Electromagnetic interference in cardiac electronic implants caused by novel electrical appliances emitting electromagnetic fields in the intermediate frequency range: a systematic review

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.

Comparative analysis of energy transfer mechanisms for neural implants

As neural implant technologies advance rapidly, a nuanced understanding of their powering mechanisms becomes indispensable, especially given the long-term biocompatibility risks like oxidative stress and inflammation, which can be aggravated by recurrent surgeries, including battery replacements. This review delves into a comprehensive analysis, starting with biocompatibility considerations for both energy storage units and transfer methods. The review focuses on four main mechanisms for powering neural implants: Electromagnetic, Acoustic, Optical, and Direct Connection to the Body. Among these, Electromagnetic Methods include techniques such as Near-Field Communication (RF). Acoustic methods using high-frequency ultrasound offer advantages in power transmission efficiency and multi-node interrogation capabilities. Optical methods, although still in early development, show promising energy transmission efficiencies using Near-Infrared (NIR) light while avoiding electromagnetic interference. Direct connections, while efficient, pose substantial safety risks, including infection and micromotion disturbances within neural tissue. The review employs key metrics such as specific absorption rate (SAR) and energy transfer efficiency for a nuanced evaluation of these methods. It also discusses recent innovations like the Sectored-Multi Ring Ultrasonic Transducer (S-MRUT), Stentrode, and Neural Dust. Ultimately, this review aims to help researchers, clinicians, and engineers better understand the challenges of and potentially create new solutions for powering neural implants.

Electromagnetic interference from automobile passive keyless entry in cardiovascular implantable electronic devices

INTRODUCTION

The automobile passive keyless entry (PKE) system is a potential source of electromagnetic interference (EMI). We aim to determine the incidence and significance of EMI from automobile PKE system in cardiovascular implantable electronic device (CIED) patients.

METHODS

This was a single-center cross-sectional study conducted at Maharaj Nakorn Chiang Mai hospital, Thailand. Patients with CIED were instructed to lock and unlock two automobiles using the PKE system. Any EMI or arrhythmias were detected by CIED interrogation and single-lead electrocardiogram event recorder. We also used a spectrum analyzer to identify the automobiles working frequency bandwidth.

RESULTS

There was a total of 102 CIED patients. Device types included 48.0% defibrillators, 37.3% permanent pacemakers, and 14.7% cardiac resynchronization therapy device. Both interrogated data from device and event monitor revealed no incidence of EMI during the PKE activation. We failed to identify the working frequency bandwidth of the two studied cars due to very low signal strength, thus blended in with the background noise.

CONCLUSIONS

Automobile PKE systems transmitted very low power signals. Therefore, under normal circumstances, CIED patients can use automobile PKE system safely without any EMI regardless of key fob positions in relation to the CIED pulse generator.

TRIAL REGISTRATION

The study was registered at ClinicalTrials.gov (https://clinicaltrials.gov), and the identification number is NCT03016390.

High-power chargers for electric vehicles: are they safe for patients with pacemakers and defibrillators?

AIMS

Battery electric vehicle (BEV) sales and use are rapidly expanding. Battery electric vehicles, along with their charging stations, are a potential source of electromagnetic interference (EMI) for patients with cardiac implantable electronic devices (CIEDs). The new 'high-power' charging stations have the potential to create strong electromagnetic fields and induce EMI in CIEDs, and their safety has not been evaluated.

METHODS AND RESULTS

A total of 130 CIED patients performed 561 charges of four BEVs and a test vehicle (350 kW charge capacity) using high-power charging stations under continuous 6-lead electrocardiogram monitoring. The charging cable was placed directly over the CIED, and devices were programmed to maximize the chance of EMI detection. Cardiac implantable electronic devices were re-interrogated after patients charged all BEVs and the test vehicle for evidence of EMI. There were no incidences of EMI, specifically no over-sensing, pacing inhibition, inappropriate tachycardia detection, mode switching, or spontaneous reprogramming. The risk of EMI on a patient-based analysis is 0/130 [95% confidence interval (CI) 0%-2%], and the risk of EMI on a charge-based analysis is 0/561 (95% CI 0%-0.6%). The effective magnetic field along the charging cable was 38.65 µT and at the charging station was 77.9 µT.

