electromagnetic interference in patients with implanted pacemakers or cardioverter-defibrillators
by：Kenwei
2019-08-27
Although no research has been conducted recently to test the effects of home microwave energy on pacemakers and ICDs, it is generally believed that all modern pacemakers are adequately shielded from the microwave energy generated by modern appliances.
Therefore, pacemakers recommend that patients with implanted devices do not need to take special precautions when using microwave ovens or other common household devices such as televisions, radios, toaster and electric blankets.
More than 10 years ago, the effects of metal detectors on the implantation of pacemakers were studied.
Of the 103 patients monitored when passing through a typical metal detector, the alarm is always activated when the patient goes through the gate.
No patient\'s pacemaker function was affected.
All devices are not reset to programmed noise protection mode (most often V00)
Or spontaneous fixed rate functional mode, in patients with normal rhythm, and no output of any device is suppressed, or improperly transmitted in patients with normal heartbeat.
Therefore, it is accepted to inform patients that although the airport screening equipment may detect a pacemaker or ICD metal casing, the equipment will not be adversely affected.
Patients should carry their device identification cards in order to obtain safety clearance. googletag. {});
Several studies have shown that mobile phones can cause EMI using complex medical devices, including pacemakers. 9-
From in vitro studies, there is compelling evidence that, in particular, digital technologies used in commercially available global mobile communication systems (GSM)
Compared with the analog system, mobile phones have great potential to interfere with medical devices. 14-
The explanation of this phenomenon may be the repetition rate of digital burst signals at 2 and 8 hz.
In a large study, Hayes and colleagues evaluated the interaction between five GSM phones and pacemakers in a randomized cross-studyOver-assessment
This study confirmed that in order to cause interference, the cell phone needs to be close to 10 cm from the pocket of the pacemaker;
When the phone is directly located on the pulse generator, the highest incidence of telephone-induced EMI is achieved.
In contrast, the incidence of EMI is very low when the phone is located next to the patient\'s ear.
There is no clinical significance for all interference events (
Prolonged inhibition of pacemaker output, resulting in presynaptic response, fainting, dizziness, or shortness of breath;
Spontaneous fast rhythm or a provocation of fast-paced chamber speed;
Changes in programmed pacemaker settings)
When the phone is placed next to the patient\'s side ear.
Compared with digital devices, it is much less likely to simulate the function of the mobile phone to interfere with the rhythm system.
However, the interference between the manufacturer and model of the pacemaker varies greatly.
The addition of modern filters reduces the possibility of EMI in both a single and bipolar system.
Hayes and collees19 showed similar incidence of interference in both a single and double polar sensing structures.
Dual-chamber pacemakers are more likely to be affected by EMI, probably because the atrial channel is programmed to be more sensitive in order to perceive and respond appropriately to low-pressure spontaneous P waves.
Excessive perception of environmental signals by atrial channels can lead to ventricular rhythm.
Dual-chamber pacemakers are also more susceptible to noise-resilient pacemakers, in which case asynchronous pacemakers can be performed.
Hayes and his colleagues reported that no obvious symptoms were observed when the phone was sufficient (>u200910u2009cm)
Far from the pulse generator
Therefore, as long as the phone is away from the pacemakers at least 10 cm, it is better to be in the opposite side ear, the phone is usually not at any risk to patients with permanent pacemakers.
Mobile phones and ICDsUntil now, in relatively few patients, the possible interactions between North American and European mobile phones in ICDs patients have been studied.
Fe and colleagues tested a phone with a manufacturer\'s various ICD models and found that there was no interaction between the tested phone and ICDs.
In contrast, Bassen and associate ates18 found a serious failure of ICDs when performing in vitro tests on two ICDs from different manufacturers.
This raises the issue that manufacturers are sensitive to mobile phones.
However, at the in vivo stage of this study, none of the 41 patients was affected by overperception independent of the pocket position.
The recommendation from this single study is that patients with ICDs should not carry or place digital cellular phones within 15 cm of the device.
Mobile phones in Europe are different from those in North America. The NADC (
Digital Cellular North America)
The phone works on a carrier frequency of 835 mhz.
For data transmission, pulse amplitude modulation using 50 pulses/second (TDMA-50)
And the peak power of the mobile phone is limited to 0. 6u2009W.
