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Steckner MC, Grainger D, Charles-Edwards G. Transitioning from 0.5 to 0.9 mT: Protecting against inadvertent activation of magnet mode in active implants. Magn Reson Med 2024; 92:2237-2245. [PMID: 38968006 DOI: 10.1002/mrm.30153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 07/07/2024]
Abstract
The "5 gauss line" is a phrase that is likely to be familiar to everyone working with MRI, but what is its significance, how was it defined, and what changes are currently in progress? This review explores the history of 5 gauss (0.5 mT) as a threshold for protecting against inadvertently putting cardiac pacemakers, implantable cardioverter defibrillators, and other active implantable medical devices into a "magnet mode." Additionally, it describes the background to the recent change of this threshold to 9 gauss (0.9 mT) in the International Standard IEC 60601-2-33 edition 4.0 that defines basic safety requirements for MRI. Practical implications of this change and some ongoing and emerging issues are also discussed.
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Affiliation(s)
- Michael C Steckner
- MKS Consulting, Ohio, Beachwood, USA
- IEC SC62B/MT40 IEC 60601-2-33, Geneva, Switzerland
- ISO/TC 150/SC 6/JWG 2 (IEC/SC62B), Geneva, Switzerland
| | - David Grainger
- IEC SC62B/MT40 IEC 60601-2-33, Geneva, Switzerland
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Geoff Charles-Edwards
- IEC SC62B/MT40 IEC 60601-2-33, Geneva, Switzerland
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
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Kewcharoen J, Shah K, Bhardwaj R, Contractor T, Turagam MK, Mandapati R, Lakkireddy D, Garg J. New-generation electronic appliances and cardiac implantable electronic devices: a systematic literature review of mechanisms and in vivo studies. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01777-z. [PMID: 38443707 DOI: 10.1007/s10840-024-01777-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Cardiac implantable electronic device (CIED) functions are susceptible to electromagnetic interference (EMI) from electromagnetic fields (EMF). Data on EMI risks from new-generation electronic appliances (EA) are limited. OBJECTIVE We performed a systematic literature review on the mechanisms of EMI, current evidence, and recently published trials evaluating the effect of EMF on CIEDs from electric vehicles (EV), smartphone, and smartwatch technology and summarize its safety data. METHODS Electronic databases, including PubMed and EMBASE, were searched for in vivo studies evaluating EMF strength and incidence between CIEDs and commercial EVs, new-generation smartphones, and new-generation smartwatches. RESULTS A total of ten studies (three on EVs, five on smartphones, one on smartphones, one on smartphones and smartwatches) were included in our systematic review. There was no report of EMI incidence associated with EVs or smartwatches. Magnet-containing smartphones (iPhone 12) can cause EMI when placed directly over CIEDs - thereby triggering the magnet mode; otherwise, no report of EMI was observed with other positions or smartphone models. CONCLUSION Current evidence suggests CIED recipients are safe from general interaction with EVs/HEVs, smartphones, and smartwatches. Strictly, results may only be applied to commercial brands or models tested in the published studies. There is limited data on EMI risk from EVs wireless charging and smartphones with MagSafe technology.
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Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Kuldeep Shah
- Division of Cardiology, Cardiac Arrhythmia Service, MercyOne Siouxland Heart and Vascular Center, Sioux City, IA, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | | | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA.
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Poorsattar SP, Kumar N, Jelly CA, Bodmer NJ, Tang JE, Lefevre R, Essandoh MK, Dalia A, Vanneman MW, Bardia A. The Year in Electrophysiology: Selected Highlights From 2022. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00194-5. [PMID: 37080842 DOI: 10.1053/j.jvca.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/22/2023]
Abstract
This special article is the fifth in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors would like to thank the Editor-in-Chief, Dr Kaplan, the Associate Editor-in-Chief, Dr Augoustides, and the editorial board for the opportunity to author this series, which summarizes the key research papers in the electrophysiology (EP) field relevant to cardiothoracic and vascular anesthesiologists. These articles are shaping perioperative EP procedures and practices, such as pulsed-field ablation, cryoablation for first-line treatment for atrial fibrillation, advancements in conduction system pacing, safety issues related to smartphones and cardiac implantable electronic devices, and alterations in EP workflow as the world emerges from the COVID-19 pandemic. Special emphasis is placed on the implications of these advancements for the anesthetic care of patients undergoing EP procedures.
