (2 Hz). Potential interference monitoring included continuous documentation of ECG Lead II, intracardiac electrograms and the marker channel. Electromagnetic interference was detected in 17 of 107 patients (15.9%). Most frequent were: interpretations as a premature ventricular beats (VS/S) in 15 patients (14%), noise reversion in 5 (4.6%) which resulted in temporary asynchronous pacing in 3 (2.8%), interpretation as ventricular tachycardia/ventricular fibrillation in 2 (1.9%), and premature atrial beat in 2 (1.9%) patients. Electromagnetic interference occurrence was influenced by position (chest, P < 0.01), higher current intensity (P < 0.01), and manufacturer (P = 0.012). CONCLUSION Overall, only intermittent and minor EMI were detected. Prior to the use of TENS in patients with ICDs, they should undergo testing under the supervision of a cardiac device specialist.
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Affiliation(s)
- Saba Suhail Arain
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anja Cretnik
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Martin Huemer
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Philipp Attanasio
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Patrick Nagel
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Juliane Hardt
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health in the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Kiran Sidhu
- Penn Heart and Vascular Center, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Verena Tscholl
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Mattias Roser
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Cardiologisches Centrum Nuernberg, Nuernberg, Germany
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2
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Stühlinger M, Burri H, Vernooy K, Garcia R, Lenarczyk R, Sultan A, Brunner M, Sabbag A, Özcan EE, Ramos JT, Di Stolfo G, Suleiman M, Tinhofer F, Aristizabal JM, Cakulev I, Eidelman G, Yeo WT, Lau DH, Mulpuru SK, Nielsen JC, Heinzel F, Prabhu M, Rinaldi CA, Sacher F, Guillen R, de Pooter J, Gandjbakhch E, Sheldon S, Prenner G, Mason PK, Fichtner S, Nitta T. EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices. Europace 2022; 24:1512-1537. [PMID: 36228183 DOI: 10.1093/europace/euac040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Markus Stühlinger
- Department of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rodrigue Garcia
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center of Heart Diseases, Zabrze, Poland
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Arian Sultan
- Department of Electrophysiology, Heart Center at University Hospital Cologne, Cologne, Germany
| | - Michael Brunner
- Department of Cardiology and Medical Intensive Care, St Josefskrankenhaus, Freiburg, Germany
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Emin Evren Özcan
- Heart Rhythm Management Center, Dokuz Eylul University, İzmir, Turkey
| | - Jorge Toquero Ramos
- Cardiac Arrhythmia and Electrophysiology Unit, Cardiology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Giuseppe Di Stolfo
- Cardiac Intensive Care and Arrhythmology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mahmoud Suleiman
- Cardiology/Electrophysiology, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Ivan Cakulev
- University Hospitals of Cleveland, Case Western University, Cleveland, OH, USA
| | - Gabriel Eidelman
- San Isidro's Central Hospital, Diagnóstico Maipú, Buenos Aires Province, Argentina
| | - Wee Tiong Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Frank Heinzel
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, 13353 Berlin, Germany
| | - Mukundaprabhu Prabhu
- Associate Professor in Cardiology, In charge of EP Division, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | | | - Frederic Sacher
- Bordeaux University Hospital, Univ. Bordeaux, Bordeaux, France
| | - Raul Guillen
- Sanatorio Adventista del Plata, Del Plata Adventist University Entre Rios Argentina, Entre Rios, Argentina
| | - Jan de Pooter
- Professor of Cardiology, Ghent University, Deputy Head of Clinic, Heart Center UZ Gent, Ghent, Belgium
| | - Estelle Gandjbakhch
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Institut de Cardiologie, ICAN, Paris, France
| | - Seth Sheldon
- The Department of Cardiovascular Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | | | - Pamela K Mason
- Director, Electrophysiology Laboratory, University of Virginia, Charlottesville, VA, USA
| | - Stephanie Fichtner
- LMU Klinikum, Medizinische Klinik und Poliklinik I, Campus Großhadern, München, Germany
| | - Takashi Nitta
- Emeritus Professor, Nippon Medical School, Presiding Consultant of Cardiology, Hanyu General Hospital, Saitama, Japan
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3
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Europace 2021; 23:1336-1337o. [PMID: 33636723 DOI: 10.1093/europace/euaa427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
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4
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H, Ambrosetti M, Deneke T, Cornelissen V, R Heinzel F, Davos CH, Kudaiberdieva G, Frederix I, Svendsen JH, Hansen D. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Eur J Prev Cardiol 2021; 28:1736-1752. [PMID: 34038513 DOI: 10.1093/eurjpc/zwaa121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | | | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta d'Adda, Italy
