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Koh CH. Commercial Air Travel for Passengers With Cardiovascular Disease: Recommendations for Common Conditions. Curr Probl Cardiol 2020; 46:100768. [PMID: 33348221 DOI: 10.1016/j.cpcardiol.2020.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
The exponential growth of commercial flights has resulted in an explosion of air travelers over the last few decades, including passengers with a wide range of cardiovascular conditions. Notwithstanding the ongoing COVID-19 pandemic that had set back the aviation industry for the next 1-2 years, air travel is expected to rebound fully by 2024. Guidelines and evidence-based recommendations for safe air travel in this group vary, and physicians often encounter situations where opinions and assessments on fitness for flights are sought. This article aims to provide an updated suite of recommendations for the aeromedical disposition of passenger with common cardiovascular conditions, such as ischemic heart disease, congestive heart failure, valvular heart disease, cardiomyopathies, and common arrhythmias.
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Affiliation(s)
- Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore; Changi Aviation Medical Centre, Changi General Hospital, Singapore.
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Koh CH. Commercial Air Travel for Passengers With Cardiovascular Disease: Stressors of Flight and Aeromedical Impact. Curr Probl Cardiol 2020; 46:100746. [PMID: 33213942 PMCID: PMC8514285 DOI: 10.1016/j.cpcardiol.2020.100746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 12/04/2022]
Abstract
The exponential growth of commercial flights has resulted in a sharp rise of air travellers over the last 2 decades, including passengers with a wide range of cardiovascular conditions. Notwithstanding the ongoing COVID-19 pandemic that had set back the aviation industry for the next 1 to 2 years, air travel is expected to rebound fully by 2023-2024. Guidelines and evidence-based recommendations for safe air travel in this group vary, and physicians often encounter situations where opinions and assessments on fitness for flights are sought. This article aims to provide an overview of the stressors of commercial passenger flights with an impact on cardiovascular health for the general cardiologist and family practitioner, when assessing the suitability of such patients for flying fitness.
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Affiliation(s)
- Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore; Changi Aviation Medical Centre, Changi General Hospital, Singapore.
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Ghaly RF, Tverdohleb T, Candido KD, Knezevic NN. Do we need to establish guidelines for patients with neuromodulation implantable devices, including spinal cord stimulators undergoing nonspinal surgeries? Surg Neurol Int 2016; 7:18. [PMID: 26958424 PMCID: PMC4766801 DOI: 10.4103/2152-7806.176373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/05/2016] [Indexed: 12/31/2022] Open
Abstract
Background: Spinal cord stimulation is currently approved to treat chronic intractable pain of the trunk and limbs. However, such implantable electronic devices are vulnerable to external electrical currents and magnetic fields. Within the hospitals and modern operating rooms (ORs), there is an abundance of electrical devices and other types of equipment that could interfere with such devices. Despite the increasing number of patients with neuromodulation implantable devices, there are no written guidelines available or consensus of cautions for such patients undergoing unrelated surgery. Case Descriptions: A 60-year-old female with a permanent St. Jude's spinal cord stimulator (SCS) presented for open total abdominal hysterectomy. Both the anesthesia and gynecology staffs were aware of the device presence, but were unaware of any precautions regarding intraoperative management. The device was found to be nonmagnetic resonance imaging compatible, and bipolar cautery was used instead of monopolar cautery. A 59-year-old female with a 9-year-old permanent Medtronic SCS, presented for right total hip arthroplasty. The device was switched off prior to entering the OR, bipolar cautery was used, and grounding pads were placed away from her battery site. In each case, the manufacturer's representative was contacted preoperative. Both surgeries proceeded uneventfully. Conclusions: The Food and Drug Administration safety information manual warns about the use of diathermy, concomitant implanted stimulation devices, lithotripsy, external defibrillation, radiation therapy, ultrasonic scanning, and high-output ultrasound, all of which can lead to permanent implant damage if not turned off prior to undertaking procedures. Lack of uniform guidelines makes intraoperative management, as well as remote anesthesia care of patients with previously implanted SCSs unsafe.