CONCLUSIONS

The use of electric cars with high-power chargers by patients with cardiac devices appears to be safe with no evidence of clinically relevant EMI. Reasonable caution, by minimizing the time spent in close proximity with the charging cables, is still advised as the occurrence of very rare events cannot be excluded from our results.

Safety evaluation of smart scales, smart watches, and smart rings with bioimpedance technology shows evidence of potential interference in cardiac implantable electronic devices

BACKGROUND

Smart scales, smart watches, and smart rings with bioimpedance technology may create interference in patients with cardiac implantable electronic devices (CIEDs).

OBJECTIVES

The purpose of this study was to determine interference at CIEDs with simulations and benchtop testing, and to compare the results with maximum values defined in the ISO 14117 electromagnetic interference standard for these devices.

METHODS

The interference at pacing electrodes was determined by simulations on a male and a female computable model. A benchtop evaluation of representative CIEDs from 3 different manufacturers as specified in the ISO 14117 standard also was performed.

RESULTS

Simulations showed evidence of interference with voltage values exceeding threshold values defined in the ISO 14117 standard. The level of interference varied with the frequency and amplitude of the bioimpedance signal, and between male and female models. The level of interference generated with smart scale and smart rings simulations was lower than with smart watches. Across device manufacturers, generators demonstrated susceptibility to oversensing and pacing inhibition at different signal amplitudes and frequencies.

CONCLUSIONS

This study evaluated the safety of smart scales, smart watches, and smart rings with bioimpedance technology via simulation and testing. Our results indicate that these consumer electronic devices could interfere in patients with CIEDs. The present findings do not recommend the use of these devices in this population due to potential interference.

Electromagnetic Absorption and Mechanical Properties of Natural Rubber Composites Based on Conductive Carbon Black and Fe3O4

In contemporary civilization, the electromagnetic radiation from electronic devices and communication systems has become a substantial pollutant. High-performance electromagnetic absorbers have become a solution for absorbing unwanted electromagnetic waves. This research proposed a lightweight and flexible electromagnetic absorber produced from natural rubber filled with conductive carbon black (CCB) and Fe₃O₄. The effect of CCB, Fe₃O₄, and a combination of CCB and Fe₃O₄ as a hybrid filler on foam morpholog, electromagnetic reflectivity, tensile strength, and compression set properties were investigated. In addition, the effect of the alternating layered structure of CCB and Fe₃O₄ on electromagnetic absorption was investigated. The results indicated that the composite foam exhibited an interconnected network structure that enhanced the electromagnetic attenuation in the absorber. CCB increased the electromagnetic absorption of the foam, whereas Fe₃O₄ had less of an effect. The foam filled with the hybrid filler at the CCB/Fe₃O₄ ratio of 8/2 exhibited excellent electromagnetic absorption. The composite foam had a higher tensile modulus and higher strength compared to neat foam. The addition of CCB decreased the compression set; however, the compression set was improved by the incorporation of Fe₃O₄. Composite foams filled with hybrid filler can serve as highly efficient electromagnetic absorbing materials.

A Review of the Effect of the Intermediate Frequency Electromagnetic Fields on Female Reproduction

ABSTRACT

The use of intermediate frequency (IF) fields in occupational equipment and domestic appliances is increasing dramatically. The World Health Organization consistently points out that there is a lack of scientific evidence to assess the reproductive risk in female species within the exposure limits as stated by the International Commission on Non-Ionizing Radiation Protection. The purpose of this review paper is to review the available literature on the effects of IF EMR on female reproduction in all species and to fully understand these effects. A literature review of experimental, epidemiological, in vivo, and in vitro literature from the 1800s to the present was conducted. Very few studies have been conducted on the effects of IF on female reproduction. The study of women in their workplace, laboratory rats and mice, and chicken embryos has yielded conflicting results on the dangers of IF. Some reports consider IF harmful during pregnancy, while other results show an insignificant (p < 0.05) correlation between the exposed group and the unexposed groups. The experiments conducted so far restrict several parameters such as field strength, frequency, and modulation to draw definitive conclusions. In two experiments, this frequency range is considered safe for non-invasive treatment of cancerous and noncancerous ovarian cells in the initial phase. Evaluation of the IF range on reproduction should be a priority for research. This review shows that there are few reports in this field, and they all contradict each other on whether the IF field is harmful or not. Nonetheless, IF is used in medicine to treat cancer and is currently being researched for non-cancerous cells. More comprehensive IF studies should be conducted to address the limitations in these summary studies.