| | - Thomas Deneke
- Heart Center Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt, Germany
| | - Veronique Cornelissen
- Cardiovascular Exercise Physiology Unit, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Frank R Heinzel
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Gulmira Kudaiberdieva
- SRI of Heart Surgery and Organ Transplantation, Center Scientific Research and Development of Education, Bishkek Kyrgyzstan, Adana, Turkey
| | - Ines Frederix
- Hasselt University, Faculty of Medicine & Life Sciences, Hasselt, Belgium.,Antwerp University, Faculty of Medicine & Health Sciences, Antwerp, Belgium.,Department of Cardiology, Jessa Hospital, Hasselt, Belgium.,Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, UHasselt, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
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5
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Czermak T, Fichtner S. [Cardiac implantable electronic devices : Electromagnetic interference from electrocauterization, lithotripsy and physiotherapy]. Herzschrittmacherther Elektrophysiol 2019; 30:168-176. [PMID: 31016389 DOI: 10.1007/s00399-019-0620-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The management of patients with a cardiac implantable electronic device (CIED) poses a particular challenge in the peri-interventional and perioperative medical environment due to the many forms of possible electromagnetic interference. Although the devices encountered nowadays are of increasing complexity, the vast majority of procedures can be safely performed in patients. The existing position statements and recommendations, however, have a low level of evidence and are often contradictory. In the context of intraoperative electrocauterization, one of the most important sources of electromagnetic interference in the medical environment, recent studies have suggested an increasingly pragmatically perioperative CIED management, which is not represented in the existing recommendations. This article gives an example of these newer findings and reports the currently used and appropriately adapted perioperative CIED management protocol. Extracorporeal shock wave lithotripsy was thought to cause severe interference in CIED patients based on older studies and in vitro experiments. Although electromagnetic interference is possible, clinical observations with modern devices show that the procedure can generally be safely applied in CIED patients. Physiotherapy often utilizes a variety of electromechanical devices, which can be a relevant source of electromagnetic interference. Although some of these therapies can be safely used, coordination with the responsible CIED unit is recommended.
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Affiliation(s)
- Thomas Czermak
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland.
| | - Stephanie Fichtner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland
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6
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Egger F, Hofer C, Hammerle FP, Löfler S, Nürnberg M, Fiedler L, Kriz R, Kern H, Huber K. Influence of electrical stimulation therapy on permanent pacemaker function. Wien Klin Wochenschr 2019; 131:313-320. [PMID: 31025164 DOI: 10.1007/s00508-019-1494-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electrical stimulation therapy (EST) and transcutaneous electrical neuromuscular stimulation (TENS), a modality of EST, have become widely applied, accepted and effective methods for the treatment of musculoskeletal and other pain conditions. According to the rising number of permanent pacemaker (PM) wearers the number of potential candidates for EST with concomitant device implantation is growing. Contradictory recommendations exist regarding the application of EST or TENS on PM wearers. AIM The study was carried out to evaluate the impact of EST on PM function. METHODS A full size model mimicking the electrical characteristics of the human body was used to evaluate the application of EST on permanent PM devices. Various configurations with respect to energy modality, position of the stimulation electrodes and PM device models were evaluated. Intracardiac PM electrogram tracings (iEGM) were analyzed for the interference of EST with PM function. RESULTS Unilateral EST application did not cause interference with PM function in any of the configurations (0%; n = 700). On the contrary, bilateral stimulation (350 configurations in total) caused either ventricular inhibition or switch to V00 back-up pacing due to electrical interference in 165 cases (47.1%) depending on the applied stimulation parameters. CONCLUSION The use of EST potentially interferes with PM therapy, especially if the electrodes are positioned bilaterally; however, unilateral EST application appeared to be safe in all tested configurations.
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Affiliation(s)
- Florian Egger
- 3rd Medical Department with Cardiology, Chest Pain Unit and Intensive Care Medicine, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria.