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Affiliation(s)
- Ramsis F Ghaly
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, JHS Hospital of Cook County, Chicago, IL, USA; Ghaly Neurosurgical Associates, Aurora, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA
| | - Tatiana Tverdohleb
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA
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Khan MMKS, Khan MMHS, Tolan A, Elmouchi D, Tavera CE. Breast tissue expanders and implantable cardioverter-defibrillator: An unusual interaction. HeartRhythm Case Rep 2015; 1:167-168. [PMID: 28491539 PMCID: PMC5419249 DOI: 10.1016/j.hrcr.2015.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
| | | | - Aaron Tolan
- Grand Rapids Medical Education Partners, Michigan State University, Grand Rapids, Michigan
| | - Darryl Elmouchi
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, Michigan.,Department of Internal Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Carlos E Tavera
- Grand Rapids Medical Education Partners, Michigan State University, Grand Rapids, Michigan.,Department of Internal Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan
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Safety of Computed Tomography in Patients With Cardiac Rhythm Management Devices. J Am Coll Cardiol 2014; 63:1769-75. [DOI: 10.1016/j.jacc.2013.12.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/04/2013] [Accepted: 12/23/2013] [Indexed: 11/19/2022]
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Santini L, Forleo GB, Santini M. Implantable devices in the electromagnetic environment. J Arrhythm 2013. [DOI: 10.1016/j.joa.2013.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Capsule Endoscopy in Patients with Implantable Electromedical Devices is Safe. Gastroenterol Res Pract 2013; 2013:959234. [PMID: 23710168 PMCID: PMC3654345 DOI: 10.1155/2013/959234] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 02/24/2013] [Indexed: 02/08/2023] Open
Abstract
Background and Study Aims. The presence of an implantable electromechanical cardiac device (IED) has long been considered a relative contraindication to the performance of video capsule endoscopy (CE). The primary aim of this study was to evaluate the safety of CE in patients with IEDs. A secondary purpose was to determine whether IEDs have any impact on images captured by CE. Patients and Methods. A retrospective chart review of all patients who had a capsule endoscopy at Mayo Clinic in Scottsdale, AZ, USA, or Rochester, MN, USA, (January 2002 to June 2010) was performed to identify CE studies done on patients with IEDs. One hundred and eighteen capsule studies performed in 108 patients with IEDs were identified and reviewed for demographic data, method of preparation, and study data. Results. The most common indications for CE were obscure gastrointestinal bleeding (77%), anemia (14%), abdominal pain (5%), celiac disease (2%), diarrhea (1%), and Crohn's disease (1%). Postprocedure assessments did not reveal any detectable alteration on the function of the IED. One patient with an ICD had a 25-minute loss of capsule imaging due to recorder defect. Two patients with LVADs had interference with capsule image acquisition. Conclusions. CE did not interfere with IED function, including PM, ICD, and/or LVAD and thus appears safe. Additionally, PM and ICD do not appear to interfere with image acquisition but LVAD may interfere with capsule images and require that capsule leads be positioned as far away as possible from the IED to assure reliable image acquisition.
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Chung JW, Hwang HJ, Chung MJ, Park JY, Pak HN, Song SY. Safety of capsule endoscopy using human body communication in patients with cardiac devices. Dig Dis Sci 2012; 57:1719-1723. [PMID: 22311369 DOI: 10.1007/s10620-012-2067-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 01/17/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND The MiroCam (IntroMedic, Ltd., Seoul, Korea) is a small-bowel capsule endoscope that uses human body communication to transmit data. The potential interactions between cardiac devices and the capsule endoscope are causes for concern, but no data are available for this matter. AIM This clinical study was designed to evaluate the potential influence of the MiroCam capsules on cardiac devices. METHODS Patients with cardiac pacemakers or implantable cardiac defibrillators referred for evaluation of small bowel disease were prospectively enrolled in this study. Before capsule endoscopy, a cardiologist checked baseline electrocardiograms and functions of the cardiac devices. Cardiac rhythms were continuously monitored by 24-h telemetry during capsule endoscopy in the hospital. After completion of procedures, functions of the cardiac devices were checked again for interference. Images from the capsule endoscopy were reviewed and analyzed for technical problems. RESULTS Six patients, three with pacemakers and three with implantable cardiac defibrillators, were included in the study. We identified no disturbances in the cardiac devices and no arrhythmias detected on telemetry monitoring during capsule endoscopy. No significant changes in the programmed parameters of the cardiac devices were noted after capsule endoscopy. There were no imaging disturbances from the cardiac devices on capsule endoscopy. CONCLUSIONS Capsule endoscopy using human body communication to transmit data was safely performed in patients with cardiac pacemakers or implantable cardiac defibrillators. Images from the capsule endoscopy were not affected by cardiac devices. A further large-scale study is required to confirm the safety of capsule endoscopy with various types of cardiac devices.
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Affiliation(s)
- Joo Won Chung
- Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Misiri J, Kusumoto F, Goldschlager N. Electromagnetic interference and implanted cardiac devices: the nonmedical environment (part I). Clin Cardiol 2012; 35:276-80. [PMID: 22539305 DOI: 10.1002/clc.21998] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/19/2012] [Indexed: 12/13/2022] Open
Abstract
The number of patients with cardiovascular implantable electronic devices (CIEDs), such as permanent pacemakers and implantable cardioverter-defibrillators, is dramatically rising due to an aging population and recent clinical trials showing benefits in mortality and morbidity. Coupled with this increase in the number of patients with CIEDs is the proliferation of technology that emits electromagnetic signals, which can potentially interfere with CIED function through electromagnetic interference (EMI). Despite continuous efforts of manufacturers to create "EMI-proof" CIEDs, adverse events from EMI still occur. Physicians caring for patients with CIEDs should be aware of potential sources of EMI and appropriate management options. This 2-part review aims to provide a contemporary overview of the current knowledge regarding risks attributable to EMI interactions from the most common nonmedical (Part I) and medical (Part II) sources.