EMI radiation of power transmission lines in Malaysia

Background: There has been rising concern amongst the public regarding their home's proximity to high tension power transmission lines. The primary cause of fear is the impact of the electromagnetic interference (EMI) radiation on the nearby occupants' health. Despite the presence of national permissible limits of EMI radiation, there is still lack of information with regards to the EMI radiation of the types of power lines configuration in Malaysia. Methods: The electric and magnetic fields of several selected power transmission lines were simulated using the EMFACDC software program from the recommendation ITU-T K.90. Five types of power transmission lines available in Malaysia are considered. Results: It was found that the simulated electric and magnetic field levels at all the power lines' right of way (ROW) boundary complies with the prescribed exposure limit. However, the electromagnetic fields (EMF) level increases significantly as the separation distance is reduced from 30m. For a more conservative approach, the ROW can be set at 30m across all transmission voltage level and corridor area condition. Conclusion: It can be concluded that Malaysia's power transmission lines are within the prescribed exposure limits. To further minimize the electric and magnetic field level, it is recommended that the residential building should be built at least 30 meters away from the power transmission lines, especially for the 275kV double circuit, 275/132kV quadruple circuit, and 500kV double circuit lines.

New Era of Electroceuticals: Clinically Driven Smart Implantable Electronic Devices Moving towards Precision Therapy

In the name of electroceuticals, bioelectronic devices have transformed and become essential for dealing with all physiological responses. This significant advancement is attributable to its interdisciplinary nature from engineering and sciences and also the progress in micro and nanotechnologies. Undoubtedly, in the future, bioelectronics would lead in such a way that diagnosing and treating patients' diseases is more efficient. In this context, we have reviewed the current advancement of implantable medical electronics (electroceuticals) with their immense potential advantages. Specifically, the article discusses pacemakers, neural stimulation, artificial retinae, and vagus nerve stimulation, their micro/nanoscale features, and material aspects as value addition. Over the past years, most researchers have only focused on the electroceuticals metamorphically transforming from a concept to a device stage to positively impact the therapeutic outcomes. Herein, the article discusses the smart implants' development challenges and opportunities, electromagnetic field effects, and their potential consequences, which will be useful for developing a reliable and qualified smart electroceutical implant for targeted clinical use. Finally, this review article highlights the importance of wirelessly supplying the necessary power and wirelessly triggering functional electronic circuits with ultra-low power consumption and multi-functional advantages such as monitoring and treating the disease in real-time.

Interfacing MXene Flakes on a Magnetic Fiber Network as a Stretchable, Flexible, Electromagnetic Shielding Fabric

A unique self-standing membrane composed of hierarchical thermoplastic polyurethane (TPU)/polyacrylonitrile (PAN) fibers is prepared by the electrospinning technique, followed by a simple dip-coating process. Fe₃O₄ nanoparticles are uniformly anchored on TPU/PAN fibers during the electrospinning process, enabling the membrane to achieve effective electromagnetic interference shielding (EMI SE) performance. Such a hybrid membrane has a high magnetization of 18.9 emu/g. When MXene (Ti₃C₂T_x) layers are further loaded on the TPU/PAN/Fe₃O₄NPs hybrid membrane, its EMI SE performance in the X band can exceed 30 dB due to the hydrogen bonds generated between the macromolecular chain of PAN and the functional group (T_x) on the surface of MXene. Simultaneously, the interfacial attraction between MXene and the TPU/PAN/Fe₃O₄NPs substrate is enhanced. The EMI SE mechanism of the hybrid membrane indicates that this film has great potential in the fields of wearable devices and flexible materials.