| | - Christian Hofer
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
| | - Fabian P Hammerle
- 3rd Medical Department with Cardiology, Chest Pain Unit and Intensive Care Medicine, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
| | - Stefan Löfler
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
| | - Michael Nürnberg
- 3rd Medical Department with Cardiology, Chest Pain Unit and Intensive Care Medicine, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
| | - Lukas Fiedler
- 2nd Department of Internal Medicine, Hospital Wiener Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Austria
| | - Ruxandra Kriz
- 3rd Medical Department with Cardiology, Chest Pain Unit and Intensive Care Medicine, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
| | - Helmut Kern
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department with Cardiology, Chest Pain Unit and Intensive Care Medicine, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
- Medical Faculty, Sigmund-Freud University, Freudplatz 3, 1020, Vienna, Austria
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7
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Libbus I, Mazar ST, Stubbs SR, KenKnight BH. Electrical Interaction between Implantable Vagus Nerve Stimulation Device and Implantable Cardiac Rhythm Management Device. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:3681-3684. [PMID: 30441171 DOI: 10.1109/embc.2018.8513067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Autonomic regulation therapy via vagus nerve stimulation (VNS) was recently approved as a therapy for chronic heart failure, and will likely be utilized in patients who are also indicated for cardiac rhythm management device implantation. This study is designed to assess the degree to which VNS is likely to cause interference in the cardiac sensing of an implantable cardiac rhythm management device. METHODS A VNS stimulation lead and a cardiac sensing lead were placed in a simulated biological medium. A nonconductive carrier frame was used to position the leads at a precise electrode spacing. Stimulation was delivered through the VNS Therapy lead at a maximum output current and a variety of combinations of stimulation frequencies from 5-30 Hz and stimulation pulse widths from 130-1000 μs. The electrode spacing began at 0 cm and was increased in 1 cm increments until the measured signal dropped below the cardiac rhythm management device noise floor for sensing. The test was conducted with both bipolar and unipolar sensing. RESULTS In the bipolar sensing configuration, the maximum sensed signal amplitude was 687 μV at an electrode separation of 0 cm, signal frequency of 30 Hz, pulse width of 1000 μs, and output current of 3.5 mA. In the unipolar sensing configuration, the maximum amplitude was 406 μV. In both configurations, the measured signal with maximum stimulation intensity decreased significantly with electrode separation, and dropped below the noise floor at an electrode spacing of 3.0 cm. The sensed signal amplitude was further attenuated at lower stimulation amplitudes and pulse widths. CONCLUSION Even at maximum neural stimulation intensity of 3.5 mA, at an electrode separation of at least 3.0 cm, neural stimulation did not result in a detectable level of interference with either bipolar or unipolar sensing. Because this separation is significantly smaller than the minimum electrode separation of 15 cm in clinical practice, VNS Therapy is not expected to interfere with the function of implantable cardiac devices.
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8
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Parikh V, Thaler E, Kato M, Gillespie MB, Nguyen S, Withrow K, Calhoun D, Soose R, Stevens D, Stevens S, Larsen C, Reddy M, Lakkireddy D. Early feasibility of hypoglossal nerve upper airway stimulator in patients with cardiac implantable electronic devices and continuous positive airway pressure-intolerant severe obstructive sleep apnea. Heart Rhythm 2018; 15:1165-1170. [DOI: 10.1016/j.hrthm.2018.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Indexed: 11/24/2022]
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9
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McClelland S, Henrikson CA, Ciporen JN, Jaboin JJ, Mitin T. Tumor Treating Fields Utilization in a Glioblastoma Patient with a Preexisting Cardiac Pacemaker: The First Reported Case. World Neurosurg 2018; 119:58-60. [PMID: 30064027 DOI: 10.1016/j.wneu.2018.07.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tumor-treating fields (TTFs) have become an important, evidence-based modality in the treatment of glioblastoma (GBM). In patients requiring cardiac pacemakers, TTF therapy is complicated by theoretical concerns regarding possible electrical interaction between the devices. CASE DESCRIPTION A 57-year-old man with past medical history of sick sinus syndrome requiring cardiac pacemaker implantation suffered an acute neurologic change associated with a left parieto-occipital lesion, which was found to be GBM. After completion of guideline-concordant chemoradiation, he chose to undergo TTF therapy. Because of the absence of cardiac symptoms and the theoretical risk of far-field sensing by the pacemaker of the TTF device (potentially resulting in pacemaker inhibition), the pacemaker was turned off before receiving TTF. Following TTF implementation, the patient responded well; he remains alive more than 25 months following his GBM diagnosis, exceeding the median 20.9-month survival of the recently completed phase III TTF randomized clinical trial for newly diagnosed GBM. Furthermore, he has exhibited neither cardiac morbidity nor adverse scalp reactions to TTF therapy. CONCLUSIONS The first reported case of successful TTF administration in a GBM patient with a previously implanted cardiac pacemaker may allay the concerns of neuro-oncologists, cardiologists, radiation oncologists, and all certified TTF prescribers regarding the applicability of TTF in suitable candidates with preexisting cardiac pacemakers. This case indicates that TTF therapy may be efficacious in patients with indwelling magnetic resonance image-conditional cardiac pacemakers turned to the off position and that physical removal of the pacemaker is not necessary before starting TTF.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA; Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA.
