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Influence of electrical stimulation therapy on permanent pacemaker function

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Summary

Background

Electrical stimulation therapy (EST) and transcutaneous electrical neuromuscular stimulation (TENS), a modality of EST, have become widely applied, accepted and effective methods for the treatment of musculoskeletal and other pain conditions. According to the rising number of permanent pacemaker (PM) wearers the number of potential candidates for EST with concomitant device implantation is growing. Contradictory recommendations exist regarding the application of EST or TENS on PM wearers.

Aim

The study was carried out to evaluate the impact of EST on PM function.

Methods

A full size model mimicking the electrical characteristics of the human body was used to evaluate the application of EST on permanent PM devices. Various configurations with respect to energy modality, position of the stimulation electrodes and PM device models were evaluated. Intracardiac PM electrogram tracings (iEGM) were analyzed for the interference of EST with PM function.

Results

Unilateral EST application did not cause interference with PM function in any of the configurations (0%; n = 700). On the contrary, bilateral stimulation (350 configurations in total) caused either ventricular inhibition or switch to V00 back-up pacing due to electrical interference in 165 cases (47.1%) depending on the applied stimulation parameters.

Conclusion

The use of EST potentially interferes with PM therapy, especially if the electrodes are positioned bilaterally; however, unilateral EST application appeared to be safe in all tested configurations.

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Abbreviations

EST:

Electrical stimulation therapy

ICD:

Implantable cardioverter defibrillator

iEGM:

Intracardiac pacemaker electrogram tracing

PM:

Pacemaker

TENS:

Transcutaneous electrical nerve stimulation

References

  1. Mulvey MR, Fawkner HJ, Johnson MI. An investigation of the effects of different pulse patterns of transcutaneous electrical nerve stimulation (TENS) on perceptual embodiment of a rubber hand in healthy human participants with intact limbs. Neuromodulation. 2015;18(8):744–50.

    Article  Google Scholar 

  2. Johnson MI, Paley CA, Howe TE, Sluka KA. Transcutaneous electrical nerve stimulation for acute pain. Cochrane Database Syst Rev. 2015;6:CD6142.

    Google Scholar 

  3. Raatikainen MJ, Arnar DO, Zeppenfeld K, Merino JL, Levya F, Hindriks G, et al. Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association. Europace. 2015;17(Suppl 1):i1–i75.

    Article  Google Scholar 

  4. Glotzer TV, Gordon M, Sparta M, Radoslovich G, Zimmerman J. Electromagnetic interference from a muscle stimulation device causing discharge of an implantable cardioverter defibrillator: epicardial bipolar and endocardial bipolar sensing circuits are compared. Pacing Clin Electrophysiol. 1998;21(10):1996–8.

    Article  CAS  Google Scholar 

  5. Siu CW, Tse HF, Lau CP. Inappropriate implantable cardioverter defibrillator shock from a transcutaneous muscle stimulation device therapy. J Interv Card Electrophysiol. 2005;13(1):73–5.

    Article  Google Scholar 

  6. Wayar L, Mont L, Silva RM, Alvarenga N, Fosch X, Castro J, et al. Electrical interference from an abdominal muscle stimulator unit on an implantable cardioverter defibrillator: report of two consecutive cases. Pacing Clin Electrophysiol. 2003;26(5):1292–3.

    Article  Google Scholar 

  7. Holmgren C, Carlsson T, Mannheimer C, Edvardsson N. Risk of interference from transcutaneous electrical nerve stimulation on the sensing function of implantable defibrillators. Pacing Clin Electrophysiol. 2008;31(2):151–8.

    Article  Google Scholar 

  8. Pyatt JR, Trenbath D, Chester M, Connelly DT. The simultaneous use of a biventricular implantable cardioverter defibrillator (ICD) and transcutaneous electrical nerve stimulation (TENS) unit: implications for device interaction. Europace. 2003;5(1):91–3.

    Article  CAS  Google Scholar 

  9. Rasmussen MJ, Hayes DL, Vlietstra RE, Thorsteinsson G. Can transcutaneous electrical nerve stimulation be safely used in patients with permanent cardiac pacemakers? Mayo Clin Proc. 1988;63(5):443–5.

    Article  CAS  Google Scholar 

  10. Carlson T, Andrell P, Ekre O, Edvardsson N, Holmgren C, Jacobsson F, et al. Interference of transcutaneous electrical nerve stimulation with permanent ventricular stimulation: a new clinical problem? Europace. 2009;11(3):364–9.