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Affiliation(s)
- Juna Misiri
- Department of Medicine, Division of Cardiovascular Disease, Electrophysiology and Pacing Service, Mayo Clinic, 4500 San Pablo Avenue, Jacksonville, FL 32224, USA
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Cuschieri JR, Osman MN, Wong RC, Chak A, Isenberg GA. Small bowel capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators: Outcome analysis using telemetry review. World J Gastrointest Endosc 2012; 4:87-93. [PMID: 22442746 PMCID: PMC3309898 DOI: 10.4253/wjge.v4.i3.87] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 02/01/2012] [Accepted: 03/01/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine if there were any interactions between cardiac devices and small bowel capsules secondary to electromagnetic interference (EMI) in patients who have undergone small bowel capsule endoscopy (SBCE).
METHODS: Authors conducted a chart review of 20 patients with a cardiac pacemaker (CP) or implantable cardioverter defibrillator (ICD) who underwent continuous electrocardiographic monitoring during their SBCE from 2003-2008. authors searched for unexplained electrocardiogram (ECG) findings, changes in CP and ICD set parameters, any abnormality in transmitted capsule data, and adverse clinical events.
RESULTS: There were no adverse events or hemodynamically significant arrhythmias reported. CP and ICD set parameters were preserved. The majority of ECG abnormalities were also found in pre- or post- SBCE ECG tracings and the CP behavior during arrhythmias appeared appropriate. Two patients seemed to have episodes of undersensing by the CP. However, similar findings were documented in ECGs taken outside the time frame of the SBCE. One patient was observed to have a low signal encountered from the capsule resulting in lack of localization, but no images were lost.
CONCLUSION: Capsule-induced EMI remains a possibility but is unlikely to be clinically important. CP-induced interference of SBCE is also possible, but is infrequent and does not result in loss of images transmitted by the capsule.
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Affiliation(s)
- Justin R Cuschieri
- Justin R Cuschieri, Division of Gastroenterology, Department of Medicine, Albert Einstein Medical Center, 5401 Old York Road, Klein building suite 363, Philadelphia, PA 19141, United States
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TIIKKAJA MARIA, ARO AAPO, ALANKO TOMMI, LINDHOLM HARRI, HIETANEN MAILA. Inappropriate Implantable Cardioverter-Defibrillator Magnet-Mode Switch Induced by a Laptop Computer. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:e177-8. [DOI: 10.1111/j.1540-8159.2012.03330.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ginwalla M, Battula S, Dunn J, Lewis WR. Termination of electrocution-induced ventricular fibrillation by an implantable cardioverter defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 33:510-2. [PMID: 20015136 DOI: 10.1111/j.1540-8159.2009.02607.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe a case in which an implantable cardioverter defibrillator (ICD) saved a patient's life after he tried to commit suicide by electrocuting himself. Deaths caused by electrocution are usually accidental and rarely suicidal. The amount of current flow is the most important factor in deciding the degree of electrical injury, which may range from transient muscle tremors to death. The ICD is electrically insulated from surrounding electromagnetic interference and the passage of electric current typically does not damage or reprogram the device. In our patient, electromagnetic interference caused by the electric current initially triggered the noise reversion mode, leading to asynchronous pacing. Ventricular fibrillation was detected and terminated only after the electromagnetic interference stopped, as depicted by the intracardiac electrogram. This case is the first documented example of an ICD-aborted fatal electrocution from ventricular fibrillation caused by an unnatural electrical source. (PACE 2010; 510-512).
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Affiliation(s)
- Mahazarin Ginwalla
- Department of Cardiology, Metrohealth Campus, Case Western Reserve University, Cleveland, Ohio, USA.
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Lippi G, Blanckaert N, Bonini P, Green S, Kitchen S, Palicka V, Vassault AJ, Mattiuzzi C, Plebani M. Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics. Clin Chem Lab Med 2009; 47:143-53. [PMID: 19099525 DOI: 10.1515/cclm.2009.045] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laboratory diagnostics, a pivotal part of clinical decision making, is no safer than other areas of healthcare, with most errors occurring in the manually intensive preanalytical process. Patient misidentification errors are potentially associated with the worst clinical outcome due to the potential for misdiagnosis and inappropriate therapy. While it is misleadingly assumed that identification errors occur at a low frequency in clinical laboratories, misidentification of general laboratory specimens is around 1% and can produce serious harm to patients, when not promptly detected. This article focuses on this challenging issue, providing an overview on the prevalence and leading causes of identification errors, analyzing the potential adverse consequences, and providing tentative guidelines for detection and prevention based on direct-positive identification, the use of information technology for data entry, automated systems for patient identification and specimen labeling, two or more identifiers during sample collection and delta check technology to identify significant variance of results from historical values. Once misidentification is detected, rejection and recollection is the most suitable approach to manage the specimen.
