The effects of mobile phones on pacemaker function

New-generation electronic appliances and cardiac implantable electronic devices: a systematic literature review of mechanisms and in vivo studies

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.

How Do Patients Understand Safety for Cardiac Implantable Devices? Importance of Postintervention Education

Aim

This study was designed to assess the effect of patient education on the knowledge of safety and awareness about living with cardiac implantable electronic devices (CIEDs) within the context of phase I cardiac rehabilitation.

Methods

The study was conducted with 28 newly implanted CIED patients who were included in “education group (EG)”. Patients were questioned with a survey about living with CIEDs and electromagnetic interference (EMI) before and 1 month after an extensive constructed interview. Ninety-three patients who had been living with CIEDs were included in the “without education group (woEG)”.

Results

Patients in EG had improved awareness on topics related to physical and daily life activities including work, driving, sports and sexual activities, EMI of household items, harmful equipment, and some of the medical devices in the hospital setting (p<0.05). Patients in EG gave significantly different percent of correct answers for doing exercise or sports, using the arm on the side of CIEDs, EMI of some of the household appliances, medical devices, and all of the harmful equipment compared to woEG (p<0.05).

Conclusion

It was demonstrated that a constructed education interview on safety of CIEDs and living with these devices within the context of phase I cardiac rehabilitation is important for improving the awareness of patients significantly. Thus, patients might achieve a faster adaptation to daily life and decrease disinformation and misperceptions and thus promote the quality of life after the device implantation.

Can active signals of cellphone interfere with electronic working length determination of a root canal in a dental clinic? An in vivo study

Objective:

To evaluate the interference of active cellphones during electronic working length (EWL) determination of a root canal.

Materials and Methods:

Thirty patients requiring root canal treatment in the anterior teeth or premolars having single canal and mature apices were selected for this study. Working length determination was done using no. 15 K-file. Electronic apex locators ProPex Pixi and Root ZX mini were used for working length determination. Cellphones iPhone 6s and Xolo Q3000 were evaluated for their interference. The experiment was conducted in a closed room (9 feet × 9 feet). Working length was measured with no cellphone in the room, iPhone 6s in a calling mode, Xolo Q3000 in a calling mode, and Xolo Q3000 and iPhone 6s simultaneously in a calling mode. Stability of the readings was also determined for every condition.

Statistical Analysis:

The data were statistically analyzed using one-way ANOVA and paired t-test at 0.05 level of significance.

Results:

Results were not statistically significant.

Conclusion:

Within the limitations of the present study, cellphones do not interfere with the EWL determination.

Clinical management of electromagnetic interferences in patients with pacemakers and implantable cardioverter-defibrillators: review of the literature and focus on magnetic resonance conditional devices

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.

Evaluation of Interference of Cellular Phones on Electronic Apex Locators: An In Vitro Study

INTRODUCTION

Use of mobile phone has been prohibited in many hospitals to prevent interference with medical devices. Electromagnetic radiation emitted from cellular phones might interfere with electronic working length determination. The purpose of this in vitro study was to evaluate the effect of a smart phone (Samsung Galaxy Note Edge) on working length determination of electronic apex locators (EALs) Propex II and Rootor.

METHODS

Fifteen intact, non-carious single-rooted teeth were decoronated at the cementoenamel junction. Visually, working length was determined by using a #15 K-file under stereomicroscope (×20). The effect of cellular phones on electronic working length (EWL) was determined under 2 experimental settings: (1) in a closed room with poor signal strength and (2) in a polyclinic set up with good signal strength and 5 conditions: (1) electronically, without cellular phone in room; (2) electronically, with cellular phone in physical contact with EAL; (3) electronically, with mobile phone in physical contact with EAL and in calling mode for a period of 25 seconds; (4) electronically, mobile phone placed at a distance of 40 cm from the EAL; and (5) electronically, mobile phone placed at a distance of 40 cm and in calling mode for a period of 25 seconds. The EWL was measured 3 times per tooth under each condition. Stability of the readings was scored from 1 to 3: (1) good stability, (2) stable reading after 1 attempt, and (3) stable reading after 2 attempts. The data were compared by using analysis of variance.

RESULTS

The EWL measurements were not influenced by the presence of cellular phone and could be determined under all experimental conditions.

CONCLUSIONS

Within the limitations of this study, it can be concluded that mobile phones do not interfere with the EWL determination.

