Effects of medically generated electromagnetic interference from medical devices on cardiac implantable electronic devices: A review

Abstract

As cardiac implantable electronic devices (CIED) become more prevalent, it is important to acknowledge potential electromagnetic interference (EMI) from other sources, such as internal and external electronic devices and procedures and its effect on these devices. EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), respectively. This review analyzes potential EMI amongst CIED and left ventricular assist device, deep brain stimulators, spinal cord stimulators, transcutaneous electrical nerve stimulators, and throughout an array of procedures, such as endoscopy, bronchoscopy, and procedures involving electrocautery. Although there is evidence to support EMI from internal and external devices and during procedures, there is a lack of large multicenter studies, and, as a result, current management guidelines are based primarily on expert opinion and anecdotal experience. We aim to provide a general overview of PPM/ICD function, review documented EMI effect on these devices, and acknowledge current management of CIED interference.

Impact of Radiotherapy on Malfunctions and Battery Life of Cardiac Implantable Electronic Devices in Cancer Patients

“…As EMI can be interpreted by the PM as an intrinsic cardiac signal, pacing can be inhibited, leading to bradycardia and potentially cardiac arrest [33]. In ICDs, oversensing due to EMI can result in unnecessary shock delivery [33]. In our study, EMI was not detected, mainly because RF emissions of the LINACs were very minor when measured.…”

“…As four CIED malfunctions were detected at treatments with a calculated cumulative dose of 0 Gy at the CIED but with photon energies ≥ 10 MeV, we assume that the scattered neutrons produced by high-energy beams might cause malfunction independently from the distance to the CIED [32]. However, other mechanisms, such as electromagnetic interference (EMI) with scattered radiofrequency (RF) waves emitted by the LINAC due to insufficient shielding, could also be potential causes for CIED malfunction and cannot be completely excluded [33,34]. EMI can lead to various effects on CIEDs, ranging from benign interference that may not affect device function to potentially more serious consequences.…”

“…EMI can lead to various effects on CIEDs, ranging from benign interference that may not affect device function to potentially more serious consequences. As EMI can be interpreted by the PM as an intrinsic cardiac signal, pacing can be inhibited, leading to bradycardia and potentially cardiac arrest [33]. In ICDs, oversensing due to EMI can result in unnecessary shock delivery [33].…”