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Abstract
Potential interference between implanted cardiac devices such as pacemakers and implantable cardioverter-defibrillators and electromagnetic fields is an important concern for physicians taking care of patients with pacemakers and implantable cardioverter-defibrillators. There are many sources of electromagnetic interference (EMI); however, only a small number of these cause significant problems that need attention. Regardless of its source, EMI is of greater concern for a patient who is dependent on paced rhythm because inhibition of the pacemaker by EMI may produce ventricular standstill. It is important that cardiologists, internists, emergency medicine, critical care physicians, and anesthesiologists be aware of how EMI can affect the function of implanted cardiac devices so that appropriate treatment can be rendered and preventive measures instituted.
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Zhan C, Baine WB, Sedrakyan A, Steiner C. Cardiac device implantation in the United States from 1997 through 2004: a population-based analysis. J Gen Intern Med 2008; 23 Suppl 1:13-9. [PMID: 18095038 PMCID: PMC2359586 DOI: 10.1007/s11606-007-0392-0] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Use of cardiac devices has been increasing rapidly along with concerns over their safety and effectiveness. This study used hospital administrative data to assess cardiac device implantations in the United States, selected perioperative outcomes, and associated patient and hospital characteristics. METHODS We screened hospital discharge abstracts from the 1997-2004 Healthcare Cost and Utilization Project Nationwide Inpatient Samples. Patients who underwent implantation of pacemaker (PM), automatic cardioverter/defibrillator (AICD), or cardiac resynchronization therapy pacemaker (CRT-P) or defibrillator (CRT-D) were identified using ICD-9-CM procedure codes. Outcomes ascertainable from these data and associated hospital and patient characteristics were analyzed. MEASUREMENTS AND MAIN RESULTS Approximately 67,000 AICDs and 178,000 PMs were implanted in 2004 in the United States, increasing 60% and 19%, respectively, since 1997. After FDA approval in 2001, CRT-D and CRT-P reached 33,000 and 7,000 units per year in the United States in 2004. About 70% of the patients were aged 65 years or older, and more than 75% of the patients had 1 or more comorbid diseases. There were substantial decreases in length of stay, but marked increases in charges, for example, the length of stay of AICD implantations halved (from 9.9 days in 1997 to 5.2 days in 2004), whereas charges nearly doubled (from $66,000 in 1997 to $117,000 in 2004). Rates of in-hospital mortality and complications fluctuated slightly during the period. Overall, adverse outcomes were associated with advanced age, comorbid conditions, and emergency admissions, and there was no consistent volume-outcome relationship across different outcome measures and patient groups. CONCLUSIONS The numbers of cardiac device implantations in the United States steadily increased from 1997 to 2004, with substantial reductions in length of stay and increases in charges. Rates of in-hospital mortality and complications changed slightly over the years and were associated primarily with patient frailty.
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Affiliation(s)
- Chunliu Zhan
- Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, Rockville, MD, USA.
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Ozben B, Bilge AK, Yilmaz E, Adalet K. Implantation of a permanent pacemaker in a patient with severe Parkinson's disease and a preexisting bilateral deep brain stimulator. Int Heart J 2007; 47:803-10. [PMID: 17106151 DOI: 10.1536/ihj.47.803] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiac pacemakers and implantable defibrillators are commonly used therapeutic modalities in cardiac arrhythmias. Thalamic deep brain stimulation has also become an important modality in the treatment of drug-refractory tremors and other complications in advanced Parkinson's disease. Concerns exist about the potential electrical interaction and interference between these 2 devices in the same patient. There are only a limited number of reports that have investigated this issue. We describe a patient with advanced Parkinson's disease and a previously implanted deep brain stimulator, who subsequently needed a permanent cardiac pacemaker due to severe bradyarrhythmia. Despite the probability of interference between the devices, there were no problems during implantation of the cardiac pacemaker; both the deep brain stimulator and cardiac pacemaker functioned appropriately afterwards.
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Affiliation(s)
- Beste Ozben
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Affiliation(s)
- J Scott Allison
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA
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Gimbel JR, Cox JW. Electronic article surveillance systems and interactions with implantable cardiac devices: risk of adverse interactions in public and commercial spaces. Mayo Clin Proc 2007; 82:318-22. [PMID: 17352368 DOI: 10.4065/82.3.318] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Electronic article surveillance (EAS) systems are widely implemented in public spaces and can adversely affect the performance of pacemakers and implantable cardioverter defibrillators. The interaction between implantable devices and EAS systems is a serious problem that can be minimized through appropriate facility design. Careful facility design and employee education along with patient vigilance remain imperative in avoiding potentially life-threatening EAS system-implantable device interactions.
