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Driving electrochemical corrosion of implanted CoCrMo metal via oscillatory electric fields without mechanical wear. Sci Rep 2021; 11:22366. [PMID: 34785746 PMCID: PMC8595661 DOI: 10.1038/s41598-021-01810-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022] Open
Abstract
Decades of research have been dedicated to understanding the corrosion mechanisms of metal based implanted prosthetics utilized in modern surgical procedures. Focused primarily on mechanically driven wear, current fretting and crevice corrosion investigations have yet to precisely replicate the complex chemical composition of corrosion products recovered from patients' periprosthetic tissue. This work specifically targets the creation of corrosion products at the metal on metal junction utilized in modular hip prosthetics. Moreover, this manuscript serves as an initial investigation into the potential interaction between implanted CoCrMo metal alloy and low amplitude electrical oscillation, similar in magnitude to those which may develop from ambient electromagnetic radiation. It is believed that introduction of such an electrical oscillation may be able to initiate electrochemical reactions between the metal and surrounding fluid, forming the precursor to secondary wear particles, without mechanically eroding the metal's natural passivation layer. Here, we show that a low magnitude electrical oscillation (≤ 200 mV) in the megahertz frequency (106 Hz) range is capable of initiating corrosion on implanted CoCrMo without the addition of mechanical wear. Specifically, a 50 MHz, 200 mVpp sine wave generates corrosion products comprising of Cr, P, Ca, O, and C, which is consistent with previous literature on the analysis of failed hip prosthetics. These findings demonstrate that mechanical wear may not be required to initiate the production of chemically complex corrosion products.
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Effects of electromagnetic interference on the functional usage of medical equipment by 2G/3G/4G cellular phones: A review. J Adv Res 2016. [DOI: 10.1016/j.jare.2016.04.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Burri H, Mondouagne Engkolo LP, Dayal N, Etemadi A, Makhlouf AM, Stettler C, Trentaz F. Low risk of electromagnetic interference between smartphones and contemporary implantable cardioverter defibrillators. Europace 2016; 18:726-31. [PMID: 26857191 DOI: 10.1093/europace/euv374] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/15/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Manufacturers of implantable cardioverter defibrillators (ICDs) recommend that cell phones be maintained at a distance of ∼15 cm from the implanted device in order to avoid risk of dysfunction due to electromagnetic interference (EMI). Data relating to this issue are outdated and do not reflect modern technology. Our aim was to evaluate whether EMI is still an issue with contemporary ICDs and smartphones. METHODS AND RESULTS Consecutive patients implanted with a wireless-enabled ICD were tested for potential interference with two models of recent 4G smartphones in conditions intended to maximize risk of EMI. A magnet effect (due to the phone speakers) was tested by placing the smartphones in the standby mode directly over the ICD generator. The presence of EMI artefacts on the real-time electrograms was evaluated by placing the smartphones in the standby, dialling, and operating modes directly over the generator casing and over the parasternal region in the vicinity of the ventricular lead. A total of 63 patients equipped with 29 different models of single, dual, or biventricular ICDs from five major manufacturers were included. None of the patients showed any evidence of interference with the smartphones during any of the 882 tests. CONCLUSION The risk of EMI between modern smartphones and contemporary ICDs is low. This is probably due to the filters incorporated in the ICDs and low emission by the phones, as well as the small size of the magnets in the smartphones tested. STUDY REGISTRATION NCT02330900 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Haran Burri
- Cardiology Service, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, Geneva 1205, Switzerland
| | | | - Nicolas Dayal
- Cardiology Service, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, Geneva 1205, Switzerland
| | - Abdul Etemadi
- Cardiology Service, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, Geneva 1205, Switzerland
| | - Anne-Marie Makhlouf
- Cardiology Service, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, Geneva 1205, Switzerland
| | - Carine Stettler
- Cardiology Service, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, Geneva 1205, Switzerland
| | - Florence Trentaz
- Cardiology Service, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, Geneva 1205, Switzerland
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Katrib J, Nadi M, Kourtiche D, Magne I, Schmitt P, Souques M, Roth P. In vitro assessment of the immunity of implantable cardioverter-defibrillators to magnetic fields of 50/60 Hz. Physiol Meas 2013; 34:1281-92. [PMID: 24021865 DOI: 10.1088/0967-3334/34/10/1281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Public concern for the compatibility of electromagnetic (EM) sources with active implantable medical devices (AIMD) has prompted the development of new systems that can perform accurate exposure studies. EM field interference with active cardiac implants (e.g. implantable cardioverter-defibrillators (ICDs)) can be critical. This paper describes a magnetic field (MF) exposure system and the method developed for testing the immunity of ICD to continuous-wave MFs. The MFs were created by Helmholtz coils, housed in a Faraday cage. The coils were able to produce highly uniform MFs up to 4000 µT at 50 Hz and 3900 µT at 60 Hz, within the test space. Four ICDs were tested. No dysfunctions were found in the generated MFs. These results confirm that the tested ICDs were immune to low frequency MFs.
