Unipolar cardiac pacemakers in electromagnetic fields of high voltage overhead lines

Cardiac pacemakers in magnetic fields of a shunt reactor at a 400 kV substation

The use of cardiac pacemakers (PMs) increases in Western countries. The aim of the study is to investigate cardiac pacemakers (PMs) using a human-shaped phantom in magnetic fields of a shunt reactor at a 400 kV substation. We performed seven PM experiments using a phantom. Two locations close to the shunt reactors were chosen. The magnetic field exposure was over 1000 µT in one location and over 600 µT in the other one. The magnetic field exposure did not disturb the tested five different PMs (in unipolar or bipolar configurations). It can be stated that in our experiment, the magnetic field exposure (over 600 µT and over 1000 µT) did not disturb the PMs (in unipolar or bipolar configurations). Since we only studied some PMs, it is possible that the magnetic field exposure at 400 kV substations can cause disturbances to other PMs. However, the risk of disturbances does not seem to be high.

Electromagnetic interference with implantable cardioverter-defibrillators at power frequency: an in vivo study

BACKGROUND

The number of implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death is continuing to increase. Given the technological complexity of ICDs, it is of critical importance to identify and control possible harmful electromagnetic interferences between various sources of electromagnetic fields and ICDs in daily life and occupational environments.

METHODS AND RESULTS

Interference thresholds of 110 ICD patients (1-, 2-, and 3-chamber ICDs) were evaluated in a specifically developed test site. Patients were exposed to single and combined electric and magnetic 50-Hz fields with strengths of up to 30 kV·m⁻¹ and 2.55 mT. Tests were conducted considering worst-case conditions, including maximum sensitivity of the device or full inspiration. With devices being programmed to nominal sensitivity, ICDs remained unaffected in 91 patients (83%). Five of 110 devices (5%) showed transient loss of accurate right ventricular sensing, whereas 14 of 31 (45%) of the 2- and 3-chamber devices displayed impaired right atrial sensing. No interference was detected in 71 patients (65%) within the tested limits with programming to maximum sensitivity, whereas 20 of 110 subjects (18%) exhibited right ventricular disturbances and 19 of 31 (61%) subjects exhibited right atrial disturbances.

CONCLUSIONS

Extremely low-frequency daily-life electromagnetic fields do not disturb sensing capabilities of ICDs. However, strong 50-Hz electromagnetic fields, present in certain occupational environments, may cause inappropriate sensing, potentially leading to false detection of atrial/ventricular arrhythmic events. When the right atrial/right ventricular interferences are compared, the atrial lead is more susceptible to electromagnetic fields.

CLINICAL TRIAL REGISTRATION URL

http://clinicaltrials.gov/ct2/show/NCT01626261. Unique identifier: NCT01626261.

Cardiac pacemakers in electric and magnetic fields of 400-kV power lines

BACKGROUND

The cardiac pacemaker (PM) implantation rate per million is high. Earlier studies have found interference to PMs by electromagnetic fields. The aim of the study is to investigate disturbances in cardiac PM using a human-shaped phantom in electric and magnetic fields of 400-kV power lines.

METHODS

The phantom was used in the following manner: isolated from the ground, grounded from left or right foot, or grounded from left or right hand.

RESULTS

Out of the tested PMs one had such a disturbance that it set the pace 60 times per minute, when the electric field was 6.7-7.5 kV/m and the magnetic field was 2.4-2.9 μT. The electrode configuration of the PM was unipolar. In bipolar configuration, the same PM had no disturbance. During the test period, other PMs only had minor disturbances or none at all. Some PMs do not record time information for minor disturbances. In such cases, it was impossible to link the disturbances to the exposure under the power line.

CONCLUSIONS

The electric field under a 400-kV power line may disturb a PM. However, only one type out of several tested PMs showed a major disturbance and that was only with a unipolar electrode configuration. The risk of disturbances is therefore not deemed to be high.