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Affiliation(s)
- J Rod Gimbel
- Department of Cardiology, Parkwest Hospital, Knoxville, Tenn, USA.
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Al Khadra AS, Al Jutaily A, Al Shuhri S. Detection of refrigerator-associated 60 Hz alternating current as ventricular fibrillation by an implantable defibrillator. ACTA ACUST UNITED AC 2006; 8:175-7. [PMID: 16627434 DOI: 10.1093/europace/euj001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This report describes a patient with an implantable defibrillator who suffered an inappropriate defibrillation shock upon retrieving some food items from his inadequately earthed refrigerator. Noise typical of electrical interference can be observed in the stored electrogram of the episode. The patient was instructed to earth his home appliances, but he decided to avoid his refrigerator altogether, and has had no subsequent shocks.
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Affiliation(s)
- Ayman S Al Khadra
- Department of Adult Cardiology, Prince Sultan Cardiac Center, PO Box 7897, X-982, Riyadh 11159, Saudi Arabia.
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Yamaji S, Imai S, Saito F, Yagi H, Kushiro T, Uchiyama T. Does High-Power Computed Tomography Scanning Equipment Affect the Operation of Pacemakers? Circ J 2006; 70:190-7. [PMID: 16434814 DOI: 10.1253/circj.70.190] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Computed tomography (CT) is widely used in clinical practice, but there has not been a detailed report of its effect on the functioning of pacemakers. METHODS AND RESULTS During CT, ECGs were recorded in 11 patients with pacemakers and the electromagnetic field in the CT room was also measured. The effect of CT on a pacemaker was also investigated in a human body model with and without shielding by rubber or lead. Transient malfunctions of pacemakers during CT occurred in 6 of 11 patients. The model showed that malfunctioning of the pacemaker was induced by CT scanning and this was prevented by lead but not by rubber. The alternating electrical field was 150 V/m on the CT scanning line, which was lower than the level influencing pacemaker functions. The alternating magnetic field was 15 muT on the CT scanning line, which was also lower than the level influencing pacemaker functions. CONCLUSIONS Malfunctions of the pacemaker during CT may be caused by diagnostic radiant rays and although they are transient, the possibility of lethal arrhythmia cannot be ignored.
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Affiliation(s)
- Satoshi Yamaji
- Division of Cardiovascular Medicine, Department of Medicine, Nihon University School of Medicine, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan
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Abstract
Sudden cardiac death (SCD) is a major healthcare problem worldwide. The majority of SCD events occur in patients with clinically recognized heart disease and most episodes result from ventricular tachyarrhythmias. Implantable cardioverter defibrillator (ICD) therapy prevents SCD in specific patient populations. Significant progress in the design and technology has been made since the Food and Drug Administration first approved the ICD in 1985. First-generation ICDs were large, were implanted in the abdomen, required a thoracotomy for placing epicardial defibrillation patches, and were nonprogrammable. Contemporary ICDs have been substantially downsized, are implanted via a transvenous approach, and are multiprogrammable. Device implantation has been simplified to be similar to that of a permanent pacemaker. In addition to treating life-threatening ventricular arrhythmias, ICDs now treat bradyarrhythmias, atrial arrhythmias, and congestive heart failure. The purpose of this article is to describe the evidence supporting the use of ICD therapy and to explain the current devices used in clinical practice.
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Affiliation(s)
- Melanie T Gura
- Pacemaker & Arrhythmia Services, The Heart Group, Inc, Akron, Ohio 44236, USA.
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Windirsch M, Hennes HJ, Wolcke B. Beeinflussung des Elektrokardiogramms durch elektromagnetische Felder. Notf Rett Med 2004. [DOI: 10.1007/s10049-004-0685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leighton JA, Sharma VK, Srivathsan K, Heigh RI, McWane TL, Post JK, Robinson SR, Bazzell JL, Fleischer DE. Safety of capsule endoscopy in patients with pacemakers. Gastrointest Endosc 2004; 59:567-9. [PMID: 15044901 DOI: 10.1016/s0016-5107(03)02879-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Capsule endoscopy, a new technology, allows visualization of the entire small intestinal mucosa. The main indication for capsule endoscopy at present is the evaluation of GI bleeding of obscure origin. Studies to date suggest that capsule endoscopy is safe and is associated with few adverse events. One concern, which has not been studied, is the potential effect of the capsule on cardiac pacemakers and other electromedical devices. The primary aims of this study were to evaluate the safety of capsule endoscopy in patients with cardiac pacemakers who are being evaluated for GI bleeding of obscure origin and to determine whether pacemakers have any effect on the images captured by the capsule endoscope. METHODS Patients with cardiac pacemakers referred for evaluation of GI bleeding of obscure origin were entered into the study. Before the procedure, an electrocardiogram was obtained, and pacemaker functions were checked. Capsule endoscopy was performed in a hospital setting to allow closer monitoring, instead of the outpatient clinic, which is our routine. Cardiac rhythm was assessed simultaneously during capsule endoscopy with a Holter monitor. Post-procedure pacemaker function was again checked for any disturbance. When the capsule endoscopy studies were reviewed, observations were made with particular reference to technical difficulty or interference with imaging. OBSERVATIONS Five consecutive patients (4 men, 1 woman; mean age, 73 years, range 56-92 years) with cardiac pacemakers were studied. In all patients, the indication for capsule endoscopy was GI bleeding of obscure origin. A cardiologist and pacemaker nurse specialist reviewed the Holter monitor recordings and evaluated pacemaker function after the procedure for each patient. No arrhythmia or other adverse cardiac event was noted during capsule transmission. No pacemaker-induced interference on the capsule endoscopy images was observed. CONCLUSIONS Capsule endoscopy appears to be safe in patients with cardiac pacemakers and does not appear to be associated with any significant adverse cardiac event. Pacemakers do not interfere with capsule imaging.