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeremy N Ciporen
- Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Timur Mitin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
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10
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Blandford AD, Wiggins NB, Ansari W, Hwang CJ, Wilkoff BL, Perry JD. Cautery selection for oculofacial plastic surgery in patients with implantable electronic devices. Eur J Ophthalmol 2018; 29:315-322. [PMID: 29998777 DOI: 10.1177/1120672118787440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To discover oculofacial plastic surgeon practice patterns for cautery selection in the setting of implantable electronic devices and present guidelines based on a review of current literature. METHODS A 10-Question web-based survey was sent to the email list serve of the American Society of Ophthalmic Plastic and Reconstructive Surgery to determine surgeon cautery preference in the setting of various implantable electronic devices and comfort level with the guidelines for cautery selection in their practice or institution. The relationship between survey questions was assessed for statistical significance using Pearson's Chi-square tests. RESULTS Two hundred ninety-three (41% response rate) surveys were completed and included for analysis. Greater than half of respondents either had no policy (36%) or were unaware of a policy (19%) in their practice or institution regarding cautery selection in patients with a cardiac implantable electronic device. Bipolar cautery was favored for use in patients with a cardiac implantable electronic device (79%-80%) and this number dropped in patients with implantable neurostimulators (30%). Overall, one-third of respondents did not feel comfortable with their practice/institution policy. CONCLUSION Choices and comfort level among oculofacial plastic surgeons for cautery selection in patients with implantable electronic devices vary considerably, and some choices may increase the risk for interference-related complications. Practice patterns vary significantly in the setting of a neurostimulator or cochlear implant, where interference can cause thermal injury to the brain and implant damage, respectively. Guidelines are proposed for cautery selection in patients with implantable electronic devices undergoing oculofacial plastic surgery.
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Affiliation(s)
| | - Newton B Wiggins
- 2 Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Waseem Ansari
- 1 Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Catherine J Hwang
- 1 Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bruce L Wilkoff
- 2 Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Julian D Perry
- 1 Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Badger J, Taylor P, Swain I. The safety of electrical stimulation in patients with pacemakers and implantable cardioverter defibrillators: A systematic review. J Rehabil Assist Technol Eng 2017; 4:2055668317745498. [PMID: 31186945 PMCID: PMC6453072 DOI: 10.1177/2055668317745498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/09/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction A number of patients are excluded from electrical stimulation treatment
because there is concern that electrical stimulation could cause
electromagnetic interference with pacemakers and implanted cardioverter
defibrillators. The decision to use electrical stimulation in these patients
needs to be supported by an assessment of benefit and harm. Methods We conducted a systematic review of the risk of electromagnetic interference
between electrical stimulation and pacemakers or implanted cardioverter
defibrillators. We included the electronic databases MEDLINE and EMBASE in
the time period between 1966 and 26 August 2016. Results 18 papers fulfilled the inclusion criteria (eight safety studies and ten case
studies). Although we were unable to accurately estimate the risk of
electromagnetic interference, the studies revealed that patients having
electrical stimulation of the lower limb are less susceptible to
electromagnetic interference. Conclusions The results suggest that electrical stimulation could be used safely to help
drop foot in patients with pacemakers or implanted cardioverter
defibrillators. However, in order to obtain an accurate estimate of the risk
of electromagnetic interference, a large, long-term, and
intervention-specific safety study is required. Until such a study is
undertaken, electrical stimulation should be used with caution in patients
with pacemakers and implanted cardioverter defibrillators.
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Affiliation(s)
- James Badger
- 1Salisbury NHS Foundation Trust, Salisbury District Hospital, Salisbury, UK
| | | | - Ian Swain
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, UK
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12
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Saitoh M, dos Santos MR, Anker M, Anker SD, von Haehling S, Springer J. Neuromuscular electrical stimulation for muscle wasting in heart failure patients. Int J Cardiol 2016; 225:200-205. [DOI: 10.1016/j.ijcard.2016.09.127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/30/2016] [Indexed: 12/12/2022]
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Cenik F, Schoberwalter D, Keilani M, Maehr B, Wolzt M, Marhold M, Crevenna R. Neuromuscular electrical stimulation of the thighs in cardiac patients with implantable cardioverter defibrillators. Wien Klin Wochenschr 2016; 128:802-808. [PMID: 27457876 PMCID: PMC5104798 DOI: 10.1007/s00508-016-1045-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 12/04/2022]
Abstract
Background The aim of this systematic review was to update scientific knowledge concerning the safety of neuromuscular electrical stimulation (NMES) to increase exercise capacity and prevent cardiac cachexia in patients with implantable cardioverter defibrillators (ICDs). Methods A systematic review including the electronic databases PubMed, MEDLINE, and SCOPUS was conducted for the time period from 1966 to March 31, 2016. Results Only four articles fulfilled the inclusion criteria (three original articles/safety studies and one case report). The three (safety) studies used NMES to increase muscle strength and/or endurance capacity of the thighs. NMES did not show electromagnetic interference (EMI) with ICD function. EMI was described in a case report of 2 patients with subpectoral ICDs and application of NMES on abdominal muscles. Conclusion This review indicates that NMES may be applied in cardiac ICD patients if 1) individual risks (e. g., pacing dependency, acute heart failure, unstable angina, ventricular arrhythmic episode in the last 3 months) are excluded by performing a safety check before starting NMES treatment and 2) “passive” exercise using NMES is performed only for thighs and gluteal muscles in 3) compliant ICD patients (especially for home-based NMES) and 4) the treatment is regularly supervised by a physician and the device is examined after the first use of NMES to exclude EMI. Nevertheless, further studies including larger sample sizes are necessary to exclude any risk when NMES is used in this patient group.