Electromagnetic immunity of implantable pacemakers exposed to wi-fi devices

The purpose of this study is to evaluate the potential for electromagnetic interference (EMI) and to assess the immunity level of implantable pacemakers (PM) when exposed to the radiofrequency (RF) field generated by Wi-Fi devices. Ten PM from five manufacturers, representative of what today is implanted in patients, have been tested in vitro and exposed to the signal generated by a Wi-Fi transmitter. An exposure setup that reproduces the actual IEEE 802.11b/g protocol has been designed and used during the tests. The system is able to amplify the Wi-Fi signal and transmits at power levels higher than those allowed by current international regulation. Such approach allows one to obtain, in case of no EMI, a safety margin for PM exposed to Wi-Fi signals, which otherwise cannot be derived if using commercial Wi-Fi equipment. The results of this study mitigate concerns about using Wi-Fi devices close to PM: none of the PM tested exhibit any degradation of their performance, even when exposed to RF field levels five times higher than those allowed by current international regulation (20 W EIRP). In conclusion, Wi-Fi devices do not pose risks of EMI to implantable PM. The immunity level of modern PM is much higher than the transmitting power of RF devices operating at 2.4 GHz.

Effects of external electrical and magnetic fields on pacemakers and defibrillators: from engineering principles to clinical practice

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.

The electromagnetic interference of mobile phones on the function of a γ-camera

PURPOSE

The aim of the present study is to evaluate whether or not the electromagnetic field generated by mobile phones interferes with the function of a SPECT γ-camera during data acquisition.

METHODS

We tested the effects of 7 models of mobile phones on 1 SPECT γ-camera. The mobile phones were tested when making a call, in ringing mode, and in standby mode. The γ-camera function was assessed during data acquisition from a planar source and a point source of Tc with activities of 10 mCi and 3 mCi, respectively. A significant visual decrease in count number was considered to be electromagnetic interference (EMI).

RESULTS

The percentage of induced EMI with the γ-camera per mobile phone was in the range of 0% to 100%. The incidence of EMI was mainly observed in the first seconds of ringing and then mitigated in the following frames.

CONCLUSIONS

Mobile phones are portable sources of electromagnetic radiation, and there is interference potential with the function of SPECT γ-cameras leading to adverse effects on the quality of the acquired images.

Testing of common electromagnetic environments for risk of interference with cardiac pacemaker function

Background

Cardiac pacemakers are known to be susceptible to strong electromagnetic fields (EMFs). This in vivo study investigated occurrence of electromagnetic interference with pacemakers caused by common environmental sources of EMFs.

Methods

Eleven volunteers with a pacemaker were exposed to EMFs produced by two mobile phone base stations, an electrically powered commuter train, and an overhead high voltage transmission lines. All the pacemakers were programmed in normal clinically selected settings with bipolar sensing and pacing configurations.

Results

None of the pacemakers experienced interference in any of these exposure situations. However, often it is not clear whether or not strong EMFs exist in various work environments, and hence an individual risk assessment is needed.

Conclusions

Modern pacemakers are well shielded against external EMFs, and workers with a pacemaker can most often return to their previous work after having a pacemaker implanted. However, an appropriate risk assessment is still necessary after the implantation of a pacemaker, a change of its generator, or major modification of its programming settings.

An update on mobile phones interference with medical devices

Mobile phones' electromagnetic interference with medical devices is an important issue for the medical safety of patients who are using life-supporting medical devices. This review mainly focuses on mobile phones' interference with implanted medical devices and with medical equipment located in critical areas of hospitals. A close look at the findings reveals that mobile phones may adversely affect the functioning of medical devices, and the specific effect and the degree of interference depend on the applied technology and the separation distance. According to the studies' findings and the authors' recommendations, besides mitigating interference, using mobile phones at a reasonable distance from medical devices and developing technology standards can lead to their effective use in hospital communication systems.

Safety of capsule endoscopy using human body communication in patients with cardiac devices

BACKGROUND

The MiroCam (IntroMedic, Ltd., Seoul, Korea) is a small-bowel capsule endoscope that uses human body communication to transmit data. The potential interactions between cardiac devices and the capsule endoscope are causes for concern, but no data are available for this matter.

AIM

This clinical study was designed to evaluate the potential influence of the MiroCam capsules on cardiac devices.

METHODS

Patients with cardiac pacemakers or implantable cardiac defibrillators referred for evaluation of small bowel disease were prospectively enrolled in this study. Before capsule endoscopy, a cardiologist checked baseline electrocardiograms and functions of the cardiac devices. Cardiac rhythms were continuously monitored by 24-h telemetry during capsule endoscopy in the hospital. After completion of procedures, functions of the cardiac devices were checked again for interference. Images from the capsule endoscopy were reviewed and analyzed for technical problems.

RESULTS

Six patients, three with pacemakers and three with implantable cardiac defibrillators, were included in the study. We identified no disturbances in the cardiac devices and no arrhythmias detected on telemetry monitoring during capsule endoscopy. No significant changes in the programmed parameters of the cardiac devices were noted after capsule endoscopy. There were no imaging disturbances from the cardiac devices on capsule endoscopy.

CONCLUSIONS

Capsule endoscopy using human body communication to transmit data was safely performed in patients with cardiac pacemakers or implantable cardiac defibrillators. Images from the capsule endoscopy were not affected by cardiac devices. A further large-scale study is required to confirm the safety of capsule endoscopy with various types of cardiac devices.

