Evaluating the effects of different dental devices on implantable cardioverter defibrillators

Implantable Electronic Cardiovascular Device Complications Related to Electrocautery During Ophthalmology Surgery: A Systematic Review

PURPOSE

Implantable electronic cardiovascular device such as cardiac pacemakers and implantable defibrillators are common life-saving devices. Device-related complications can arise when undergoing surgical interventions with electrosurgical tools due to electromagnetic interference, based on electrocautery type, implantable electronic cardiovascular device type, electrocautery location, and a number of other factors. The risk of device-related complications due to electrocautery in oculoplastic surgery has not been established. This systematic literature review assesses prevalence, risk factors, and outcomes of electrocautery-related device complications in oculoplastic surgery.

METHODS

Systematic literature review followed Preferred Reporting Items for Systematic and Meta-Analysis guidelines and used the search terms "pacemaker," "implantable cardioverter defibrillator," "electrocautery," "cautery," and "electrosurgery" through June 2022. Inclusion criteria were full-text articles, discussing ocular, oculoplastic, or other facial surgery. Exclusion criteria were non-English language or surgery focused on other parts of the body. Full-text manuscripts of identified articles were reviewed and relevant data were extracted.

RESULTS

Twelve studies met inclusion criteria. Two studies were level I and II evidence, while 10 studies were level III or IV. There were no reports of electromagnetic interference with bipolar cautery use. With monopolar cautery use, cases of electromagnetic interference were reported, but without related significant morbidity or mortality. Safety recommendations to minimize electrical flow through the implantable electronic cardiovascular device are described.

CONCLUSIONS

There were no reports of implantable electronic cardiovascular device-related complications from bipolar or thermocautery use in ophthalmic or oculoplastic surgeries. Monopolar have been associated with electromagnetic interference, but additional preoperative and perioperative measures can be taken to mitigate this risk.

Electromagnetic interference effect of dental equipment on cardiac implantable electrical devices: A systematic review

BACKGROUND

The electromagnet interference (EMI) effect resulting from using dental equipment near cardiovascular implantable electronic devices (CIEDs) is controversial based on in vitro and in vivo studies. We aimed to summarize the available evidence to investigate the safety of using dental equipment on patients with CIEDs.

METHODS

An electronic search was performed in PubMed, Embase, MEDLINE Ovid, and the Cochrane Library for relevant studies published between January 2000 and May 2020. The search strategy centered on terms related to dental devices and CIEDs. Two independent reviewers determined the final inclusion of the studies in the systematic review. The EMI effect was summarized based on different dental instruments detected in in vitro or in vivo studies.

RESULTS

The primary search identified 84 articles, and 18 studies were finally included in this systematic review after exclusions. Most in vitro studies (n = 12) reported background noise or severe EMI affecting CIED function at a close distance from the lead tip or at a high sensitivity setting of CIEDs. In in vivo studies (n = 6), EMI that altered CIED function was not detected at clinical distance and sensitivity settings. The summary, based on electronic apex locators, ultrasonic devices, and electric pulp testers, demonstrated the compatibility of these common dental devices with CIEDs.

CONCLUSIONS

This systematic review indicates that most dental instruments can be used safely in routine dental practice. The EMI effect of dental equipment depends on the exposure distance and lead-related parameters of the CIEDs.

Influence and safety of electronic apex locators in patients with cardiovascular implantable electronic devices: a systematic review

The widespread use of cardiovascular implantable electronic devices has increased concerns regarding using electronic apex locators in patients with these devices. This systematic review investigated the effects and safety of using electronic apex locators in patients with cardiovascular implantable electronic devices.

METHODS

An electronic search in the Cochrane Library, PubMed (MEDLINE), ScienceDirect, and Scientific Electronic Library Online (Scielo) databases for relevant articles published between December 2000 and December 2018 was performed. The search strategy centered on terms related to electronic apex locators use during root canal treatment in patients with cardiovascular implantable electronic devices.

RESULTS

Seven studies (five in vitro and two in vivo) fulfilled the inclusion criteria for this review. It was found that electronic apex locators can be used safely in patients with cardiovascular implantable electronic devices, when general precautions are followed.

CONCLUSIONS

Although the present review suggests that electronic apex locators can be used safely in patients with implantable cardioverter defibrillators, consultation with patients' cardiologists remains advisable.

Electromagnetic interference of dental equipment with implantable cardioverter defibrillators

OBJECTIVE

Implantable cardioverter defibrillators (ICDs) are subject to electromagnetic interference (EMI). The aim of this study was to assess both the EMI of dental equipments with ICDs and related factors.