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Affiliation(s)
- Fadime Cenik
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Dieter Schoberwalter
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Department of Cardiology, Hanusch-Krankenhaus, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bruno Maehr
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Therapiezentrum Rosalienhof, Versicherungsanstalt öffentlich Bediensteter, Bad Tatzmannsdorf, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Maximilian Marhold
- Department of Internal Medicine I/Oncology, Medical University of Vienna, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Corzani A, Ziacchi M, Biffi M, Allaria L, Diemberger I, Martignani C, Bratten T, Gardini B, Boriani G. Clinical management of electromagnetic interferences in patients with pacemakers and implantable cardioverter-defibrillators: review of the literature and focus on magnetic resonance conditional devices. J Cardiovasc Med (Hagerstown) 2016; 16:704-13. [PMID: 26313816 DOI: 10.2459/jcm.0000000000000301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The number of cardiac implantable electronic devices (CIEDs) has greatly increased in the last 10 years. Many electronic devices used in daily activities generate electromagnetic interferences (EMIs) that can interact with CIEDs. In clinical practice, it is very important to know the potential sources of EMIs and their effect on CIEDs in order to understand how to manage or mitigate them. A very important source of EMI is magnetic resonance (MR), which is considered nowadays the diagnostic gold standard for different anatomical districts. In this review, we focused on the effects of EMI on CIEDs and on the clinical management. Moreover, we made a clarification about MR and CIEDs.In patients with CIEDs, EMIs may cause potentially serious and even life-threatening complications (inappropriate shocks, device malfunctions, inhibition of pacing in pacemaker-dependent patients) and may rarely dictate device replacement. The association of inappropriate shocks with increased mortality highlights the importance of minimizing the occurrence of EMI. Adequate advice and recommendations about the correct management of EMIs in patients with CIEDs are required to avoid all complications during hospitalization and in daily life. Furthermore, the article focused on actual management about MR and CIEDs.
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Affiliation(s)
- Alessandro Corzani
- aDepartment of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S.Orsola Malpighi University Hospital, Bologna, Italy bMedtronic Inc, Minneapolis, Minnesota, USA *These authors contributed equally to this work
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15
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Kamiya K, Satoh A, Niwano S, Tanaka S, Miida K, Hamazaki N, Maekawa E, Matsuzawa R, Nozaki K, Masuda T, Ako J. Safety of neuromuscular electrical stimulation in patients implanted with cardioverter defibrillators. J Electrocardiol 2016; 49:99-101. [DOI: 10.1016/j.jelectrocard.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Indexed: 10/22/2022]
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Beinart R, Nazarian S. Effects of external electrical and magnetic fields on pacemakers and defibrillators: from engineering principles to clinical practice. Circulation 2014; 128:2799-809. [PMID: 24366589 DOI: 10.1161/circulationaha.113.005697] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The overall risk of clinically significant adverse events related to EMI in recipients of CIEDs is very low. Therefore, no special precautions are needed when household appliances are used. Environmental and industrial sources of EMI are relatively safe when the exposure time is limited and distance from the CIEDs is maximized. The risk of EMI-induced events is highest within the hospital environment. Physician awareness of the possible interactions and methods to minimize them is warranted.
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Affiliation(s)
- Roy Beinart
- Section for Cardiac Electrophysiology, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD. (R.B., S.N.); and Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel (R.B.)
