Should the trend toward smaller lead sizes with pacemakers and defibrillators be reconsidered?

The Miniaturization of Cardiac Implantable Electronic Devices: Advances in Diagnostic and Therapeutic Modalities

The Fourth Industrial Revolution, characterized by an unprecedented fusion of technologies that is blurring the lines between the physical, digital, and biological spheres, continues the trend to manufacture ever smaller mechanical, optical and electronic products and devices. In this manuscript, we outline the way cardiac implantable electronic devices (CIEDs) have evolved into remarkably smaller units with greatly enhanced applicability and capabilities.

Computation of Pacemakers Immunity to 50 Hz Electric Field: Induced Voltages 10 Times Greater in Unipolar Than in Bipolar Detection Mode

Thisstudy aims to compute 50 Hz electric field interferences on pacemakers for diverse lead configurations and implantation positions. Induced phenomena in a surface-based virtual human model (standing male grounded with arms closed, 2 mm resolution) are computed for vertical exposure using CST EM^® 3D software, with and without an implanted pacemaker. Induced interference voltages occurring on the pacemaker during exposure are computed and the results are discussed. The bipolar mode covers 99% of the implanted pacing leads in the USA and Europe, according to statistics. The tip-to-ring distance of a lead may influence up to 46% of the induced voltage. In bipolar sensing mode, right ventricle implantation has a 41% higher induced voltage than right atrium implantation. The induced voltage is in average 10 times greater in unipolar mode than in bipolar mode, when implanted in the right atrium or right ventricle. The electric field threshold of interference for a bipolar sensing mode in the worst case setting is 7.24 kV·m⁻¹, and 10 times higher for nominal settings. These calculations will be completed by an in vitro study.