    Article  Google Scholar 

  11. Irnich W. Interference in pacemakers. Pacing Clin Electrophysiol. 1984;7(6 Pt 1):1021–48.

    Article  CAS  Google Scholar 

  12. Crevenna R, Stix G, Pleiner J, Pezawas T, Schmidinger H, Quittan M, et al. Electromagnetic interference by transcutaneous neuromuscular electrical stimulation in patients with bipolar sensing implantable cardioverter defibrillators: a pilot safety study. Pacing Clin Electrophysiol. 2003;26(2 Pt 1):626–9.

    Article  Google Scholar 

  13. Digby GC, Daubney ME, Baggs J, Campbell D, Simpson CS, Redfearn DP, et al. Physiotherapy and cardiac rhythm devices: a review of the current scope of practice. Europace. 2009;11(7):850–9.

    Article  Google Scholar 

  14. Bradshaw PJ, Stobie P, Knuiman MW, Briffa TG, Hobbs MS. Trends in the incidence and prevalence of cardiac pacemaker insertions in an ageing population. Open Heart. 2014;1(1):e177.

    Article  Google Scholar 

  15. Pergolizzi JV Jr., Raffa RB, Fleischer C, Zampogna G, Taylor R Jr.. Management of moderate to severe chronic low back pain with buprenorphine buccal film using novel bioerodible mucoadhesive technology. J Pain Res. 2016;9:909–16.

    Article  CAS  Google Scholar 

  16. Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, et al. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008;9(10):883–91.

    Article  Google Scholar 

  17. Jauregui JJ, Cherian JJ, Gwam CU, Chughtai M, Mistry JB, Elmallah RK, et al. A meta-analysis of transcutaneous electrical nerve stimulation for chronic low back pain. Surg Technol Int. 2016;28:296–302.

    PubMed  Google Scholar 

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Acknowledgements

This work was supported by the Association for the Promotion of Research in Atherosclerosis, Thrombosis and Vascular Biology, the Ludwig Boltzman Foundation for Cardiovascular Research and the Ludwig Boltzman Institute for Electrical Stimulation and Physical Rehabilitation.

Funding

Funding

This pece of research did not reveive any specific funding or grant. However the authors could use the facilities from the Association for the Promotion of Research in Atherosclerosis, Thrombosis and Vascular Biology, the Ludwig Boltzman Foundation for Cardiovascular Research and the Ludwig Boltzman Institute for Electrical Stimulation and Physical Rehabilitation to conduct their research. Consequently this appears to be no contradiction to the authors.

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Authors and Affiliations

  1. 3rd Medical Department with Cardiology, Chest Pain Unit and Intensive Care Medicine, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria

    Florian Egger MD, Fabian P. Hammerle, Michael Nürnberg MD, Ruxandra Kriz MD & Kurt Huber MD, FESC, FACC, FAHA

  2. Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria

    Christian Hofer PhD, Stefan Löfler & Helmut Kern MD, PhD

  3. 2nd Department of Internal Medicine, Hospital Wiener Neustadt, Corvinusring 3–5, 2700, Wiener Neustadt, Austria

    Lukas Fiedler MD

  4. Medical Faculty, Sigmund-Freud University, Freudplatz 3, 1020, Vienna, Austria

    Kurt Huber MD, FESC, FACC, FAHA

Authors
  1. Florian Egger MD
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  2. Christian Hofer PhD
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  3. Fabian P. Hammerle
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  4. Stefan Löfler
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  5. Michael Nürnberg MD
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  7. Ruxandra Kriz MD
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  8. Helmut Kern MD, PhD
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  9. Kurt Huber MD, FESC, FACC, FAHA
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Corresponding author

Correspondence to Florian Egger MD.

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Conflict of interest

F. Egger reports personal fees from Medtronic outside the submitted work. M. Nürnberg reports personal fees from Medtronic, Biotronik, Boston Scientific, St. Jude Medical/Abbott and Sorin outside the submitted work. L. Fiedler reports personal fees from Boston Scientific and St. Jude Medical/Abbott outside the submitted work. C. Hofer, F.P. Hammerle, S. Löfler, R. Kriz, H. Kern and K. Huber have no conflicts of interest with respect to this publication.

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Florian Egger and Christian Hofer contributed equally to the manuscript.

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Egger, F., Hofer, C., Hammerle, F.P. et al. Influence of electrical stimulation therapy on permanent pacemaker function. Wien Klin Wochenschr 131, 313–320 (2019). https://doi.org/10.1007/s00508-019-1494-5

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  • DOI: https://doi.org/10.1007/s00508-019-1494-5

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