In contrast, the peak power of the digital phone used in GSM in Europe-
Net is 2 w for D-
E-net and 1 wnet. 21 The D-
Net Works on 217 mhz carrier frequency modulated with 900 hz; the E-
Net Works on carrier frequency of 1800 mhz.
Since cell phones in North America are different from those used in Europe, we evaluated in our own research the susceptibility of layered single-room ICDs to other functional barriers caused by EMI or commercially available digital phones
In our evaluation, two different types of European digital mobile phone systems were used.
We looked forward at 97 patients with different ICDs and exposed them to two different types of European digital phones (
Ericsson GH337, 900 mhz and Nokia NHK1EA, 1. 8u2009GHz).
The effect of high RF output was tested during continuous recording of labeled channels and in-cardiac ECG.
During the recording, the convenient phone is placed in the call position close to the patient\'s ear and the top of the device.
We noticed several disturbances.
Loss of communication at the time of inquiry or temporary shutdown of the device)
Most of the 38 patients (93%)
During the testing process close to the device.
The main findings of our research are that digital cellular handheld D-or E-
Internet telephones commonly used in Europe do not interfere with the normal ICD function of single-chamber devices tested in daily living conditions.
Inappropriate sensory and rapid rhythm abnormalities were not found in the test room.
The observations were consistent with the results described by tter and colleagues, 20 Occhetta and colleagues, 23 Barbaro and colleagues, 24 Jimenez and jim.
25 compared to fe and colleagues, 20 we did not see any temporary suspension of the static magnetic field on the function of the ICD (
Magnetic recovery counter = 0)
Generated by the speakers in the handset headset, this may be partly explained by the static magnetic field that the evaluated GSM handset is not too strong.
The implantation technique has nothing to do with the interference of ICD function.
We conclude that there is no evidence that independent of the used GSM network, it would be harmful to use the tested European GSM phones for the tested single-room ICDs.
Since most interference events are recorded when the GSM phone is not far away from the ICDs, it should be recommended that patients do not approach the GSM phone to the device.
This is consistent with the results of in vitro research on GSM mobile phones in the United States.
18. Since the ICD inquiry is the most vulnerable stage to interference, the use of GSM phones should be prohibited in the hospital area where the inquiry occurred.
Electronic item monitoring systems have recently been thought to have the potential to interact with implanted rhythm devices.
26 the commercial use of this scanning device is extensive, case reports have been released, and patients have received inappropriate ICD treatment while hovering or touching between Electronic Article monitoring doors.
The electronic monitoring system uses three different techniques to detect the presence of metal alloy labels in the magnetic field generated between two parallel Gates: magnetic audio, scanning frequency, and acoustic or pulse low frequency.
Detection of such a label means theft.
The literature suggests that significant EMI of implanted rhythm devices is most likely to occur in the acoustic and magnetic mode monitored by electronic articles, and that pacemakers are more likely to be affected than ICDs.
Due to the magnetic field of the six different electronic items monitoring devices, no significant interference to the normal ICD function was found.
In another study, ICDs patients with pacemakers performed routine walking through an electronic item monitoring door, as well as prolonged exposure with or without pacemakers on the implant device
In extreme exposure conditions, of the 169 patients, 7 showed some interaction between the ICD and the electronic item monitoring device (
Noise sensing resulting in complete or long-term suppression of the device output).
This output inhibition may be clinically relevant and noise may also result in inappropriate ICD shocks.
Older-generation devices, as well as those implanted in the abdomen, are more likely to show these interactions than the next generation of devices implanted under the chest.
In general, under reasonable and normal circumstances, electronic monitoring systems do not pose a threat to the tachycardia function of ICDs.
Prolonged exposure or proximity to the transmitter may result in inappropriate shocks.
Electro-acoustic and magnetic monitoring devices can interact with permanent pacemakers.
Asynchronous speed regulation (Noise recovery)
In real life, in the process of crossing these gates, pacemakers induced by atrial and cardiac oversensing and monitoring devices have been described.
Differences in the effects of electronic item monitoring devices on pacemakers were not observed between the single polarity and bipolar sensing configurations.
Because these effects on pacemakers occur only when the patient is in the magnetic field of the electronic item monitoring device, it is recommended that the patient avoid prolonged contact with the electronic item monitoring system and direct contact with the gate is prudent.