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Misiri J, Kusumoto F, Goldschlager N. Electromagnetic interference and implanted cardiac devices: the medical environment (part II). Clin Cardiol 2012; 35:321-8. [PMID: 22539263 DOI: 10.1002/clc.21997] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/19/2012] [Accepted: 03/19/2012] [Indexed: 11/07/2022] Open
Abstract
Electromagnetic interference produced by medical equipment can interact with implanted cardiac devices such as pacemakers and implantable cardioverter-defibrillators. The most commonly observed interaction is in the operating room with electrosurgery. The risk of interactions can often be mitigated by close communication between the cardiac-device specialist and the anesthesiology/surgical team to develop a patient-specific strategy that accounts for factors such as type of device, type of surgery, and whether the patient is pacemaker dependent. Although magnetic resonance imaging should generally not be used in patients with implanted cardiac devices, several published guidelines provide strategies and recommendations for managing risks if magnetic resonance imaging is required with no suitable diagnostic alternatives. Other common sources of electromagnetic interference in the medical environment are ionizing radiation and left ventricular assist devices.
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Affiliation(s)
- Juna Misiri
- Department of Medicine, Division of Cardiovascular Disease, Electrophysiology and Pacing Service, Mayo Clinic, Jacksonville, Florida, USA
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18
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Pangarkar S, Lee PC. Conservative treatment for neck pain: medications, physical therapy, and exercise. Phys Med Rehabil Clin N Am 2011; 22:503-20, ix. [PMID: 21824590 DOI: 10.1016/j.pmr.2011.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article offers conservative treatment strategies for patients suffering from musculoskeletal causes of neck pain. Basic pharmacology is reviewed, including that of opioids, nonsteroidal anti-inflammatory drugs, adjuvants, and topical analgesics. Moreover, indications for therapeutic exercise, manual therapy, and modalities are reviewed, along with any supporting literature. Treatment considerations with each category of medication and physical therapy are discussed. This article is meant to serve as a resource for physicians to tailor conservative treatment options to their individual patients.
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Affiliation(s)
- Sanjog Pangarkar
- Inpatient Pain Service, Veterans Health Service Greater Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA
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19
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Gombotz H, Anelli Monti M, Leitgeb N, Nürnberg M, Strohmer B. Perioperatives Management von Patienten mit implantiertem Schrittmacher oder Kardioverter/Defibrillator. Anaesthesist 2009; 58:485-98. [DOI: 10.1007/s00101-009-1553-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Digby GC, Daubney ME, Baggs J, Campbell D, Simpson CS, Redfearn DP, Brennan FJ, Abdollah H, Baranchuk A. Physiotherapy and cardiac rhythm devices: a review of the current scope of practice. ACTA ACUST UNITED AC 2009; 11:850-9. [DOI: 10.1093/europace/eup102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Burri H, Piguet V. UninTENSional pacemaker interactions with transcutaneous electrical nerve stimulation. Europace 2009; 11:283-4. [PMID: 19240107 DOI: 10.1093/europace/eup008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Casillas JM, Gremeaux V, Labrunee M, Troigros O, Laurent Y, Deley G, Eicher JC. Low-frequency electromyostimulation and chronic heart failure. ACTA ACUST UNITED AC 2008; 51:461-72. [PMID: 18550196 DOI: 10.1016/j.annrmp.2008.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 04/10/2008] [Accepted: 04/10/2008] [Indexed: 11/20/2022]
Abstract
Low-frequency electromyostimulation (EMS) acts on the skeletal muscle abnormalities that aggravate intolerance to effort in patients with chronic heart failure (CHF). It improves the oxidative capacity of muscles and thus enhances aerobic performance and physical capacity to almost the same degree, as does conventional physical training. No local or hemodynamic intolerance has been reported, even in cases of severe CHF. However, the presence of a pacemaker is one of the relative contra-indications (prior evaluation of tolerance is required), while that of an implanted defibrillator is one of the absolute contra-indications. EMS is an alternative to physical effort training when the latter is impossible due to a high degree of deconditioning or because there is a contra-indication, which may be temporary, due to the risk of acute decompensation and/or rhythm troubles. EMS can also be used in patients waiting for a heart transplant or in CHF patients who are unwilling to engage in physical activities. As EMS is not expensive and easy to set up, its use is likely to develop in the future.
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Affiliation(s)
- J-M Casillas
- Pôle rééducation-réadaptation, CHU de Dijon, 23, rue Gaffarel, 21079 Dijon cedex, France.