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Affiliation(s)
- J Katrib
- Université de Lorraine, CNRS, Institut Jean Lamour, UMR 7198, Nancy, France BP 70239, 54506 Vandoeuvre, France. National Centre for Industrial Microwave Processing, University of Nottingham, UK
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Maiorana C, Grossi GB, Garramone RA, Manfredini R, Santoro F. Do ultrasonic dental scalers interfere with implantable cardioverter defibrillators? An in vivo investigation. J Dent 2013; 41:955-9. [PMID: 23948395 DOI: 10.1016/j.jdent.2013.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/02/2013] [Accepted: 08/03/2013] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To test the in vivo effects of an ultrasonic dental scaler on various implanted cardioverter defibrillator (ICD) models. METHODS 12 consecutive patients with ICDs had continuous both electrocardiogram monitoring and device interrogation to detect interferences during the use of an ultrasonic dental scaler. RESULTS No interferences were detected by any ICD. Evaluation of the electrocardiograms for each patient failed to show any abnormalities in pacing during testing. CONCLUSION The results of this study suggest that the routinary clinic use of piezoelectric dental scalers do not interfere with the functioning of any of the tested ICDs. CLINICAL SIGNIFICANCE Ultrasonic dental scalers have been suspected of electromagnetic interference (EMI) with the normal functioning of ICDs and the use of this type of equipment for patients with these devices has been controversial. This is the first in vivo study to investigate EMI of ICD activity during the operation with ultrasonic dental scaler.
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Affiliation(s)
- Carlo Maiorana
- School of Oral Surgery, Dental Clinic, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Chung S, Yi J, Park SW. Electromagnetic Interference of Wireless Local Area Network on Electrocardiogram Monitoring System: A Case Report. Korean Circ J 2013; 43:187-8. [PMID: 23613696 PMCID: PMC3629245 DOI: 10.4070/kcj.2013.43.3.187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/24/2012] [Accepted: 08/28/2012] [Indexed: 11/30/2022] Open
Abstract
Electromagnetic interference (EMI) can affect various medical devices. Herein, we report the case of EMI from wireless local area network (WLAN) on an electrocardiogram (ECG) monitoring system. A patient who had a prior myocardial infarction participated in the cardiac rehabilitation program in the sports medicine center of our hospital under the wireless ECG monitoring system. After WLAN was installed, wireless ECG monitoring system failed to show a proper ECG signal. ECG signal was distorted when WLAN was turned on, but it was normalized after turning off the WLAN.