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Affiliation(s)
- Sophia P Poorsattar
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Nicolas Kumar
- Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christina A Jelly
- Department of Anesthesiology,Vanderbilt University Medical Center, Nashville, TN
| | - Natalie J Bodmer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jonathan E Tang
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Ryan Lefevre
- Department of Anesthesiology,Vanderbilt University Medical Center, Nashville, TN
| | - Michael K Essandoh
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Adam Dalia
- Division of Cardiac Anesthesiology, Department of Critical Care, Anesthesia, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Matthew W Vanneman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Amit Bardia
- Division of Cardiac Anesthesiology, Department of Critical Care, Anesthesia, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Kewcharoen J, Shah K, Bhardwaj R, Contractor T, Turagam MK, Mandapati R, Lakkireddy D, Garg J. Electromagnetic Field-Induced Interactions Among Electric Vehicles, New-Generation Electronic Devices, and Cardiovascular Implantable Electronic Devices. JACC Clin Electrophysiol 2023; 9:257-259. [PMID: 36858694 DOI: 10.1016/j.jacep.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 01/20/2023]
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Richman T, Stanton T, Fryer M, Dayananda N, Tung M. Evaluating the magnet response in deep subcutaneous implanted cardioverter defibrillator implants. Pacing Clin Electrophysiol 2023; 46:93-99. [PMID: 36269082 DOI: 10.1111/pace.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The manufacturer of subcutaneous implantable cardioverter defibrillators (S-ICDs) acknowledges that 'deep implants' may fail to elicit a magnet response, however, does not define 'deep implant' or recommend a maximum implant depth. This study aims to systematically evaluate the effect of subcutaneous tissue depth and magnet types on evoked magnet response. METHODS Sunshine Coast University Hospital's S-ICD cohort underwent magnet response evaluation; where bar and donut magnets were compared and the evoked magnet response was recorded in three separate zones, guided by a template. Ordinal regression (OR) models assessed the relationship between the evoked magnet response and tissue depth (TD), measured via post-implant X-Ray. The patient's ability to hear the magnet response audible tone was recorded. RESULTS Patients (n = 39) with measurable TD (n = 30) were analyzed. The bar magnet evoked a magnet response in all zones in 53% of patients, compared with 73% of patients with the donut magnet (p = 0.18). The relationship between bar magnet response and TD showed the odds of an evoked magnet response decreased by 11% every 1 mm increase in TD (OR of 0.89, p < 0.01), whereas the donut magnet decreased by 16% per 1 mm (OR of 0.84, p < 0.01). Directly over the S-ICD was the most effective in evoking magnet response with the bar (85% of patients), and off-centre was most effective for the donut magnet (100%). BMI and Praetorian score were not significantly associated with magnet response. We found 23% of patients were unable to detect the audible tone. CONCLUSION We observed a statistically significant association between TD and ability to evoke magnet response. The bar magnet was less reliable than the donut magnet for therapy inhibition in deep implants.
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Affiliation(s)
| | - Tony Stanton
- Sunshine Coast University Hospital, Birtinya, Australia.,University of the Sunshine Coast, Sippy Downs, Australia
| | - Michael Fryer
- Sunshine Coast University Hospital, Birtinya, Australia
| | | | - Matthew Tung
- Sunshine Coast University Hospital, Birtinya, Australia.,School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
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Saha N, Millward JM, Herrmann CJJ, Rahimi F, Han H, Lacour P, Blaschke F, Niendorf T. High-Fidelity 3D Stray Magnetic Field Mapping of Smartphones to Address Safety Considerations with Active Implantable Electronic Medical Devices. SENSORS (BASEL, SWITZERLAND) 2023; 23:1209. [PMID: 36772249 PMCID: PMC9919430 DOI: 10.3390/s23031209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/07/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Case reports indicate that magnets in smartphones could be a source of electromagnetic interference (EMI) for active implantable medical devices (AIMD), which could lead to device malfunction, compromising patient safety. Recognizing this challenge, we implemented a high-fidelity 3D magnetic field mapping (spatial resolution 1 mm) setup using a three-axis Hall probe and teslameter, controlled by a robot (COSI Measure). With this setup, we examined the stray magnetic field of an iPhone 13 Pro, iPhone 12, and MagSafe charger to identify sources of magnetic fields for the accurate risk assessment of potential interferences with AIMDs. Our measurements revealed that the stray fields of the annular array of magnets, the wide-angle camera, and the speaker of the smartphones exceeded the 1 mT limit defined by ISO 14117:2019. Our data-driven safety recommendation is that an iPhone 13 Pro should be kept at least 25 mm away from an AIMD to protect it from unwanted EMI interactions. Our study addresses safety concerns due to potential device-device interactions between smartphones and AIMDs and will help to define data-driven safety guidelines. We encourage vendors of electronic consumer products (ECP) to provide information on the magnetic fields of their products and advocate for the inclusion of smartphones in the risk assessment of EMI with AIMDs.