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Holmgren C, Carlsson T, Mannheimer C, Edvardsson N. Risk of interference from transcutaneous electrical nerve stimulation on the sensing function of implantable defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:151-8. [PMID: 18233966 DOI: 10.1111/j.1540-8159.2007.00962.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of transcutaneous electrical nerve stimulation (TENS) for pain relief is increasing. At the same time the implantable cardioverter defibrillator (ICD) is a routine treatment for malignant tachyarrhythmias. Today patients often need devices for more than one condition, and consideration must be given to the interaction between them. We studied the risk of interference between TENS and the ICD function. METHODS AND RESULTS Thirty patients who had received an ICD underwent a test protocol including TENS at the mammilla and hip levels, at two energy levels, and at the highest comfortable stimulation level. The effects of TENS on the electrocardiogram lead II, intracardiac electrograms, and the ICD marker channels were analyzed. Disturbance from TENS on the sensing function was seen at all stimulation attempts. Interference between the systems was observed in 16 patients. In eight patients (27%) the interpretation was VT/VF and in 14 patients (47%) as ventricular premature extra beats. Other kinds of interactions were seen in five patients (16%). Each patient could have more than one kind of interference. CONCLUSIONS Noise reversion and undersensing might prevent the ICD from delivering shock when it should and the interpretation as VT/VF could result in inappropriate shocks. Because of the potentially serious consequences of interference we do not recommend the use of TENS in patients with ICD.
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Affiliation(s)
- Christina Holmgren
- Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
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Abstract
Potential interference between implanted cardiac devices such as pacemakers and implantable cardioverter-defibrillators and electromagnetic fields is an important concern for physicians taking care of patients with pacemakers and implantable cardioverter-defibrillators. There are many sources of electromagnetic interference (EMI); however, only a small number of these cause significant problems that need attention. Regardless of its source, EMI is of greater concern for a patient who is dependent on paced rhythm because inhibition of the pacemaker by EMI may produce ventricular standstill. It is important that cardiologists, internists, emergency medicine, critical care physicians, and anesthesiologists be aware of how EMI can affect the function of implanted cardiac devices so that appropriate treatment can be rendered and preventive measures instituted.
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Stanik-Hutt JA. Management Options for Angina Refractory to Maximal Medical and Surgical Interventions. ACTA ACUST UNITED AC 2005; 16:320-32. [PMID: 16082235 DOI: 10.1097/00044067-200507000-00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the seemingly daily advances in the primary, secondary, and tertiary prevention for coronary artery disease, many patients will ultimately experience progression of their disease and experience angina refractory to further active treatment. In these patients, disabling angina occurs at rest or during simple activities of daily living. When this occurs, symptom management, a predominant focus of nursing, becomes the goal of care. Several medical and surgical alternatives are available to patients with refractory angina. Enhanced external counterpulsation and transmyocardial laser revascularization are Food and Drug Administration approved therapies that can be used to attempt to restore the balance of supply and demand. Modulation of sympathetic tone via procedures such as stellate ganglion blocks has also been employed. Other methods to control the pain are techniques that alter pain perception such as spinal opioids, transcutaneous electrical nerve stimulation, and spinal cord stimulation. Too few patients with refractory angina are referred for any of these palliative therapies. Armed with knowledge regarding these therapies, nurses will be better prepared to provide anticipatory guidance to patients and their families and to support the patient's hope for relief as they cope with this devastating condition.
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Affiliation(s)
- Julie A Stanik-Hutt
- School of Nursing, Johns Hopkins University, Baltimore, Maryland 21205-2110, USA.
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Abstract
Both acute and chronic pain are common coexisting problems in patients with heart failure. Because nonsteroidal anti-inflammatory drugs and corticosteroids are contraindicated in heart failure, traditional pain management algorithms require modification. This article reviews pertinent pain management principles, including pain vocabulary, barriers to pain management, and general pain assessment and treatment measures. Issues unique to the heart failure patient are discussed and specific interventions for the heart failure patient with acute or chronic pain are then delineated.
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Senatus PB, McClelland S, Ferris AD, Ford B, Winfield LM, Pullman SL, Yu Q, McKhann GM, Schneller SJ, Goodman RR. Implantation of bilateral deep brain stimulators in patients with Parkinson disease and preexisting cardiac pacemakers. J Neurosurg 2004; 101:1073-7. [PMID: 15597774 DOI: 10.3171/jns.2004.101.6.1073] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
✓ Deep brain stimulation (DBS) has become an important modality in the treatment of refractory Parkinson disease (PD). In patients with comorbid arrhythmias requiring cardiac pacemakers, DBS therapy is complicated by concerns over a possible electrical interaction between the devices (or with device programming) and the inability to use magnetic resonance imaging guidance for implantation. The authors report two cases of PD in which patients with preexisting cardiac pacemakers underwent successful implantation of bilateral DBS electrodes in the subthalamic nucleus (STN).