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Affiliation(s)
- Seungmin Chung
- Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joohee Yi
- Department of Information Strategy, Samsung Medical Center, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Information Strategy, Samsung Medical Center, Seoul, Korea
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Crossley GH, Poole JE, Rozner MA, Asirvatham SJ, Cheng A, Chung MK, Ferguson TB, Gallagher JD, Gold MR, Hoyt RH, Irefin S, Kusumoto FM, Moorman LP, Thompson A. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the Perioperative Management of Patients with Implantable Defibrillators, Pacemakers and Arrhythmia Monitors: Facilities and Patient Management. Heart Rhythm 2011; 8:1114-54. [DOI: 10.1016/j.hrthm.2010.12.023] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Indexed: 11/26/2022]
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Carranza N, Ramos V, Lizana FG, García J, del Pozo A, Monteagudo JL. A Literature Review of Transmission Effectiveness and Electromagnetic Compatibility in Home Telemedicine Environments to Evaluate Safety and Security. Telemed J E Health 2010; 16:818-26. [DOI: 10.1089/tmj.2010.0036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Noemí Carranza
- Telemedicine and eHealth Research Unit, Carlos III Health Institute, Madrid, Spain
| | - Victoria Ramos
- Telemedicine and eHealth Research Unit, Carlos III Health Institute, Madrid, Spain
| | - Francisca G. Lizana
- Agencia de Evaluación de Tenologías Sanitarias, Carlos III Health Institute, Madrid, Spain
| | - Jorge García
- Telemedicine and eHealth Research Unit, Carlos III Health Institute, Madrid, Spain
| | - Alejando del Pozo
- Telemedicine and eHealth Research Unit, Carlos III Health Institute, Madrid, Spain
| | - José Luis Monteagudo
- Telemedicine and eHealth Research Unit, Carlos III Health Institute, Madrid, Spain
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Benditt DG, Goldstein M, Belalcazar A. The leadless ultrasonic pacemaker: A sound idea? Heart Rhythm 2009; 6:749-51. [DOI: 10.1016/j.hrthm.2009.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Indexed: 11/29/2022]
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10
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Interference of electrical dental equipment with implantable cardioverter-defibrillators. Br Dent J 2007; 203:577-9. [DOI: 10.1038/bdj.2007.1043] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2007] [Indexed: 11/08/2022]
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Saleh GM, Gauba V, Mitra A, Beckingsale AB, Aziz O, Allen RJ. Electromagnetic interference by cellular phones with ophthalmic equipment. ACTA ACUST UNITED AC 2007; 85:345-6. [PMID: 17488470 DOI: 10.1111/j.1600-0420.2006.00837.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nägele H, Azizi M. Inappropriate ICD discharge induced by electrical interference from a physio-therapeutic muscle stimulation device. Herzschrittmacherther Elektrophysiol 2006; 17:137-9. [PMID: 16969728 DOI: 10.1007/s00399-006-0527-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2005] [Accepted: 03/15/2006] [Indexed: 05/11/2023]
Abstract
This report illustrates the case of a patient with an implantable cardioverter defibrillator (ICD) who during physiotherapy with transcutaneous electrical stimulation of the lumbar musculature perceived a shock discharge by the ICD. Analysis of the stored electrogram showed inappropriate therapy due to electromagnetic interference with the external stimulation. Patients as well as physiotherapists should be informed about this potential interaction to avoid such iatrogenic, inappropriate ICD therapy.
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Affiliation(s)
- H Nägele
- St. Adolfstift, Medical Clinic, Hamburger Str. 41, 21465, Reinbek, Germany
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Tandogan I, Ozin B, Bozbas H, Turhan S, Ozdemir R, Yetkin E, Topal E. Effects of mobile telephones on the function of implantable cardioverter defibrillators. Ann Noninvasive Electrocardiol 2006; 10:409-13. [PMID: 16255750 PMCID: PMC6932492 DOI: 10.1111/j.1542-474x.2005.00057.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We investigated whether mobile telephones affect the function of implantable cardioverter defibrillators (ICDs). BACKGROUND It is well known that electromagnetic fields can affect medical devices. METHODS The study included 43 patients with ventricular tachycardia and/or fibrillation treated with transvenous pectoral ICDs. Testing was done under continuous electrocardiograph monitoring under supervision of an ICD programmer. Initially, each patient was tested during spontaneous rhythm. Then the ICD was programmed to a pace rhythm higher than the patient's heart rate, and the tests were repeated at paced rhythm. In 7 patients, tests were performed during the implantation procedure as well. In 3 of the patients, only a single defibrillation zone was active. The other 40 patients had one or more active ventricular tachycardia zones. Two mobile phones (both GSM 900 MHz) were positioned 50 cm away from the implanted device in opposite directions and switched on. Communication was established between these phones, two investigators had a 20-second conversation, and then the phones were switched off. The same procedure was repeated at 30, 20, and 10 cm away from the implantation site, respectively. Finally, the procedure was performed with the antennae of both phones touching the device pocket. In the above-mentioned 7 cases where testing was done during implantation of the ICD, a call was made from one phone to the other, ringing occurred for 5 seconds, and then two investigators conversed while the device was implanted. RESULTS There was no change in the function of the ICDs during any of the phone testing procedures. In 5 cases, artifacts were noted on the surface electrocardiographic (ECG) screen of the programmer during the tests, but no such changes were observed on the simultaneous intracardiac ECGs. CONCLUSION The results of the study suggest that mobile phones have no effects on ICD function.