Experimental study on malfunction of pacemakers due to exposure to different external magnetic fields

PURPOSE

Cardiac pacemaker malfunction due to exposure to magnetic fields may cause serious problems in some work environments for workers having cardiac pacemakers. The aim of this study was to find the magnetic field interference thresholds for several commonly used pacemaker models.

METHODS

We investigated 16 pacemakers from three different manufacturers with the frequency range of 2 to 1,000 Hz, using sinusoidal, pulse, ramp, and square waveforms. The magnetic fields were produced by a computer-controlled Helmholtz coil system.

RESULTS

Pacemaker malfunction occurred in six of 16 pacemakers. Interaction developed almost immediately after high-intensity magnetic field exposure started. With each waveform, at least two pacemakers exhibited interference. In most exposure settings, there was no interference at magnetic field levels below the international occupational safety limits. Nevertheless, some frequencies using ramp or square waveforms interfered with pacemakers even at levels below public exposure limits. The occurrence of interference depended greatly on the waveform, frequency, magnetic field intensity, and the sensing configuration of the pacemaker. Unipolar configurations were more susceptible for interference than the bipolar ones. In addition, magnetic fields perpendicular to the pacemaker loops were more likely to cause interference than parallel fields.

CONCLUSION

There is a need for further investigations on pacemaker interference caused by different external magnetic fields to ensure safe working environment to workers with a pacemaker.

Experimental and theoretical investigation of implantable cardiac pacemaker exposed to low frequency magnetic field

This paper presents in vitro investigation of an implantable cardiac pacemaker exposed to low frequency magnetic fields. The method used in this study is based on the interaction by inductive coupling through the loop formed by the pacemaker and its loads and the surrounding medium. This interaction results in an induced electromotive force between the terminals of the pacemaker, which can potentially disturb its operation. The studied frequencies are 50/60 Hz and 10/25 kHz. The experimental tests were carried out on several cardiac pacemakers, single chamber, and dual chamber. The results show a window effect of the detection circuits of cardiac pacemakers for the four studied frequencies. The modelling of the test bed requires studying the effects of the induced currents generated by the application of a magnetic field. Analytical calculations and Numerical simulations were carried out. We modelled the interactions of the magnetic field with a simplified representation of pacemaker embedded in the medium. The comparison of the results in the air and in vitro enabled us to make an equivalent electric model. The results obtained in experimental and theoretical studies allowed us to validate the test bed. The method applied is valid for other medical implants such as cardiac defibrillators, implant hearing aids system...etc.

In vitro investigation of eddy current effect on pacemaker operation generated by low frequency magnetic field

This paper presents in vitro investigation of the eddy current induction effects to the cardiac pacemaker exposed to low frequency magnetic fields. The method used in this study is based to the interaction by inductive coupling through the loop formed by the pacemaker and its leads and the surrounding medium. This interaction results in an induced electromotive force between the terminals of the pacemaker which can potentially disturb the operation of this last. In this article we present experimental results, analytical calculations and numerical simulations using the finite element method.

The behavior of dual-chamber pacemakers exposed to a conducted low-frequency disruptive signal

This paper presents a study of the behavior of dual-chamber cardiac pacemakers submitted to low-frequency conducted disruptions. The disruptive signal is sinusoidal, operating at 50 Hz, 60 Hz, 10 kHz and 25 kHz. The behavior of the pacemakers is described by statistical data obtained with a telemetry system and by visualization of the pacemaker signal during the application of the interfering signal. The pacemakers were tested in two configurations. The first one consists of direct application of the interfering signal between the pacemaker terminals. In the second, these attempts are completed by in vitro tests using an electromagnetic model which allow us to take into account the interface which constitutes the human body. The pacemaker under test is inserted into a gelatine phantom mimicking the electrical conductivity of tissues. This study allowed us to define the pacemaker detection thresholds for the two test configurations. For the in vitro approach, which constitutes a complementary approach to a realistic implantation situation, oversensing is noticed for 10 kHz and 25 kHz interfering signal frequencies. Detection thresholds vary from a few tens to a few hundreds of mV, depending on the interfering signal frequency, the device and its programmed detection sensitivities.