Electromagnetic interference and implanted cardiac devices: the nonmedical environment (part I)

The number of patients with cardiovascular implantable electronic devices (CIEDs), such as permanent pacemakers and implantable cardioverter-defibrillators, is dramatically rising due to an aging population and recent clinical trials showing benefits in mortality and morbidity. Coupled with this increase in the number of patients with CIEDs is the proliferation of technology that emits electromagnetic signals, which can potentially interfere with CIED function through electromagnetic interference (EMI). Despite continuous efforts of manufacturers to create "EMI-proof" CIEDs, adverse events from EMI still occur. Physicians caring for patients with CIEDs should be aware of potential sources of EMI and appropriate management options. This 2-part review aims to provide a contemporary overview of the current knowledge regarding risks attributable to EMI interactions from the most common nonmedical (Part I) and medical (Part II) sources.

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.

Shortcomings and challenges of information system adoption

The number of institutions implementing AIMS is increasing. Shortcomings in the design and implementation of EMRs have been associated with unanticipated consequences, including changes in workflow. These have often resulted from the carryover of paper-based documentation practices into an electronic environment. The new generation of mobile devices allows providers to have situational awareness of multiple care sites simultaneously, possibly allowing for improved proactive decision making. Although potentially facilitating safer anesthetic supervision, technologic and cultural barriers remain. Security, quality of information delivery, regulatory issues, and return on investment will continue as challenges in implementing and maintaining this new technology.

Effects of electromagnetic interference on implanted cardiac devices and their management

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.

Demodulation in tissue, the relevant parameters and the implications for limiting exposure

In the biomedical literature there are a number of reports that speculate about possible effects in the body due to the demodulation of electromagnetic fields. However, only few interactions in amplitude-modulated or even pulse-modulated electromagnetic waves are fundamentally plausible and have been demonstrated to occur in humans. The following observations fall into this specific category: thermal effects of amplitude- or pulse-modulated microwaves; demodulation of amplitude- or pulse-modulated electromagnetic waves in cell membranes; and demodulation of amplitude- or pulse-modulated electromagnetic fields in the electronics of implants such as cardiac pacemakers or cardioverter defibrillators. The possible consequences of these effects for the organism, their probability of occurrence in everyday life field conditions, and, consequently, the implications for limiting exposure are very different. Microwave hearing is a harmless effect which is perceived by humans only in strong fields with high peak power densities of more than 100 mW cm(-2). In normal residential or occupational environments the peak power density of even the strongest microwave sources is only around 1 mW cm(-2). Demodulation of pulse-modulated electromagnetic fields in the cell membranes decreases the stimulation threshold of nerves and muscles and can introduce numerous adverse effects ranging from perception of pain to dangerous cardiac fibrillations. The stimulation and demodulation effects are restricted to carrier frequencies up to several MHz. In experiments with 900 and 1,800 MHz packets with lengths of up to 100 ms and applied powers of up to 100 W, neither a direct stimulation of superficial nerves and muscles nor the conditioning of an electrical current stimulus could be confirmed. Pulse-modulated electromagnetic waves are demodulated in the electronic circuits of implants and can inhibit cardiac pacemakers and introduce cardiac arrest in this way. The highest sensitivity results from repetition rates of pulses below 100 Hz. The preceding two implications should be considered in the elaboration of new general guidelines limiting the exposure for healthy as well as for sick persons in the future.

Risk of cellular phone interference with an implantable loop recorder

This study examined the risk of cellular phone ringing interference with implantable loop recorders (ILR). The technical manual of ILR warns of potential interference by cellular phone in close proximity to the implanted device, corrupting the data stored in memory or causing inappropriate device operation. The ringing phase of a digital Global System for Mobile Communication (GSM) or Personal Communication Services (PCS) cellular phone includes a brief burst of peak emitted power. To obviate the risk of dysfunction in recipients of implanted ILRs, the testing was performed with externally applied devices. The ILR was positioned in the left parasternal region and the telemetry wand removed after regular programming. Digital cellular telephones were placed over the device at a 1-cm distance and calls were placed. The phone systems tested were single- or dual-band receivers. The GSM used a maximal power output of 2 W, operating on a 900 MHz carrier frequency, and the PCS a maximal output of 1 W, operating on a 1800 MHz carrier frequency. The device activator was used to store the episodes encompassing the tests. Sixty nine tests were performed in 45 patients. In 61 tests, high-frequency polymorphic artifacts were visible on manually activated recordings, beginning a few seconds before the first audible ringing tone and persisting throughout the ringing phase. Cellular phone ringing in close proximity to an externally applied ILR caused bursts of high-frequency signals during electrocardiogram monitoring, without causing permanent device dysfunction or reprogramming. Cellular telephones are a potential source of electrocardiographic artifacts on ILR recordings.