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. 2021 Apr;44(4):531-536.
doi: 10.1002/clc.23571. Epub 2021 Feb 16.

Safety of mechanical lung vibrator and high-frequency chest wall oscillation in patients with cardiac implantable electronic device

Hye Bin Gwag  1 , Hyun Sung Joh  2 , June Soo Kim  2 , Kyoung-Min Park  2 , Young Keun On  2 , Seung-Jung Park  2
Affiliations

Safety of mechanical lung vibrator and high-frequency chest wall oscillation in patients with cardiac implantable electronic device

Hye Bin Gwag et al. Clin Cardiol. 2021 Apr.

Abstract

Background: Chest physiotherapy (CPT) is a non-pharmacological therapy to facilitate airway secretion removal. There have been concerns about potential electromagnetic interference (EMI) and lead integrity problems during the use of vibrating CPT devices in patients with cardiac implantable electronic devices (CIEDs).

Hypothesis: Two CPT devices can be used safely in patients with CIED.

Methods: Volunteer patients with CIED underwent device interrogation to check lead integrity and device function before and after application of CPT devices. Mechanical lung vibrator and high-frequency chest wall oscillation (HFCWO) vests were used while monitoring surface electrocardiograms and intra-cardiac electrograms.

Results: We prospectively enrolled 46 patients with CIEDs (25 pacemakers, 15 implantable cardioverter-defibrillators, and six cardiac resynchronization therapy-defibrillators). There was no noise detection or EMI during CPT in any patient. None of the patients showed clinically significant changes in lead integrity parameters. HFCWO inappropriately accelerated the pacing rate up to the maximal programmed value in five patients with pacemakers and two with cardiac resynchronization therapy-defibrillators.

Conclusion: CPT may be safely applied to patients with CIED without compromising lead integrity or device function, except for unwanted increase in pacing rate caused by misdetection of chest wall vibration as patients' activity while using HFCWO. Deactivation of the accelerometer-based activity sensor may be needed when HFCWO is planned for CPT.

Keywords: cardiac implantable electronic device; chest physiotherapy; device safety.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Study protocol. CIED, cardiac implantable electronic device; CPT, chest physiotherapy
FIGURE 2
FIGURE 2
Lung vibrator device and chest wall locations for application of the vibration device (A), and high‐frequency chest wall oscillation device (B)
FIGURE 3
FIGURE 3
Lead integrity data according to follow‐up period after chest physiotherapy. Pacing threshold (A), sensing amplitude (B), and impedance (C) values are presented as median with interquartile range. P values were presented only when they were statistically significant. LV, left ventricular; RA, right atrial; RV, right ventricular
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