Despite the lack of data, ICDs, as part of all existing systems, may have the same considerations and considerations.
The safety of magnetic resonance imaging in patients with magnetic resonance imaging implanted pacemakers and ICDs has been debated for many years.
In general, the presence of these devices is an absolute taboo to receive magnetic resonance imaging, as full suppression of cardiac pacemakers and outputs may occur during magnetic resonance exposure.
27 However, it was suggested that no significant interaction would occur if the patient was positioned as if the chest did not enter the magnet hole.
In addition, magnetic resonance imaging was shown at 0.
5 u2009 t can be performed safely in patients implanted with pacemakers in carefully selected clinical cases, under appropriate strategies (
Programming to asynchronous mode, sufficient monitoring technology, limited RF exposure)are used.
These data need to be confirmed before patients with implanted devices allow magnetic resonance imaging of the limbs.
It is well known that the electric burning device may interfere with the function of the pacemaker.
The frequency generated by these devices can be through the high energy magnetic field of the filters of ICDs and pacemakers.
This may lead to over-perception and has nothing to do with the use of a single-pole or bipolar coagulation pattern.
This over-perception can lead to false detection of pacemaker inhibition or abnormal rapid rhythm in the chamber.
Therefore, for surgical operations using an electrocautery device, patients who rely on a pacemaker should be programmed into an asynchronous pacemaker mode.
Usually, ICD patients should be programmed to test-
Use a programmer.
Nevertheless, if there are monitoring and external vibrators, the detection of ICDs can be temporarily deactivated using a pacemaker magnet placed above the device.
Complementary metal oxide semiconductor (CMOS)
The electronic devices currently used in all pacemakers and ICDs are responsible for the high sensitivity of these devices to ionising radiation.
However, no major studies have been conducted recently to test the effects of radiation therapy on pacemakers and ICDs.
In 1991 reports, Rodriguez and colleague 29 showed a serious failure of pacemakers and ICDs: 8 of the 17 pacemakers exposed to photon radiation failed before 50 gy, whereas exposure
For ICDs, the detection and charging time increased with the increase of the cumulative radiation dose, compared to the charging time of the six ICDs implanted at the same time, the charging time was under less than 50 total pulses
In 1995 Roethig and colleague 30, similar results were shown using 9 mv photon radiation.
Our own experience with three ICD patients receiving cumulative dose
Therefore, pacemakers recommend that patients with implanted devices do not need to take special precautions when using microwave ovens or other common household devices such as televisions, radios, toaster and electric blankets.
More than 10 years ago, the effects of metal detectors on the implantation of pacemakers were studied.
Of the 103 patients monitored when passing through a typical metal detector, the alarm is always activated when the patient goes through the gate.
No patient\'s pacemaker function was affected.
All devices are not reset to programmed noise protection mode (most often V00)
Or spontaneous fixed rate functional mode, in patients with normal rhythm, and no output of any device is suppressed, or improperly transmitted in patients with normal heartbeat.
Therefore, it is accepted to inform patients that although the airport screening equipment may detect a pacemaker or ICD metal casing, the equipment will not be adversely affected.
Patients should carry their device identification cards in order to obtain safety clearance. googletag. {});
Several studies have shown that mobile phones can cause EMI using complex medical devices, including pacemakers. 9-
From in vitro studies, there is compelling evidence that, in particular, digital technologies used in commercially available global mobile communication systems (GSM)
Compared with the analog system, mobile phones have great potential to interfere with medical devices. 14-
The explanation of this phenomenon may be the repetition rate of digital burst signals at 2 and 8 hz.
In a large study, Hayes and colleagues evaluated the interaction between five GSM phones and pacemakers in a randomized cross-studyOver-assessment
This study confirmed that in order to cause interference, the cell phone needs to be close to 10 cm from the pocket of the pacemaker;
When the phone is directly located on the pulse generator, the highest incidence of telephone-induced EMI is achieved.
In contrast, the incidence of EMI is very low when the phone is located next to the patient\'s ear.
There is no clinical significance for all interference events (
Prolonged inhibition of pacemaker output, resulting in presynaptic response, fainting, dizziness, or shortness of breath;
Spontaneous fast rhythm or a provocation of fast-paced chamber speed;
Changes in programmed pacemaker settings)
When the phone is placed next to the patient\'s side ear.