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Affiliation(s)
- Jonathan A Leighton
- Current affiliations: Division of Gastroenterology and Hepatology and Division of Cardiology, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA
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Rosenow JM, Tarkin H, Zias E, Sorbera C, Mogilner A. Simultaneous use of bilateral subthalamic nucleus stimulators and an implantable cardiac defibrillator. Case report. J Neurosurg 2003; 99:167-9. [PMID: 12854761 DOI: 10.3171/jns.2003.99.1.0167] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bilateral electrical stimulation of the subthalamic nucleus is being used with increasing frequency as a treatment for severe Parkinson disease (PD). Implantable cardiac defibrillators improve survival in certain high-risk patients with coronary artery disease and ventricular arrhythmias. Because of concern about possible interaction between these devices, deep brain stimulation (DBS) systems are routinely disconnected before defibrillators are implanted in patients with PD and arrhythmia. The authors report on a patient with bilateral subthalamic stimulators who underwent successful placement of an implantable defibrillator. Testing of the devices over a wide range of settings revealed no interaction. The patient subsequently underwent multiple episodes of cardioversion when the ventricular lead became dislodged. There was no evidence of adverse neurological effects, and interrogation of the DBS devices after cardioversion revealed no changes in stimulus parameters. The outcome in this case indicates that DBS systems may be safely retained in selected patients who require implantable cardiac defibrillators.
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Affiliation(s)
- Joshua M Rosenow
- Department of Neurosurgery, New York Medical College, Valhalla, New York 10595, USA
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Kolb C, Schmieder S, Lehmann G, Zrenner B, Karch MR, Plewan A, Schmitt C. Do airport metal detectors interfere with implantable pacemakers or cardioverter-defibrillators? J Am Coll Cardiol 2003; 41:2054-9. [PMID: 12798581 DOI: 10.1016/s0735-1097(03)00424-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether airport metal detector gates (AMDGs) interfere with pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs). BACKGROUND It is currently unknown whether AMDGs interfere with implanted PMs or ICDs. METHODS A total of 348 consecutive patients (200 PM and 148 ICD recipients) have been tested for the occurrence of electromagnetic interference (EMI) within the electromagnetic field of a worldwide-used airport metal detector. RESULTS No interference, such as pacing or sensing abnormalities, was observed in any of the 200 PM and 148 ICD patients; also no reprogramming occurred. CONCLUSIONS In vivo testing of PM and ICD systems showed no EMI with a standard AMDG. Clinically relevant interactions with implanted PMs or ICDs seem unlikely.
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Affiliation(s)
- Christof Kolb
- Deutsches Herzzentrum München, Klinikum rechts der Isar, Elektrophysiologie, Technischen Universität München, Lazarettstrasse 36, 80636 Munich, Germany.
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27
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Abstract
The phenomenon of electromagnetic interference by mobile phones is real and potentially clinically significant. This has been recognised by the Department of Health and the Medical Devices Agency, leading to bans on phone use in hospitals. Current evidence suggests that mobile phones can cause malfunction of medical equipment, but only when used in close proximity. Allowing phone use in non-patient care areas and improving staff education may improve compliance with hospital policies.
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Affiliation(s)
- A A Klein
- Cardiovascular Anaesthesia and Intensive Care Medicine, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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Garg A, Wadhwa M, Brown K, Luckett C, Vaughn T, Birgersdotter-Green U, Feld G. Inappropriate implantable cardioverter defibrillator discharge from sensing of external alternating current leak. J Interv Card Electrophysiol 2002; 7:181-4. [PMID: 12397229 DOI: 10.1023/a:1020846007149] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) are now an accepted and effective therapy for treatment of survivors of sudden cardiac death (SCD) and prevention of SCD in high-risk patients. Normal ICD function and delivery of therapy depends on appropriate sensing and detection of myocardial electrical potentials. Electromagnetic interference resulting in ICD malfunction is a well-documented phenomenon, however, there are less well-known external sources of interference, which may cause life threatening ICD malfunction. We report a unique case of repeated inappropriate ICD shocks in a ten-year old boy caused by the ICD sensing alternating current from an unexpected external source.
