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Güner F, Leitz P, Ellermann C, Köbe J, Lange PS, Wolfes J, Rath B, Doldi F, Willy K, Frommeyer G, Eckardt L. [Electromagnetic interference in 3D-mapping procedures]. Herzschrittmacherther Elektrophysiol 2022; 33:290-296. [PMID: 35970909 DOI: 10.1007/s00399-022-00883-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
Catheter-based ablation is nowadays a safe and widespread procedure for the treatment of cardiac arrhythmia. This requires exact anatomical knowledge both before and during the examination and is an important prerequisite for targeted treatment. At the beginning of the era of interventional catheter-based treatment, fluoroscopy was the only and usual means of visualization, whereas in the middle of the 1990s continuous 3D-mapping systems were developed for the non-fluoroscopic examination of patients. The correct use of these 3‑D systems, which non-fluoroscopically visualize the catheter and mostly identify mechanisms of arrhythmia in great detail, nowadays makes an important contribution to successful interventional catheter treatment of arrhythmia; however, it is not uncommon for patients with ventricular arrhythmia to also carry implanted electronic devices, such as pacemakers, defibrillators or less frequently left ventricular hemodynamic support systems. All implantable devices lead to electromagnetic interferences, which can complicate the diagnostics and treatment during electrophysiological examinations and ablation. This article addresses the adversities and experiences associated with magnet-based 3D systems and implantable electromagnetically active cardiac devices.
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Affiliation(s)
- Fatih Güner
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
| | - Patrick Leitz
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Christian Ellermann
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Julia Köbe
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Philipp S Lange
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Julian Wolfes
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Benjamin Rath
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Florian Doldi
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Kevin Willy
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Gerrit Frommeyer
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Lars Eckardt
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
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Krumpholz R, Fuchtmann J, Berlet M, Hangleiter A, Ostler D, Feussner H, Wilhelm D. Telemedical percussion: objectifying a fundamental clinical examination technique for telemedicine. Int J Comput Assist Radiol Surg 2021; 17:795-804. [PMID: 34820748 PMCID: PMC8612625 DOI: 10.1007/s11548-021-02520-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/07/2021] [Indexed: 11/14/2022]
Abstract
Purpose While demand for telemedicine is increasing, patients are currently restricted to tele-consultation for the most part. Fundamental diagnostics like the percussion still require the in person expertize of a physician. To meet today’s challenges, a transformation of the manual percussion into a standardized, digital version, ready for telemedical execution is required. Methods In conjunction with a comprehensive telemedical diagnostic system, in which patients can get examined by a remote-physician, a series of three robotic end-effectors for mechanical percussion were developed. Comprising a motor, a magnetic and a pneumatic-based version, the devices strike a pleximeter to perform the percussion. Emitted sounds were captured using a microphone-equipped stethoscope. The 84 recordings were further integrated into a survey in order to classify lung and non-lung samples. Results The study with 21 participants comprised physicians, medical students and non-medical-related raters in equal parts. With 71.4% correctly classified samples, the ventral motorized device prevailed. While the result is significantly better compared to a manual or pneumatic percussion in this very setup, it only has a small edge over the magnetic devices. In addition, for all ventral versions non-lung regions were rather correctly identified than lung regions. Conclusion The overall setup proves the feasibility of a telemedical percussion. Despite the fact, that produced sounds differ compared to today’s manual technique, the study shows that a standardized mechanical percussion has the potential to improve the gold standard’s accuracy. While further extensive medical evaluation is yet to come, the system paves the way for future uncompromised remote examinations.
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Affiliation(s)
- Roman Krumpholz
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany.
| | - Jonas Fuchtmann
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany
| | - Maximilian Berlet
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany.,Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Annika Hangleiter
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany
| | - Daniel Ostler
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany
| | - Hubertus Feussner
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany.,Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk Wilhelm
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany.,Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Magnetic field-induced interactions between phones containing magnets and cardiovascular implantable electronic devices: Flip it to be safe? Heart Rhythm 2021; 19:372-380. [PMID: 34767986 DOI: 10.1016/j.hrthm.2021.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/19/2021] [Accepted: 11/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent case reports and small studies have reported activation of the magnet-sensitive switches in cardiovascular implantable electronic devices (CIEDs) by the new iPhone 12 series, initiating asynchronous pacing in pacemakers and suspension of antitachycardia therapies in implantable cardioverter-defibrillators (ICDs). OBJECTIVE The purpose of this prospective single-center observational study was to quantify the risk of magnetic field interactions of the iPhone 12 with CIEDs. METHODS A representative model of each CIED series from all manufacturers was tested ex vivo. Incidence and minimum distance necessary for magnet mode triggering were analyzed in 164 CIED patients with either the front or the back of the phone facing the device. The magnetic field of the iPhone 12 was analyzed using a 3-axis Hall probe. RESULTS Ex vivo, magnetic interference occurred in 84.6% with the back compared to 46.2% with the front of the iPhone 12 facing the CIED. In vivo, activation of the magnet-sensitive switch occurred in 30 CIED patients (18.3%; 21 pacemaker, 9 ICD) when the iPhone 12 was placed in close proximity over the CIED pocket and the back of the phone was facing the skin. Multiple binary logistic regression analysis identified implantation depth (95% confidence interval 0.02-0.24) as an independent predictor of magnet-sensitive switch activation. CONCLUSION Magnetic field interactions occur only in close proximity and with precise alignment of the iPhone 12 and CIEDs. It is important to advise CIED patients to not put the iPhone 12 directly on the skin above the CIED. Further recommendations are not necessary.
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