Each patient underwent computerized tomography—guided stereotactic frame—based placement of DBS electrodes with microelectrode recording. Both extension wires were passed from the right side of the head and neck (contralateral to the pacemaker) to place the cranial pulse generators subcutaneously in the left and right abdomen. The cranial pulse generators were placed farther than 6 in from the cardiac pacemaker and from each other to decrease the chance of interference between the devices during telemetry reprogramming.
Postoperative management involved brain stimulator programming sessions with simultaneous cardiological monitoring of pacemaker function and cardiac rhythm. No interference was noted at any time, and proper pacemaker function was maintained throughout the follow-up period. With bilateral STN stimulation, both patients experienced a dramatic improvement in their PD symptoms, including elimination of dyskinesias, reduction of “off” severity, and increase of “on” duration.
With some modifications of implantation strategy, two patients with cardiac pacemakers were successfully treated with bilateral DBS STN therapy for refractory PD. To our knowledge, this is the first report on patients with cardiac pacemakers undergoing brain stimulator implantation.
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Affiliation(s)
- Patrick B Senatus
- Department of Neurological Surgery, Columbia College of Physicians and Surgeons, New York, New York 10032, USA
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Murphy PM, MacSullivan R. Spinal Cord Stimulation for Refractory Angina Pectoris: A Shocking Experience. Neuromodulation 2004; 7:246-8. [DOI: 10.1111/j.1094-7159.2004.04209.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fiek M, Dorwarth U, Durchlaub I, Janko S, Von Bary C, Steinbeck G, Hoffmann E. Application of Radiofrequency Energy in Surgical and Interventional Procedures:. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:293-8. [PMID: 15009852 DOI: 10.1111/j.1540-8159.2004.00430.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
During surgical and interventional procedures, interference may occur between ICDs and electrical cautery or with the application of RF energy. This may lead to the false induction of ICD therapies or could even result in device malfunction, which represents a potential perioperative hazard for the patient. This study analyzed the intraoperative interactions in 45 consecutive ICD patients in reference to different surgical and interventional procedures. A total of 33 surgical operations (general surgery [n = 14], urologic [n = 5], abdominal [n = 10], gynecological [n = 2], thoracic [n = 1], neurosurgical [n = 1]) and 12 interventional therapies (RF catheter ablation [n = 10], endoscopic papillotomy [n = 2]) were performed. The ICD devices were all located in left pectoral position and consisted of 25 single and 20 dual chamber defibrillators. During the procedure, tachyarrhythmia detection (VF 296 +/- 20 ms, VT 376 +/- 49 ms) of the devices was maintained active (monitoring mode), only ICD therapies were inactivated. The indifferent electrode of the electrical cauter/RF generator was placed in standard positions (right/left mid-femoral position [n = 27/8], thoracic spine area [n = 10]). After the procedure, the ICD memory was checked for detections and for changes in the programming. There was no oversensing, reprogramming, or damage of any defibrillator caused by RF energy. Despite the lack of undesired interactions, ICDs should be inactivated preoperatively to assure maximum patient safety. However, should inactivation not be possible, or the achievement uncertain, electromagnetic interference is highly unlikely.
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Affiliation(s)
- Michael Fiek
- Medical Hospital I, University of Munich, Grosshadern, Germany.
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Rao BH, Saksena S. Implantable cardioverter-defibrillators in cardiovascular care: technologic advances and new indications. Curr Opin Crit Care 2003; 9:362-8. [PMID: 14508148 DOI: 10.1097/00075198-200310000-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Present generation implantable cardioverter-defibrillators (ICD) have become a proven primary therapeutic option in management of symptomatic ventricular arrhythmias and are now being increasingly used for primary prevention. The addition of biventricular pacing and atrial defibrillation to these devices has had an impact on the management of several new patient populations. The widespread application of these devices requires precise knowledge of their potential benefits and factors that could adversely affect device function. RECENT FINDINGS ICD therapy has improved the survival of coronary disease patients with left ventricular dysfunction by reducing sudden death rate. In congestive heart failure patients, ICD therapy and biventricular pacing improves heart failure status thus improving overall survival and quality of life. Atrial defibrillation can establish rhythm control in drug refractory atrial fibrillation usually in a "hybrid therapy" prescription. SUMMARY Implantable cardioverter defibrillators have proven to be invaluable in the primary and secondary prevention of sudden cardiac death. Incorporation of new technology in these devices has resulted in expanded indications that improve survival and quality of life of new patient populations.
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Affiliation(s)
- B Hygriv Rao
- Electrophysiology Research Foundation, Warren, New Jersey, USA
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