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Affiliation(s)
- Izzet Tandogan
- Department of Cardiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
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14
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Tri JL, Trusty JM, Hayes DL. Potential for Personal Digital Assistant interference with implantable cardiac devices. Mayo Clin Proc 2004; 79:1527-30. [PMID: 15595337 DOI: 10.4065/79.12.1527] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine whether the wireless local area network (WLAN) technology, specifically the Personal Digital Assistant (PDA), interferes with implantable cardiac pacemakers and defibrillators. MATERIAL AND METHODS Various pacemakers and defibrillators were tested in vitro at the Mayo Clinic in Rochester, Minn, between March 6 and July 30, 2003. These cardiac devices were exposed to an HP Compaq IPAQ PDA fitted with a Cisco Aironet WLAN card. Initial testing was designed to show whether the Aironet card radiated energy in a consistent pattern from the antenna of the PDA to ensure that subsequent cardiac device testing would not be affected by the orientation of the PDA to the cardiac device. Testing involved placing individual cardiac devices in a simulator and uniformly exposing each device at its most sensitive programmable value to the WLAN card set to maximum power. RESULTS During testing with the Cisco WLAN Aironet card, all devices programmed to the unipolar or bipolar configuration single- or dual-chamber mode had normal pacing and sensing functions and exhibited no effects of electromagnetic interference except for 1 implantable cardioverter-defibrillator (ICD). This aberration was determined to relate to the design of the investigators' testing apparatus and not to the output of the PDA. The ICD device appropriately identified and labeled the electromagnetic aberration as "noise." CONCLUSIONS We documented no electromagnetic interference caused by the WLAN technology by using in vitro testing of pacemakers and ICDs; however, testing ideally should be completed in vivo to confirm the lack of any clinically important interactions.
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Affiliation(s)
- Jeffrey L Tri
- Division of Foundation Telecommunications and Network Services, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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16
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Kolb C, Deisenhofer I, Weyerbrock S, Schmieder S, Plewan A, Zrenner B, Schmitt C. Incidence of Antitachycardia Therapy Suspension Due to Magnet Reversion in Implantable Cardioverter Defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:221-3. [PMID: 14764174 DOI: 10.1111/j.1540-8159.2004.00414.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Electromagnetic interference may result in transient or persistent suspension of antitachycardia therapies in ICDs. The incidence of such events has not been assessed so far. Patient charts were retrospectively analyzed for the occurrence of temporary suspension of antitachycardia therapies as it is stored in the Holter of St. Jude Medical or Ventritex ICDs. Follow-up data of 46 patients and 83.7-patient years were analyzed. Overall, 43 episodes of transient ICD inactivation occurred. Twenty-two of these episodes were related to intentional ICD inactivation in the emergency room or during surgery and 12 episodes were related to ICD follow-up. In nine episodes an environmental source of electromagnetic interference is presumed. None of the interactions resulted in persistent ICD inactivation or reprogramming of the devices. The risk for temporary suspension of ICD therapies unrelated to surgery, intentional magnet application in the emergency room, or routine follow-up is 11% per patient and year. Evaluation of its potential sources and the prevalence of ICD inhibition is warranted.