Mechanical, Thermal, Electrical Characteristics and EMI Absorption Shielding Effectiveness of Rubber Composites Based on Ferrite and Carbon Fillers

In this work, rubber composites were fabricated by incorporation of manganese-zinc ferrite alone and in combination with carbon-based fillers into acrylonitrile-butadiene rubber. Electromagnetic parameters and electromagnetic interference (EMI) absorption shielding effectiveness of composite materials were examined in the frequency range 1 MHz-3 GHz. The influence of ferrite and fillers combination on thermal characteristics and mechanical properties of composites was investigated as well. The results revealed that ferrite imparts absorption shielding efficiency to the composites in tested frequency range. The absorption shielding effectiveness and absorption maxima of ferrite filled composites shifted to lower frequencies with increasing content of magnetic filler. The combination of carbon black and ferrite also resulted in the fabrication of efficient EMI shields. However, the EMI absorption shielding effectiveness was lower, which can be ascribed to higher electrical conductivity and higher permittivity of those materials. The highest conductivity and permittivity of composites filled with combination of carbon nanotubes and ferrite was responsible for the lowest absorption shielding effectiveness within the examined frequency range. The results also demonstrated that combination of ferrite with carbon-based fillers resulted in the enhancement of thermal conductivity and improvement of mechanical properties.

Safety of smartwatches and their chargers in patients with cardiac implantable electronic devices

AIMS

Cardiac implantable electronic devices (CIEDs) are susceptible to electromagnetic interference (EMI). Smartwatches and their chargers could be a possible source of EMI. We sought to assess whether the latest generation smartwatches and their chargers interfere with proper CIED function.

METHODS AND RESULTS

We included consecutive CIED recipients in two centres. We tested two latest generation smartwatches (Apple Watch and Samsung Galaxy Watch) and their charging cables for potential EMI. The testing was performed under continuous electrocardiogram recording and real-time device telemetry, with nominal and 'worst-case' settings. In vitro magnetic field measurements were performed to assess the emissions from the tested devices, initially in contact with the probe and then at a distance of 10 cm and 20 cm. In total, 171 patients with CIEDs (71.3% pacemakers-28.7% implantable cardioverter-defibrillators) from five manufacturers were enrolled (63.2% males, 74.8 ± 11.4 years), resulting in 684 EMI tests. No EMI was identified in any patient either under nominal or 'worst-case scenario' programming. The peak magnetic flux density emitted by the smartwatches was similar to the background noise level (0.81 μT) even when in contact with the measuring probe. The respective values for the chargers were 4.696 μΤ and 4.299 μΤ for the Samsung and Apple chargers, respectively, which fell at the background noise level when placed at 20 cm and 10 cm, respectively.

CONCLUSION

Two latest generation smartwatches and their chargers resulted in no EMI in CIED recipients. The absence of EMI in conjunction with the extremely low intensity of magnetic fields emitted by these devices support the safety of their use by CIED patients.

Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA)

Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.

Electromagnetic Interference Shielding and Physical-Mechanical Characteristics of Rubber Composites Filled with Manganese-Zinc Ferrite and Carbon Black

In the present work, composite materials were prepared by incorporation of manganese-zinc ferrite, carbon black and combination of ferrite and carbon black into acrylonitrile-butadiene rubber (NBR). For cross-linking of composites, standard sulfur-based curing system was applied. The main goal was to investigate the influence of the fillers on the physical-mechanical properties of composites. Then, the electromagnetic absorption shielding ability was investigated in the frequency range 1 MHz-3 GHz. The results revealed that composites filled with ferrite provide sufficient absorption shielding performance in the tested frequency range. On the other hand, ferrite behaves as an inactive filler and deteriorates the physical-mechanical characteristics of composites. Carbon black reinforces the rubber matrix and contributes to the improvement of physical-mechanical properties. However, composites filled with carbon black are not able to absorb electromagnetic radiation in the given frequency range. Finally, the combination of carbon black and ferrite resulted in the modification of both physical-mechanical characteristics and absorption shielding ability of hybrid composites.

Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA)

Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.

