Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2021; 9(19): 5313-5318
Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5313
Neuromuscular electrical stimulation for a dysphagic stroke patient with cardiac pacemaker using magnet mode change: A case report
Myeongkyu Kim, Jin-Kyu Park, Ji Young Lee, Mi Jung Kim
Myeongkyu Kim, Mi Jung Kim, Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul 04763, South Korea
Jin-Kyu Park, Department of Internal Medicine-Cardiology, Hanyang University College of Medicine, Seoul 04763, South Korea
Ji Young Lee, Department of Radiology, Hanyang University College of Medicine, Seoul 04763, South Korea
Author contributions: Kim M and Kim MJ contributed the conceptualization; Kim M wrote original draft preparation; Park JK, Lee JY reviewed the literature and contributed to manuscript drafting; Lee JY analyzed and interpreted the imaging findings; Kim MJ edited the manuscript; Kim MJ was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mi Jung Kim, MD, PhD, Professor, Department of Rehabilitation Medicine, Hanyang University College of Medicine, 222-1, Wangsimni-ro, Seongdong-gu, Seoul 04763, South Korea. kimmjreh@hanyang.ac.kr
Received: February 22, 2021
Peer-review started: February 22, 2021
First decision: April 14, 2021
Revised: April 17, 2021
Accepted: May 15, 2021
Article in press: May 15, 2021
Published online: July 6, 2021
Processing time: 121 Days and 19.9 Hours
Abstract
BACKGROUND

Electromagnetic interference (EMI), means disturbance to the operation of implanted electrical devices caused by external sources. If cardiac pacemaker is implanted into the body, the risk of EMI should be considered when performing neuromuscular electrical stimulation (NMES). So far, no case has been reported that clinical magnets are used to safely manage the EMI risk of patients with cardiac pacemaker in NMES.

CASE SUMMARY

A 72-year-old male with swallowing disorder due to pure motor lacunar syndrome was transferred to rehabilitation department six days after the symptom onset. EMI risk needed be considered when implementing NMES on pharyngeal muscles, since cardiac pacemaker was implanted on his left chest due to the sick sinus syndrome. In the first NMES, the function of the pacemaker was directly monitored using telemetric instruments. From the second day, by a simple method of placing a magnet on the pacemaker, we chose to move the pacemaker into a mode that the device was not influenced by external stimulus. This magnet method has been used repeatedly for a year for the safe NMES treatment. We could remove Levin tube four months after the initial symptom and dysphagia related symptoms had not been noted during two-year follow-up period.

CONCLUSION

This report is the first case of dysphagia rehabilitation that EMI risk was handled using mode change of pacemaker with magnet. This method is unfamiliar to doctors, but safe and easy approach. This paper could be guidance for clinicians who need to treat patients with EMI risk.

Keywords: Dysphagia rehabilitation; Electromagnetic interference; Neuromuscular electrical stimulation; Pacemaker; Magnet; Case report

Core Tip: Electromagnetic interference (EMI), means disturbance generated by external source to implanted devices’ function. It should be considered when conducting neuromuscular electrical stimulation to patient with cardiac pacemaker. In this paper, we reported that mode change using magnet allowed us to safely perform dysphagia rehabilitation and manage EMI risk in stroke patient with cardiac pacemaker. This approach is unfamiliar to physicians, but we hope that this paper could be guidance for clinicians who need to treat patients with risk above.