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Affiliation(s)
- Christof Kolb
- Deutsches Herzzentrum München and 1. Med. Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
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Angeloni A, Barbaro V, Bartolini P, Calcagnini G, Censi F. A novel heart/trunk simulator for the study of electromagnetic interference with active implantable devices. Med Biol Eng Comput 2003; 41:550-5. [PMID: 14572005 DOI: 10.1007/bf02345317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper describes a portable heart simulator for the study of electromagnetic interference with active implantable devices. The simulator consists of plexiglas box divided into three chambers simulating the left atrium and the ventricles, plus a lateral compartment for the implantable device. The box is linked to a laptop computer by an analogue-to-digital convertor board, and the three chambers are monitored and driven by dedicated hardware and software interfaces. Synthetic endocardial atrial and ventricle signals for 13 cardiac rhythms are stored in the computer. They are applied to the cardiac chambers by AgCl plates. Sensing electrodes are in the form of AgCl needles inserted in saline. The simulator was able to demonstrate the behaviour of three pacemakers tested in the absence and presence of electromagnetic interference, generated by mobile phones (European GSM 900 and 1800 MHz) that emitted up to 2W (1 W at 1800 MHz). Pacemakers can be programmed with sensitivity from 0.1 mV to 5 mV, pulse width from 0.1 ms to 1.5 ms and pulse amplitude from 0.5 V to 5 V. The structural separation in three cardiac chambers (plus the one for the device) allowed a fast analysis procedure for dual- and tri-chamber implantable devices.
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Affiliation(s)
- A Angeloni
- Biomedical Engineering Laboratory, Istituto Superiore di Sanità, Roma, Italy
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18
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Kolb C, Schmieder S, Lehmann G, Zrenner B, Karch MR, Plewan A, Schmitt C. Do airport metal detectors interfere with implantable pacemakers or cardioverter-defibrillators? J Am Coll Cardiol 2003; 41:2054-9. [PMID: 12798581 DOI: 10.1016/s0735-1097(03)00424-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether airport metal detector gates (AMDGs) interfere with pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs). BACKGROUND It is currently unknown whether AMDGs interfere with implanted PMs or ICDs. METHODS A total of 348 consecutive patients (200 PM and 148 ICD recipients) have been tested for the occurrence of electromagnetic interference (EMI) within the electromagnetic field of a worldwide-used airport metal detector. RESULTS No interference, such as pacing or sensing abnormalities, was observed in any of the 200 PM and 148 ICD patients; also no reprogramming occurred. CONCLUSIONS In vivo testing of PM and ICD systems showed no EMI with a standard AMDG. Clinically relevant interactions with implanted PMs or ICDs seem unlikely.
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Affiliation(s)
- Christof Kolb
- Deutsches Herzzentrum München, Klinikum rechts der Isar, Elektrophysiologie, Technischen Universität München, Lazarettstrasse 36, 80636 Munich, Germany.
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Wayar L, Mont L, Silva RMFL, Alvarenga N, Fosch X, Castro J, Brugada J. Electrical interference from an abdominal muscle stimulator unit on an implantable cardioverter defibrillator: report of two consecutive cases. Pacing Clin Electrophysiol 2003; 26:1292-3. [PMID: 12765461 DOI: 10.1046/j.1460-9592.2003.t01-1-00183.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two consecutive cases are presented of patients with ICDs in whom the use of commercial units for muscle stimulation for abdominal training caused interference with the device, mimicked cardiac signals, and resulted in inappropriate treatment shock delivery.
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Affiliation(s)
- Luis Wayar
- Arrhythmia Section, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Spain
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Abstract
The phenomenon of electromagnetic interference by mobile phones is real and potentially clinically significant. This has been recognised by the Department of Health and the Medical Devices Agency, leading to bans on phone use in hospitals. Current evidence suggests that mobile phones can cause malfunction of medical equipment, but only when used in close proximity. Allowing phone use in non-patient care areas and improving staff education may improve compliance with hospital policies.