Compared with digital devices, it is much less likely to simulate the function of the mobile phone to interfere with the rhythm system.
However, the interference between the manufacturer and model of the pacemaker varies greatly.
The addition of modern filters reduces the possibility of EMI in both a single and bipolar system.
Hayes and collees19 showed similar incidence of interference in both a single and double polar sensing structures.
Dual-chamber pacemakers are more likely to be affected by EMI, probably because the atrial channel is programmed to be more sensitive in order to perceive and respond appropriately to low-pressure spontaneous P waves.
Excessive perception of environmental signals by atrial channels can lead to ventricular rhythm.
Dual-chamber pacemakers are also more susceptible to noise-resilient pacemakers, in which case asynchronous pacemakers can be performed.
Hayes and his colleagues reported that no obvious symptoms were observed when the phone was sufficient (>u200910u2009cm)
Far from the pulse generator
Therefore, as long as the phone is away from the pacemakers at least 10 cm, it is better to be in the opposite side ear, the phone is usually not at any risk to patients with permanent pacemakers.
Mobile phones and ICDsUntil now, in relatively few patients, the possible interactions between North American and European mobile phones in ICDs patients have been studied.
Fe and colleagues tested a phone with a manufacturer\'s various ICD models and found that there was no interaction between the tested phone and ICDs.
In contrast, Bassen and associate ates18 found a serious failure of ICDs when performing in vitro tests on two ICDs from different manufacturers.
This raises the issue that manufacturers are sensitive to mobile phones.
However, at the in vivo stage of this study, none of the 41 patients was affected by overperception independent of the pocket position.
The recommendation from this single study is that patients with ICDs should not carry or place digital cellular phones within 15 cm of the device.
Mobile phones in Europe are different from those in North America. The NADC (
Digital Cellular North America)
The phone works on a carrier frequency of 835 mhz.
For data transmission, pulse amplitude modulation using 50 pulses/second (TDMA-50)
And the peak power of the mobile phone is limited to 0. 6u2009W.
In contrast, the peak power of the digital phone used in GSM in Europe-
Net is 2 w for D-
E-net and 1 wnet. 21 The D-
Net Works on 217 mhz carrier frequency modulated with 900 hz; the E-
Net Works on carrier frequency of 1800 mhz.
Since cell phones in North America are different from those used in Europe, we evaluated in our own research the susceptibility of layered single-room ICDs to other functional barriers caused by EMI or commercially available digital phones
In our evaluation, two different types of European digital mobile phone systems were used.
We looked forward at 97 patients with different ICDs and exposed them to two different types of European digital phones (
Ericsson GH337, 900 mhz and Nokia NHK1EA, 1. 8u2009GHz).
The effect of high RF output was tested during continuous recording of labeled channels and in-cardiac ECG.
During the recording, the convenient phone is placed in the call position close to the patient\'s ear and the top of the device.
We noticed several disturbances.
Loss of communication at the time of inquiry or temporary shutdown of the device)
Most of the 38 patients (93%)
During the testing process close to the device.
The main findings of our research are that digital cellular handheld D-or E-
Internet telephones commonly used in Europe do not interfere with the normal ICD function of single-chamber devices tested in daily living conditions.
Inappropriate sensory and rapid rhythm abnormalities were not found in the test room.
The observations were consistent with the results described by tter and colleagues, 20 Occhetta and colleagues, 23 Barbaro and colleagues, 24 Jimenez and jim.
25 compared to fe and colleagues, 20 we did not see any temporary suspension of the static magnetic field on the function of the ICD (
Magnetic recovery counter = 0)
Generated by the speakers in the handset headset, this may be partly explained by the static magnetic field that the evaluated GSM handset is not too strong.
The implantation technique has nothing to do with the interference of ICD function.
We conclude that there is no evidence that independent of the used GSM network, it would be harmful to use the tested European GSM phones for the tested single-room ICDs.
Since most interference events are recorded when the GSM phone is not far away from the ICDs, it should be recommended that patients do not approach the GSM phone to the device.
This is consistent with the results of in vitro research on GSM mobile phones in the United States.
18. Since the ICD inquiry is the most vulnerable stage to interference, the use of GSM phones should be prohibited in the hospital area where the inquiry occurred.
Electronic item monitoring systems have recently been thought to have the potential to interact with implanted rhythm devices.