An in vitro Evaluation of the Effect of Transient Electromagnetic Fields on Pacemakers and Clinical Mitigation Measures

Background: The effect of transient electromagnetic fields on the function of pacemakers is not well-evaluated. There is a lack of effective methods for clinicians to reduce electromagnetic susceptibility (EMS) during implantation of pacemakers. This study aimed to evaluate whether a novel method of handling the excess leads in the pocket can lower the EMS of pacemakers and consequently reduce the effect of electromagnetic interference caused by transient electromagnetic fields on pacemakers.

Methods: An in vitro chest model was established to simulate the clinical condition of dual-chamber pacemaker implantation. Three different intertwining patterns of excess leads were examined: parallel, twisted once, and multiple twisted-pair. Oscillated currents were injected into a copper electrical wire set horizontally above the model to create a radiated magnetic field to simulate the transient daily electromagnetic exposure of pacemakers. The electromagnetic induction of current was measured. The occurrence of EMS-related adverse events was evaluated when the induced pulsed voltage was applied.

Results: Transient electromagnetic fields can induce electromagnetic noise in the pacing loop and inhibit the release of pacing pulses. The multiple twisted-pair intertwining pattern of excess leads was associated with a lower induced voltage amplitude than both the parallel and once-twisted patterns (P < 0.001). Even once twisted could significantly reduce induced voltage amplitude compared to not twisted (P < 0.001). A lower incidence of pacing inhibition was also observed in the multiple twisted-pair group than in the other two groups (P < 0.001).

Conclusions: Transient electromagnetic fields can cause pacing inhibition. Twisting the excess leads for multiple turns in the pocket is an effective method to reduce the EMS of the dual-chamber pacemaker.

Progress in polymers and polymer composites used as efficient materials for EMI shielding

The explosive progress of electronic devices and communication systems results in the production of undesirable electromagnetic pollution, known as electromagnetic interference. The accumulation of electromagnetic radiation in space results in the malfunction of commercial and military electronic appliances, and it may have a negative impact on human health. Thus, the shielding of undesirable electromagnetic interference has become a serious concern of the modern society, and has been a very perspective field of research and development. This paper provides detailed insight into current trends in the advancement of various polymer-based materials with the effects of electromagnetic interference shielding. First, the theoretical aspects of shielding are outlined. Then, the comprehensive description of the structure, morphology and functionalization of the intrinsic conductive polymers, polymers filled with the different types of inorganic and organic fillers, as well as multifunctional polymer architectures are provided with respect to their conductive, dielectric, magnetic and shielding characteristics.

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.

Safety of bioelectrical impedance analysis in advanced heart failure patients

BACKGROUND

Cardiac cachexia and frailty are major complications of advanced heart failure (AHF). Bioelectrical impedance analysis (BIA) may provide valuable information regarding fluid balance, muscle mass and prognosis. The main concerns regarding the use of BIA in AHF patients remain arrhythmias and electromagnetic interferences with cardiac implantable electronic devices (CIEDs). Reliable data regarding patients on continuous-flow ventricular assist device (cf-VAD) remain scarce. The aim of this study is to evaluate the safety of BIA in AHF patients on pro-arrhythmogenic therapy with an implanted CIED and/or with a cf-VAD.

METHODS

We prospectively performed 217 BIA measurements in 143 AHF patients at risk of severe arrhythmias due to inotropic support/a history of ventricular arrhythmias and/or treated with CIED, including 104 patients with an ICD, CRT or pacemaker and 95 patients with a cf-VAD. All patients were under continuous Electrocardiogram (ECG) monitoring and clinical surveillance for 24 hours.

RESULTS

No adverse events were observed during the 217 BIA measurements: No rhythm disturbances were documented in the telemetric monitoring during or within 30 minutes after the measurement. CIEDs showed no malfunction, regardless of the location measured or the device manufacturer. In particular, no inappropriate shocks were observed. No alarms, flow disturbances, or malfunctions of the cf-VAD occurred during or after the measurements.

CONCLUSION

We consider BIA a safe measurement with major clinical relevance in our cohort of AHF patients, despite an increased arrhythmic potential on inotropic support or the presence of implanted electronic devices (ICD, CRT, pacemaker and cf-VAD).