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Affiliation(s)
- A A Klein
- Cardiovascular Anaesthesia and Intensive Care Medicine, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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21
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Abstract
Implantable cardioverter defibrillators (ICDs) have evolved from the treatment of last resort to the gold standard therapy for patients at high risk for ventricular tachyarrhythmias. High-risk patients include those who have survived life-threatening arrhythmias, and individuals with cardiac diseases who are at risk for such arrhythmias, but are symptomless. Use of an ICD will affect the patient's quality of life. Some drugs can substantially affect defibrillator function and efficacy, and possible drug-device interactions should be considered. Patients with ICDs may encounter cell phones, antitheft detectors, and many other sources of potential electromagnetic Interference. In addition to treating ventricular tachyarrhythmias, new defibrillators provide full featured dual chamber pacing, and could treat atrial arrhythmias, and congestive heart failure by means of biventricular pacing.
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Affiliation(s)
- M Glikson
- Heart Institute, Sheba Medical Centre, Tel Aviv University, Tel Hashomer, Israel
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Abstract
Clinical trials have established the superiority of the implantable cardioverter-defibrillator (ICD) over antiarrhythmic drug therapy in survivors of sudden cardiac death and in high-risk patients with coronary artery disease. The ICD has evolved to overcome the limitation of earlier devices that required thoracotomy for implantation and were fraught with inappropriate shock delivery. Current ICDs are implanted in a similar manner to cardiac pacemakers and incorporate sophisticated rhythm-discrimination algorithms to prevent inappropriate therapy. Managing the patient with an ICD requires an understanding of the multiprogrammable features of modern devices. Drug interactions and potential sources of electromagnetic interference may adversely affect ICD function. Driving restrictions may be necessary under certain conditions. The cost-effectiveness of ICD therapy appears favorable, given the marked survival benefit seen in randomized trials relative to antiarrhythmic drug treatment. The growing number of ICD recipients necessitates an understanding of the specialized features of the modern ICD and the role of device therapy in clinical practice.
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Affiliation(s)
- M H Gollob
- Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA.
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Abstract
Pacing is a field of rapid clinical progress and technologic advances. Clinical progress in the 1990s included the refinement of indications for pacing as well as the use of pacemakers for new, nonbradycardiac indications, such as the treatment of cardiomyopathies and CHF and the prevention of atrial fibrillation. Important published data and studies in progress are shedding new light on issues of pacing mode selection, and they may influence future practice significantly. Important technologic advances include development of new rate-adaptive sensors and sensor combinations and the evolution of pacemakers into sophisticated diagnostic devices with the capability to store data and ECGs. Automatic algorithms monitor the patient for appropriate capture, sensing, battery status, and lead impedance, providing better patient safety and pacemaker longevity.
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Affiliation(s)
- M Glikson
- Pacemaker Service, Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Tri JL, Hayes DL, Smith TT, Severson RP. Cellular phone interference with external cardiopulmonary monitoring devices. Mayo Clin Proc 2001; 76:11-5. [PMID: 11155403 DOI: 10.4065/76.1.11] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine the potential effect (electromagnetic interference) of cellular telephones on external cardiopulmonary monitoring devices. METHODS For this study, we tested 17 different medical devices with 5 portable telephones (4 digital, 1 analog) to assess the potential for electromagnetic interference. The telephones were tested in a normal operating mode to simulate a typical hospital environment with patients or their families using their cellular phones. The medical devices were connected to the appropriate simulators for proper operation while the tests were under way. The screens and alarms of the medical devices were monitored while the telephones were maneuvered in the y and z planes near the devices. Clinically important interference was defined as interference that may hinder interpretation of the data or cause the equipment to malfunction. RESULTS Any type of interference occurred in 7 (41%) of the 17 devices tested during 54.7% of the 526 tests. The incidence of clinically important interference was 7.4%. CONCLUSIONS Cellular telephones may interfere with the operation of external cardiopulmonary monitoring devices. However, most of the test results showed that the interference would rarely be clinically important.
