Cardiac implantable electronic device interactions with electromagnetic fields in the non-hospital environment
- David L Hayes, MD
David L Hayes, MD
- Professor of Medicine
- Mayo Medical School
While there has always been concern about the potential for electromagnetic interference with pacemaker, implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) function, due to interaction between the device and an electromagnetic field, the risk is quite low (table 1) [1,2]. Electromagnetic interference (EMI) can occur in a variety of settings, but overall is more likely in the hospital environment than in the non-hospital environment .
There have been occasional reports of cardiac implantable electronic devices (CIEDs) being impacted by sources of EMI in the non-hospital environment (eg, slot machines, laptop computers, etc). There are also disclaimers that wireless sources could be the source of EMI with CIEDs, even though no published data exists (eg, automobile manufacturers providing "caution" for device patients purchasing automobiles with "keyless" entry mechanisms, hybrid engines, etc). Nonetheless, there are few sources of EMI in the non-hospital environment which are truly concerning [4,5]. However, with the proliferation of wireless technology, any new device which operates on a new frequency or new technology platform should be assessed in order to determine whether there is indeed any significant potential for EMI with any CIED.
Electromagnetic interference with medical sources is discussed separately. (See "Pacing system malfunction: Evaluation and management", section on 'Electromagnetic interference' and "Implantable cardioverter-defibrillators: Complications", section on 'Electromagnetic interference'.)
Although there are no studies that have systematically evaluated the effect of household microwave ovens on implanted devices, it is widely accepted that contemporary pacemakers and ICDs are adequately shielded from microwave energy produced by modern appliances . Pacemaker manufacturers do not recommend any special precautions when using common household appliances, such as televisions, radios, toasters, microwave ovens, and electric blankets. As a new appliance that uses a new or different energy source reaches the market, the appliance needs to be tested to determine whether there is any potential for device interference.
There are circumstances in which a device may be affected by specific sources of energy under narrow circumstances. This was illustrated in a study assessing the potential for induction cook tops to interfere with pacemaker function. Patients with a unipolar, left-sided implant could experience interference if the pot was not concentrically placed on the induction coil and if the patient stood as close as possible to the cook top. The most common response to interference was a reset to an asynchronous interference mode . Most contemporary devices utilize bipolar pacing and sensing configuration, which minimizes the chance of device malfunction from electromagnetic interference. One study demonstrates that the iPAD 2, if placed in direct contact with the ICD implant site, may result in the ICD going to "magnet mode" .
- Pinski SL, Trohman RG. Interference in implanted cardiac devices, Part I. Pacing Clin Electrophysiol 2002; 25:1367.
- Kolb C, Zrenner B, Schmitt C. Incidence of electromagnetic interference in implantable cardioverter defibrillators. Pacing Clin Electrophysiol 2001; 24:465.
- Goldschlager N, Epstein A, Friedman P, et al. Environmental and drug effects on patients with pacemakers and implantable cardioverter/defibrillators: a practical guide to patient treatment. Arch Intern Med 2001; 161:649.
- Napp A, Stunder D, Maytin M, et al. Are patients with cardiac implants protected against electromagnetic interference in daily life and occupational environment? Eur Heart J 2015; 36:1798.
- Misiri J, Kusumoto F, Goldschlager N. Electromagnetic interference and implanted cardiac devices: the nonmedical environment (part I). Clin Cardiol 2012; 35:276.
- Irnich W, Bernstein AD. Do induction cooktops interfere with cardiac pacemakers? Europace 2006; 8:377.
- Kozik TM, Chien G, Connolly TF, et al. iPad2(R) use in patients with implantable cardioverter defibrillators causes electromagnetic interference: the EMIT Study. J Am Heart Assoc 2014; 3:e000746.
- Irnich W, Batz L, Müller R, Tobisch R. Electromagnetic interference of pacemakers by mobile phones. Pacing Clin Electrophysiol 1996; 19:1431.
- Hayes DL, Wang PJ, Reynolds DW, et al. Interference with cardiac pacemakers by cellular telephones. N Engl J Med 1997; 336:1473.
- Trigano A, Blandeau O, Dale C, et al. Reliability of electromagnetic filters of cardiac pacemakers tested by cellular telephone ringing. Heart Rhythm 2005; 2:837.
- Ismail MM, Badreldin AM, Heldwein M, Hekmat K. Third-generation mobile phones (UMTS) do not interfere with permanent implanted pacemakers. Pacing Clin Electrophysiol 2010; 33:860.