MATERIALS AND METHODS

High- and low-speed handpieces, an electric toothbrush, an implant motor and two types of ultrasonic devices were tested next to an ICD with different sensitivity settings. The ICD was immersed in a saline solution with electrical resistance of 400-800 ohms to simulate the resistance of the human body. The dental equipments were tested in both horizontal (0°) and vertical (90°) positions in relation to the components of the ICD. The tests were performed with a container containing saline solution, which was placed on a dental chair in order to assess the cumulative effect of electromagnetic fields.

RESULTS

The dental chair, high- and low-speed handpieces, electric toothbrush, implant motor and ultrasonic devices caused no EMI with the ICD, irrespective of the program set-up or positioning. No cumulative effect of electromagnetic fields was verified.

CONCLUSIONS

The results of this study suggest that the devices tested are safe for use in patients with an ICD.

Safety concerns of Piezoelectric Units in Implantable Cardioverter Defibrillator

PURPOSE

Evidence-based research appears to conflict on the potential risk of electromagnetic interference (EMI) between piezoelectric units (Pzs) and implantable cardioverters and defibrillators (ICDs). The purpose of this study was to observe whether the EMI produced by Pzs is hazardous for ICDs.

MATERIALS AND METHODS

A cross-sectional study of 6 Pzs was conducted in vitro for EMI using an ICD system. To simulate the human body's electrical resistance, electrographic recordings were made of the ICD and lead that were immersed in a bath of saline solution. The variables investigated were the presence of EMI, the distance between the ICD and the Pz, and signal intensity, damage, and type of damage to the ICD and lead. Each series of tests was repeated 3 times, beginning with a 15-second baseline recording (control), until all recording conditions had been covered. Each Pz was recorded under the following conditions: less than 2 cm from the tip of the ICD lead; less than 2 cm from the ICD; less than 2 cm from the lead body and coils; and 15 cm from the lead or the ICD (R4).

RESULTS

In the positive control (direct contact between the lead or the ICD with the Pz switched on), the ICD detected electrical activity as false heart activity. However, after covering all test conditions, no EMI was produced by the Pzs.

CONCLUSION

No EMI or permanent changes in the functioning of the ICD were detected in vitro.

Management of Patients With Cardiovascular Implantable Electronic Devices in Dental, Oral, and Maxillofacial Surgery

The prevalence of cardiovascular implantable electronic devices as life-prolonging and life-saving devices has evolved from a treatment of last resort to a first-line therapy for an increasing number of patients. As these devices become more and more popular in the general population, dental providers utilizing instruments and medications should be aware of dental equipment and medications that may affect these devices and understand the management of patients with these devices. This review article will discuss the various types and indications for pacemakers and implantable cardioverter-defibrillators, common drugs and instruments affecting these devices, and management of patients with these devices implanted for cardiac dysrhythmias.

Electromagnetic interference of endodontic equipments with cardiovascular implantable electronic device

OBJECTIVES

Assess the electromagnetic interference (EMI) of endodontic equipment with cardiovascular implantable electronic devices (CIEDs) and related factors.

METHODS

The laser device, electronic apex locators (EAL), optical microscope, endodontic rotary motors, gutta-percha heat carrier (GH), gutta-percha gun and ultrasonic device were tested next to CIEDs (Medtronic and Biotronik) with varied sensitivity settings and distances. CIEDs were immersed in a saline solution to simulate the electrical resistence of the human body. The endodontic equipment was tested in both horizontal and vertical positions in relation to the components of the CIED. The tests were performed on a dental chair in order to assess the cumulative effect of electromagnetic fields.

RESULTS

It was found no EMI with the Biotronik pacemaker. EALs caused EMI with Medtronic PM at a 2 cm distance, with the NSK(®) EAL also affecting the Medtronic defibrillator. GH caused EMI at 2 cm and 5 cm from the Medtronic defibrillator. EMI occurred when devices were horizontally positioned to the CIED. In the majority of the cases, EMI occurred when the pacemaker was set to maximum sensitivity. There was cumulative effect of electromagnetic fields between GH and dental chair.

CONCLUSIONS

EALs and GH caused EMI which ranged according to type and sensitivity setting of the CIEDs and the distance. However, no endodontic equipment caused permanent damage to the CIED. The use of GH caused a cumulative effect of electromagnetic fields. It suggests that during the treatment of patients with CIEDs, only the necessary equipments should be kept turned on.

CLINICAL RELEVANCE

Patients with CIEDs may be subject to EMI from electronic equipment used in dental offices, as they remain turned on throughout the treatment. This is the first article assessing the cumulative effect of electromagnetic fields.