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

Drießen, Sarah; Napp, Andreas; Schmiedchen, Kristina; Kraus, Thomas; Stunder, Dominik

doi:10.1093/europace/euy155

Cited by 42 publications

(26 citation statements)

References 67 publications

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“…A systematic review by Driessen et al showed that electromagnetic fields in the intermediate frequency range (1 kHz to 1 MHz) may interfere with CIEDs depending on the duration of exposure and device or lead characteristics 29 . Interference occurs when electromagnetic waves which are in constant phase to each other overlap precisely 30 .…”

Section: Discussionmentioning

confidence: 99%

Safety of bioelectrical impedance analysis in advanced heart failure patients

Roehrich

Suendermann

Just

et al. 2020

Pacing Clinical Electrophis

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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).

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Section: Discussionmentioning

confidence: 99%

Safety of bioelectrical impedance analysis in advanced heart failure patients

Roehrich

Suendermann

Just

et al. 2020

Pacing Clinical Electrophis

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“…Some studies detected severe EMI with altered CIED function when the sensitivity of the CIEDs was lowered and at the setting of a unipolar sensing configuration 25 . In fact, the risk of EMI with CIEDs could be reduced by programming the sensitivity settings and altering the lead sensing configuration from a unipolar to bipolar model 31 . The sensitivity should be set at a high value, which could both ensure an appropriate sensing of intrinsic cardiac signals and avoid oversensing in the atrial or ventricular channel.…”

Section: Discussionmentioning

confidence: 99%

Electromagnetic interference effect of dental equipment on cardiac implantable electrical devices: A systematic review

Niu

Chen

et al. 2020

Pacing Clinical Electrophis

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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.

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“…Implantable medical devices (IMDs) are an example of a safety-critical system where external electromagnetic interference (EMI) can cause physical harm to people. As a result, there is extensive research on the EMI behavior of various IMDs [82]- [94]. Some of these works have even pinpointed the properties of "non-linear circuit elements" in pacemakers as the culprits for demodulating RF signals produced by cell phones [86], [95].…”

Section: Electromagnetic Transmissionsmentioning

confidence: 99%

Taxonomy and Challenges of Out-of-Band Signal Injection Attacks and Defenses

Giechaskiel

Rasmussen

2020

IEEE Commun. Surv. Tutorials

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Recent research has shown that the integrity of sensor measurements can be violated through out-of-band signal injection attacks. These attacks target the conversion process from a physical quantity to an analog property-a process that fundamentally cannot be authenticated. Out-of-band signal injection attacks thus pose previously-unexplored security risks by exploiting hardware imperfections in the sensors themselves, or in their interfaces to microcontrollers. In response to the growingyet-disjointed literature in the subject, this article presents the first survey of out-of-band signal injection attacks. It focuses on unifying their terminology and identifying commonalities in their causes and effects through a chronological, evolutionary, and thematic taxonomy of attacks. By highlighting cross-influences between different types of out-of-band signal injections, this paper underscores the need for a common language irrespective of the attack method. By placing attack and defense mechanisms in the wider context of their dual counterparts of side-channel leakage and electromagnetic interference, this study identifies common threads and gaps that can help guide and inform future research. Overall, the ever-increasing reliance on sensors embedded in everyday commodity devices necessitates that a stronger focus be placed on improving the security of such systems against out-of-band signal injection attacks.

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

Cited by 42 publications

References 67 publications

Safety of bioelectrical impedance analysis in advanced heart failure patients

Safety of bioelectrical impedance analysis in advanced heart failure patients

Electromagnetic interference effect of dental equipment on cardiac implantable electrical devices: A systematic review

Taxonomy and Challenges of Out-of-Band Signal Injection Attacks and Defenses

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