- Barbaro V, Bartolini P, Bellocci F, et al. Electromagnetic interference of digital and analog cellular telephones with implantable cardioverter defibrillators: in vitro and in vivo studies. Pacing Clin Electrophysiol 1999; 22:626.
- Chiladakis JA, Davlouros P, Agelopoulos G, Manolis AS. In-vivo testing of digital cellular telephones in patients with implantable cardioverter-defibrillators. Eur Heart J 2001; 22:1337.
- Occhetta E, Plebani L, Bortnik M, et al. Implantable cardioverter defibrillators and cellular telephones: is there any interference? Pacing Clin Electrophysiol 1999; 22:983.
- Hayes DL, Carrillo RG, Findlay GK, Embrey M. State of the science: pacemaker and defibrillator interference from wireless communication devices. Pacing Clin Electrophysiol 1996; 19:1419.
- Fetter JG, Ivans V, Benditt DG, Collins J. Digital cellular telephone interaction with implantable cardioverter-defibrillators. J Am Coll Cardiol 1998; 31:623.
- Bassen H. Low frequency magnetic emissions and resulting induced voltages in a pacemaker by iPod portable music players. Biomed Eng Online 2008; 7:7.
- Thaker JP, Patel MB, Jongnarangsin K, et al. Electromagnetic interference with pacemakers caused by portable media players. Heart Rhythm 2008; 5:538.
- Webster G, Jordao L, Martuscello M, et al. Digital music players cause interference with interrogation telemetry for pacemakers and implantable cardioverter-defibrillators without affecting device function. Heart Rhythm 2008; 5:545.
- Lee S, Fu K, Kohno T, et al. Clinically significant magnetic interference of implanted cardiac devices by portable headphones. Heart Rhythm 2009; 6:1432.
- Gimbel JR, Cox JW Jr. Electronic article surveillance systems and interactions with implantable cardiac devices: risk of adverse interactions in public and commercial spaces. Mayo Clin Proc 2007; 82:318.
- Mugica J, Henry L, Podeur H. Study of interactions between permanent pacemakers and electronic antitheft surveillance systems. Pacing Clin Electrophysiol 2000; 23:333.
- McIvor ME, Reddinger J, Floden E, Sheppard RC. Study of Pacemaker and Implantable Cardioverter Defibrillator Triggering by Electronic Article Surveillance Devices (SPICED TEAS). Pacing Clin Electrophysiol 1998; 21:1847.
- Wilke A, Kruse T, Hesse H, et al. Interactions between pacemakers and security systems. Pacing Clin Electrophysiol 1998; 21:1784.
- Santucci PA, Haw J, Trohman RG, Pinski SL. Interference with an implantable defibrillator by an electronic antitheft-surveillance device. N Engl J Med 1998; 339:1371.
- Groh WJ, Boschee SA, Engelstein ED, et al. Interactions between electronic article surveillance systems and implantable cardioverter-defibrillators. Circulation 1999; 100:387.
- Fetter JG, Benditt DG, Stanton MS. Electromagnetic interference from welding and motors on implantable cardioverter-defibrillators as tested in the electrically hostile work site. J Am Coll Cardiol 1996; 28:423.
- Glotzer TV, Gordon M, Sparta M, et al. Electromagnetic interference from a muscle stimulation device causing discharge of an implantable cardioverter defibrillator: epicardial bipolar and endocardial bipolar sensing circuits are compared. Pacing Clin Electrophysiol 1998; 21:1996.
- Philbin DM, Marieb MA, Aithal KH, Schoenfeld MH. Inappropriate shocks delivered by an ICD as a result of sensed potentials from a transcutaneous electronic nerve stimulation unit. Pacing Clin Electrophysiol 1998; 21:2010.
- Wolber T, Ryf S, Binggeli C, et al. Potential interference of small neodymium magnets with cardiac pacemakers and implantable cardioverter-defibrillators. Heart Rhythm 2007; 4:1.
- HOUSEHOLD APPLIANCES
- CELLULAR TELEPHONES
- Permanent pacemakers
- Implantable cardioverter-defibrillators
- PORTABLE MEDIA PLAYERS
- SECURITY SYSTEMS
- Permanent pacemakers
- Implantable cardioverter-defibrillators
- EXTERNAL ELECTRICAL EQUIPMENT
- LEAKAGE OF CURRENT FROM ELECTRICAL EQUIPMENT DRIVEN BY A POWER LINE
- TRANSCUTANEOUS MUSCLE/NERVE STIMULATORS
- SMALL MAGNETS INCORPORATED INTO CLOTHING, FURNITURE, AND IDENTIFICATION BADGES
- MAGNETIC RESONANCE IMAGING
- INFORMATION FOR PATIENTS