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Affiliation(s)
- Ashok Garg
- Department of Medicine, Cardiology Division, Cardiac Electrophysiology Program, University of California, San Diego, School of Medicine, 200 West Arbor Drive, San Diego, CA 92103, USA
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Abstract
Implantable cardioverter defibrillators (ICDs) have evolved from the treatment of last resort to the gold standard therapy for patients at high risk for ventricular tachyarrhythmias. High-risk patients include those who have survived life-threatening arrhythmias, and individuals with cardiac diseases who are at risk for such arrhythmias, but are symptomless. Use of an ICD will affect the patient's quality of life. Some drugs can substantially affect defibrillator function and efficacy, and possible drug-device interactions should be considered. Patients with ICDs may encounter cell phones, antitheft detectors, and many other sources of potential electromagnetic Interference. In addition to treating ventricular tachyarrhythmias, new defibrillators provide full featured dual chamber pacing, and could treat atrial arrhythmias, and congestive heart failure by means of biventricular pacing.
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Affiliation(s)
- M Glikson
- Heart Institute, Sheba Medical Centre, Tel Aviv University, Tel Hashomer, Israel
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Lapostolle F, Pommerie F, Catineau J, Adnet F, Wenzek M. Millennium bug or electrocardiogram interferences? Am J Emerg Med 2001; 19:168-9. [PMID: 11239269 DOI: 10.1053/ajem.2001.21349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
Pacing is a field of rapid clinical progress and technologic advances. Clinical progress in the 1990s included the refinement of indications for pacing as well as the use of pacemakers for new, nonbradycardiac indications, such as the treatment of cardiomyopathies and CHF and the prevention of atrial fibrillation. Important published data and studies in progress are shedding new light on issues of pacing mode selection, and they may influence future practice significantly. Important technologic advances include development of new rate-adaptive sensors and sensor combinations and the evolution of pacemakers into sophisticated diagnostic devices with the capability to store data and ECGs. Automatic algorithms monitor the patient for appropriate capture, sensing, battery status, and lead impedance, providing better patient safety and pacemaker longevity.
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Affiliation(s)
- M Glikson
- Pacemaker Service, Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Obwegeser AA, Uitti RJ, Turk MF, Wszolek UM, Flipse TR, Smallridge RC, Witte RJ, Wharen RE. Simultaneous thalamic deep brain stimulation and implantable cardioverter-defibrillator. Mayo Clin Proc 2001; 76:87-9. [PMID: 11155420 DOI: 10.4065/76.1.87] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Thalamic deep brain stimulation is becoming increasingly popular for the control of drug-refractory tremor. Implantable cardiac pacemakers and defibrillators are commonly used therapeutic modalities. Concerns exist about the potential interactions between these 2 devices in the same patient, but no experience has been reported previously. We describe a patient with essential tremor who had a deep brain stimulator implanted into the left ventral intermediate nucleus of thalamus, who subsequently needed an implantable cardioverter-defibrillator. Despite concerns about possible interactions between the 2 types of implanted electrical devices (i.e., a situation similar to drug-drug interactions), the deep brain stimulator and the implanted pacemaker-defibrillator functioned appropriately, and no interaction occurred in our patient.
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Affiliation(s)
- A A Obwegeser
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Fla. 32224, USA
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Abstract
Ventricular arrhythmias remain a major cause of cardiovascular mortality. Therapy for serious ventricular arrhythmias has evolved over the past decade, from treatment primarily with antiarrhythmic drugs to implanted devices. The implantable cardioverter-defibrillator (ICD) is the best therapy for patients who have experienced an episode of ventricular fibrillation not accompanied by an acute myocardial infarction or other transient or reversible cause. It is also superior therapy in patients with sustained ventricular tachycardia (VT) causing syncope or hemodynamic compromise. Controlled clinical trials have confirmed the utility of these devices. As primary prevention, the ICD is superior to conventional antiarrhythmic drug therapy in patients who have survived a myocardial infarction and who have spontaneous, nonsustained ventricular tachycardia, a low ejection fraction, inducible VT at electrophysiologic study, and whose VT is not suppressed by procainamide. The effect of the ICD on survival of other patient populations remains to be proven. The device is costly, but its price is generally accepted to be reasonable. The ICD has been a major advance in the treatment of ventricular arrhythmias.