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Affiliation(s)
- J L Tri
- Telecommunications and Mobile Services, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Glatter K, Liem LB. Implantable Cardioverter Defibrillator: Current Progress and Management. Semin Cardiothorac Vasc Anesth 2000. [DOI: 10.1053/scva.2000.8496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With greater technologic advances during the past decade, use of the implantable cardioverter defibrillator (ICD) has increased to more than 200,000 implants worldwide to date. Indications for ICD implant have expanded to include both patients who have survived sudden cardiac death (secondary prevention of cardiac arrest) and those who are at high risk for experiencing lethal arrhythmias (primary prevention of cardiac ar rest). Thus, it is likely that physicians will encounter defibrillators in their clinical practice and must be familiar with their indications for implant, basic opera tion, and long-term management of devices. Several prospective clinical trials have recently shown the long- term efficacy of ICD therapy at aborting sudden death in the high-risk patient population. Although still evolving, general guidelines and indications for ICD implant have been put forth and are discussed in this review. From the first defibrillation in humans during surgery in 1947 to the sophisticated dual-chamber pacing and memory functions of the modern device, ICD development has led to ever smaller devices with more complex technol ogy. The implant procedure of current ICDs parallels that used to place pacemakers. However, the anesthe sia team plays a vital role in initial ICD implantation by monitoring cardiopulmonary status during defibrilla tion threshold (DFT) testing. Additionally, long-term management of ICDs often requires repeat DFT testing with anesthesia involvement. Finally, possible electro magnetic (environmental) interactions with the ICD of which physicians should be aware are described in this article.
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Affiliation(s)
- Kathy Glatter
- Cardiac Electrophysiology Unit, Stanford University, Stanford, CA
| | - L. Bing Liem
- Cardiac Electrophysiology Unit, Stanford University, Stanford, CA
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Abstract
Implantable cardioverter defibrillators (ICD) are highly effective in the identification and termination of malignant ventricular tachycardia and fibrillation. It is anticipated that the number of patients receiving this device will increase because of major advancements in technology and the results of prospective controlled clinical trials. Major life changes occur after implantation of the device. Continued research is needed to identify concerns and needs of patients with ICDs and their families. Specific interventions must be tested to determine efficacy. Nurses must be able to provide education and psychologic support to assist patients in their successful transition to home.
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Affiliation(s)
- E White
- Mainline Arrhythmia and Cardiology Consultants, Wynnewood, Pennsylvania, USA
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Abstract
Most exposures to electromagnetic interference are transient and pose no threat to patients with pacemakers and implantable cardioverter defibrillators. Prolonged exposure may be catastrophic in pacemaker dependent patients. New technologies (wireless phones, electronic antitheft surveillance) are safe if proper precautions are takes. Radiofrequency ablation requires concomitant temporary pacing. MR imaging remains contraindicated in patients with these devices until further study is undertaken.
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Affiliation(s)
- S L Pinski
- Department of Medicine, Rush Medical College, Chicago, Illinois, USA.
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Affiliation(s)
- S Saksena
- Eastern Heart Institute-Atlantic Health System, Passaic, New Jersey.
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Abstract
Implantable defibrillators have become the dominant therapeutic modality for patients with life-threatening ventricular arrhythmias. Current defibrillators are small (<60 mL) and implanted with techniques similar to standard pacemakers. They provide high-energy shocks for ventricular fibrillation and rapid ventricular tachycardia, antitachycardia pacing for monomorphic ventricular tachycardia, as well as antibradycardia pacing. Newer devices incorporating an atrial lead allow dual-chamber pacing and better discrimination between ventricular and supraventricular tachyarrhythmias. Randomized controlled trials have shown superior survival with implantable defibrillators than with antiarrhythmic drugs in survivors of life-threatening ventricular tachyarrhythmias and in high-risk patients with coronary artery disease. Complications associated with implantable defibrillator therapy include infection, lead failure, and spurious shocks for supraventricular tachyarrhythmias. Most patients adapt well to living with an implantable defibrillator, although driving often has to be restricted. Limited evidence suggests that implantable defibrillator therapy is cost-effective when compared with other widely accepted treatments. The use of implantable defibrillators is likely to continue to expand in the future. Ongoing clinical trials will define further prophylactic indications of the implantable defibrillator and clarify its cost-effectiveness ratio in different clinical settings.
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Affiliation(s)
- S L Pinski
- Section of Cardiology, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA
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