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Affiliation(s)
- Nandita Saha
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
- Experimental and Clinical Research Center (ECRC), A Joint Cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Jason M. Millward
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
- Experimental and Clinical Research Center (ECRC), A Joint Cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Carl J. J. Herrmann
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
- Department of Physics, Humboldt University of Berlin, 10117 Berlin, Germany
| | - Faezeh Rahimi
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
- Chair of Medical Engineering, Technische Universität Berlin, 10623 Berlin, Germany
| | - Haopeng Han
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
| | - Philipp Lacour
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353 Berlin, Germany
| | - Florian Blaschke
- Department of Cardiology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353 Berlin, Germany
| | - Thoralf Niendorf
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
- Experimental and Clinical Research Center (ECRC), A Joint Cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
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Magnetic field interactions of smartwatches and portable electronic devices with CIEDs – Did we open a Pandora’s box? IJC HEART & VASCULATURE 2022; 43:101122. [PMID: 36111261 PMCID: PMC9467892 DOI: 10.1016/j.ijcha.2022.101122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 12/02/2022]
Abstract
Introduction Magnetic interaction of portable electronic devices (PEDs), such as state-of-the art mobile phones, with cardiovascular implantable electronic devices (CIEDs) has been reported. The aim of the study was to quantify the magnetic fields of latest generation smartwatches and other PEDs and to evaluate and predict their risk of CIED interactions. Methods High resolution magnetic field characterization of five smartwatches (Apple Watch 6/7, Fitbit Sense, Samsung Galaxy 3, Withings Scanwatch) was performed using a novel magnetic field camera. Ex vivo measurements of the minimal safety distance (MSD) at which no mode switch can be observed were performed between 11 PEDs and six representative CIEDs. Results Maximal 1 mT distances ranged between 10 mm (Withings) and 19 mm (Fitbit and AppleWatch), and 1 mT volumes between 6 cm3 (Withings) and 19 cm3 (Fitbit). All these measures were observed only for the back side of the smartwatches. While most smartwatches with measured 1 mT distance < 15 mm posed low ex vivo interaction within a distance of < 10 mm, PEDs such as electronic pens and in-ear-headphones with measured 1 mT distance > 15 mm showed device interaction up to > 15 mm. Linear regression analysis showed a linear relationship of the MSD with 1 mT distance (B coefficient: 0.46; 95 %-CI: 0.25–0.67, p < 0.001). Conclusion Smartwatches are safer compared to other PEDs such as electronic pens or in-ear headphones with regards to CIED interaction. With a standardized magnetic field camera, the risk assessment of CIED interaction of novel PEDs is feasible.
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Magnetic interactions between CIEDs and consumer devices: a little distance goes a long way. J Interv Card Electrophysiol 2022; 65:261-262. [PMID: 35705733 DOI: 10.1007/s10840-022-01280-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 10/18/2022]
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Babic MD, Tomovic M, Milosevic M, Djurdjevic B, Zugic V, Nikolic A. Inappropriate shock delivery as a result of electromagnetic interference originating from the faulty electrical installation. Ann Noninvasive Electrocardiol 2022; 27:e12952. [PMID: 35467789 PMCID: PMC9484028 DOI: 10.1111/anec.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022] Open
Abstract
We present a case report of a 74‐year‐old male patient with an implantable cardioverter defibrillator who suffered an inappropriate defibrillation shock while bathing in the tub. Insight in the ICD stored electrogram episodes revealed electromagnetic interferences, with a typical 50 Hz electrical artifact mimicking fast ventricular tachycardia as a device misinterpreted. After this event, the maintenance workers investigated the electrical installation in the bathroom and revealed that there was voltage leaking between electrical installation and metal pipes. After the repair was completed without any additional programming, the patient has had no subsequent shocks.
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Affiliation(s)
- Milos D Babic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Milosav Tomovic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Maja Milosevic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | | | - Vasko Zugic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Aleksandra Nikolic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,School Of Medicine, University of Belgrade, Belgrade, Serbia
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