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Affiliation(s)
- H L Greene
- University of Washington, AVID Clinical Trial Center, Seattle 98105, USA
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Abstract
Implantable cardioverter defibrillators (ICD) are highly effective in the identification and termination of malignant ventricular tachycardia and fibrillation. It is anticipated that the number of patients receiving this device will increase because of major advancements in technology and the results of prospective controlled clinical trials. Major life changes occur after implantation of the device. Continued research is needed to identify concerns and needs of patients with ICDs and their families. Specific interventions must be tested to determine efficacy. Nurses must be able to provide education and psychologic support to assist patients in their successful transition to home.
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Affiliation(s)
- E White
- Mainline Arrhythmia and Cardiology Consultants, Wynnewood, Pennsylvania, USA
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Mugica J, Henry L, Podeur H. Study of interactions between permanent pacemakers and electronic antitheft surveillance systems. Pacing Clin Electrophysiol 2000; 23:333-7. [PMID: 10750133 DOI: 10.1111/j.1540-8159.2000.tb06758.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Interference of electronic antitheft systems (EASs) with pacemakers has been an object of controversy. This study was performed in 204 patients followed by our pacemaker surveillance center. The data from a total of 408-patient exposures to the EAS were analyzed. The device tested consisted of 129 DDD, 71 VVI, and 4 VDD pacemakers from seven manufacturers. The EAS studied consisted of an "acoustomagnetic" system that emits an intermittent 58-kHz signal, and a magnetic audio frequency system that emits a continuous 73-Hz signal. Complete interrogation of the pacemakers was performed before and after the consecutive exposure of the patients to both EASs. Electrocardiograms were recorded while the patients were exposed to the magnetic fields of each EAS for up to 30 seconds. One or more EAS interferences occurred in 17% of patients. EAS was observed in 26 (20%) of 129 patients with DDD, 7 (10%) of 71 patients with VVI, and 2 (50%) of 4 patients with VDD pacemakers. Over twice as many instances of EAS interference were observed with the "acoustomagnetic" system as were with the magnetic audio frequency system. Among pacemakers programmed in the DDD mode, a considerably greater prevalence of interference was observed at the atrial versus ventricular level, despite the same programmed sensing polarity in both chambers in all but one case. Sensing anomalies were the most common EAS induced disturbance, and typically lasted for the duration of exposure. In a few instances of pacing inhibition, the phenomenon was limited to 1 cycle at the onset of EAS exposure. No changes occurred in the programming of the pacemakers, and a single patient experienced palpitation during EAS induced rapid pacing. During exposure to EAS mimicking the normal use of the systems, interference with a variety of pacemakers was relatively common. However, the anomalies observed were transient and the cause of no symptom or device reprogramming. Patients should be advised to not stand unnecessarily in the close proximity of EASs.
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Affiliation(s)
- J Mugica
- Pacing and Electrophysiology Department, Surgical Center Val d'Or, Saint-Cloud, France
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Abstract
Most exposures to electromagnetic interference are transient and pose no threat to patients with pacemakers and implantable cardioverter defibrillators. Prolonged exposure may be catastrophic in pacemaker dependent patients. New technologies (wireless phones, electronic antitheft surveillance) are safe if proper precautions are takes. Radiofrequency ablation requires concomitant temporary pacing. MR imaging remains contraindicated in patients with these devices until further study is undertaken.
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Affiliation(s)
- S L Pinski
- Department of Medicine, Rush Medical College, Chicago, Illinois, USA.
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Groh WJ, Boschee SA, Engelstein ED, Miles WM, Burton ME, Foster PR, Crevey BJ, Zipes DP. Interactions between electronic article surveillance systems and implantable cardioverter-defibrillators. Circulation 1999; 100:387-92. [PMID: 10421599 DOI: 10.1161/01.cir.100.4.387] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with implantable cardioverter-defibrillators (ICDs). inappropriate shocks have been reported with exposure to electronic article surveillance systems. The risk to patients with ICDs of walking through or lingering near surveillance systems requires further investigation. METHODS AND RESULTS We evaluated the response in ICD function in 170 subjects during a 10- to 15-second midgate walk-through of and during extreme (2 minutes within 6 in of the gate) exposure to 3 common article surveillance systems. Complete testing was done in 169 subjects. During a 10- to 15-second (very slow) walk-through of the 3 surveillance systems, no interactions were observed that would negatively affect ICD function. During extreme exposure (169 subjects) and during extreme exposure and pacing via the ICD (126 subjects), interactions between the ICD and the article surveillance systems were observed in 19 subjects. In 7 subjects, this interaction was clinically relevant and would have likely (3 subjects) and possibly (4 subjects) resulted in ICD shocks. In 12 subjects, the interaction was minor. CONCLUSIONS It is safe for a patient with an ICD to walk through electronic article surveillance systems. Lingering in a surveillance system may result in an inappropriate ICD shock.
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Affiliation(s)
- W J Groh
- Krannert Institute of Cardiology, Indiana University, Indianapolis, IN, USA
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Affiliation(s)
- S Saksena
- Eastern Heart Institute-Atlantic Health System, Passaic, New Jersey.
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