26 the commercial use of this scanning device is extensive, case reports have been released, and patients have received inappropriate ICD treatment while hovering or touching between Electronic Article monitoring doors.
The electronic monitoring system uses three different techniques to detect the presence of metal alloy labels in the magnetic field generated between two parallel Gates: magnetic audio, scanning frequency, and acoustic or pulse low frequency.
Detection of such a label means theft.
The literature suggests that significant EMI of implanted rhythm devices is most likely to occur in the acoustic and magnetic mode monitored by electronic articles, and that pacemakers are more likely to be affected than ICDs.
Due to the magnetic field of the six different electronic items monitoring devices, no significant interference to the normal ICD function was found.
In another study, ICDs patients with pacemakers performed routine walking through an electronic item monitoring door, as well as prolonged exposure with or without pacemakers on the implant device
In extreme exposure conditions, of the 169 patients, 7 showed some interaction between the ICD and the electronic item monitoring device (
Noise sensing resulting in complete or long-term suppression of the device output).
This output inhibition may be clinically relevant and noise may also result in inappropriate ICD shocks.
Older-generation devices, as well as those implanted in the abdomen, are more likely to show these interactions than the next generation of devices implanted under the chest.
In general, under reasonable and normal circumstances, electronic monitoring systems do not pose a threat to the tachycardia function of ICDs.
Prolonged exposure or proximity to the transmitter may result in inappropriate shocks.
Electro-acoustic and magnetic monitoring devices can interact with permanent pacemakers.
Asynchronous speed regulation (Noise recovery)
In real life, in the process of crossing these gates, pacemakers induced by atrial and cardiac oversensing and monitoring devices have been described.
Differences in the effects of electronic item monitoring devices on pacemakers were not observed between the single polarity and bipolar sensing configurations.
Because these effects on pacemakers occur only when the patient is in the magnetic field of the electronic item monitoring device, it is recommended that the patient avoid prolonged contact with the electronic item monitoring system and direct contact with the gate is prudent.
Despite the lack of data, ICDs, as part of all existing systems, may have the same considerations and considerations.
The safety of magnetic resonance imaging in patients with magnetic resonance imaging implanted pacemakers and ICDs has been debated for many years.
In general, the presence of these devices is an absolute taboo to receive magnetic resonance imaging, as full suppression of cardiac pacemakers and outputs may occur during magnetic resonance exposure.
27 However, it was suggested that no significant interaction would occur if the patient was positioned as if the chest did not enter the magnet hole.
In addition, magnetic resonance imaging was shown at 0.
5 u2009 t can be performed safely in patients implanted with pacemakers in carefully selected clinical cases, under appropriate strategies (
Programming to asynchronous mode, sufficient monitoring technology, limited RF exposure)are used.
These data need to be confirmed before patients with implanted devices allow magnetic resonance imaging of the limbs.
It is well known that the electric burning device may interfere with the function of the pacemaker.
The frequency generated by these devices can be through the high energy magnetic field of the filters of ICDs and pacemakers.
This may lead to over-perception and has nothing to do with the use of a single-pole or bipolar coagulation pattern.
This over-perception can lead to false detection of pacemaker inhibition or abnormal rapid rhythm in the chamber.
Therefore, for surgical operations using an electrocautery device, patients who rely on a pacemaker should be programmed into an asynchronous pacemaker mode.
Usually, ICD patients should be programmed to test-
Use a programmer.
Nevertheless, if there are monitoring and external vibrators, the detection of ICDs can be temporarily deactivated using a pacemaker magnet placed above the device.
Complementary metal oxide semiconductor (CMOS)
The electronic devices currently used in all pacemakers and ICDs are responsible for the high sensitivity of these devices to ionising radiation.
However, no major studies have been conducted recently to test the effects of radiation therapy on pacemakers and ICDs.
In 1991 reports, Rodriguez and colleague 29 showed a serious failure of pacemakers and ICDs: 8 of the 17 pacemakers exposed to photon radiation failed before 50 gy, whereas exposure
For ICDs, the detection and charging time increased with the increase of the cumulative radiation dose, compared to the charging time of the six ICDs implanted at the same time, the charging time was under less than 50 total pulses
In 1995 Roethig and colleague 30, similar results were shown using 9 mv photon radiation.
Our own experience with three ICD patients receiving cumulative dose
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