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. 2022 Oct 13;24(9):1512-1537.
doi: 10.1093/europace/euac040.

EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices

Markus Stühlinger  1 , Haran Burri  2 , Kevin Vernooy  3 , Rodrigue Garcia  4   5 , Radoslaw Lenarczyk  6   7 , Arian Sultan  8 , Michael Brunner  9 , Avi Sabbag  10 , Emin Evren Özcan  11 , Jorge Toquero Ramos  12 , Giuseppe Di Stolfo  13 , Mahmoud Suleiman  14 , Florian Tinhofer  15 , Julian Miguel Aristizabal  16 , Ivan Cakulev  17 , Gabriel Eidelman  18 , Wee Tiong Yeo  19 , Dennis H Lau  20 , Silva K Mulpuru  21 , Jens Cosedis Nielsen  22 ; ESC Scientific Document Group:; Frank Heinzel  23 , Mukundaprabhu Prabhu  24 , Christopher Aldo Rinaldi  25 , Frederic Sacher  26 , Raul Guillen  27 , Jan de Pooter  28 , Estelle Gandjbakhch  29 , Seth Sheldon  30 , Günther Prenner  31 , Pamela K Mason  32 , Stephanie Fichtner  33 , Takashi Nitta  34
Affiliations

EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices

Markus Stühlinger et al. Europace. .
No abstract available

Keywords: CIED; Defibrillator; Electrocautery; Electrosurgery; ICD; Magnet mode; Magnetic resonance imaging; Pacemaker; Therapeutic radiation.

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Conflict of interest statement

Conflict of interest: J.M.A.: speaker honoraria (Pfizer); M.B.: speaker honoraria (Medtronic); H.B.: speaker honoraria and institutional fellowship support (Abbott, Biotronik, Boston Scientific, Medtronic, Microport); G.D.S.: speaker honoraria (Novartis, Vifor Pharma, Daiichi Sankyo) E.F.: speaker honoraria (Daiichi Sankyo, Biosense Webster); R.G.: research grant (Boston Scientific; Medtronic, Microport, Abbott), speaker honoraria (Abbott), consultant (Microport); D.H.L.: speaker honoraria (Bayer, Boehringer-Ingelheim, Pfizer, Abbott, Medtronic, Biotronik, Microport CRM); R.L.: consultancy and speaker honoraria (Abbott, Biotronik, Boston Scientific, Boehringer-Ingelheim, Medtronic), institutional research grants (EU Horizon 2020 research and innovation programme; grant agreement nr. 847999); S.K.M.: speaker honoraria (Biosense Webster); J.C.N.: institutional research grants (Novo Nordisk Foundation); E.E.Ö.: speaker honoraria and consultant (Medtronic, Pfizer, Bayer, Sandoz); M.S.: speaker honoraria (Biotronik, Boehringer-Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Medtronic); Ar.S.: consultant (Abbott, Medtronic), speaker honoraria (Bayer, Abbott, Medtronic, Biosense Webster), institutional research grants (Abbott); J.T.R.: speaker honoraria (Medtronic, Abbott, Boston Scientific), research grant (Medtronic), and institutional fellowship support (Abbott); K.V.: consultant for Medtronic, Boston, Abbott, Philips, Biosense Webster; research/educational grants from Medtronic, Biosense webster, Philips, Abbott; I.C., G.E., Av.S., M.S., and W.T.Y.: none declared.

Figures

Figure 1
Figure 1
(A) Inhibition of right-ventricular pacing by unipolar electrocautery during revision of the atrial lead in a 64-year-old PM-dependent patient: ECG Leads I and II and invasive blood pressure measurements are shown; arrows indicate the initiation of cautery bursts (arrow), leading to pacing inhibition and subsequent drops in blood pressure.
Figure 1
Figure 1
(B) Ventricular oversensing in a 69-year-old VVI-ICD patient with ischaemic cardiomyopathy during TENS: electrical bursts result in the inhibition of ventricular pacing and detection of VF leading to shock therapy (arrow).
Figure 2
Figure 2
(A) Algorithm for perioperative management of PM (including CRT-P) during surgery: areprogramming/magnet application is optional, if surgery is performed below the iliac crest and no full-body return electrodes are used; basynchronous mode (D00/V00/A00); rate response may be inactivated to avoid rapid pacing with patient mobilization or respiratory monitoring (if the PM has a minute-ventilation sensor); cabsence of intrinsic escape rhythm or heart rate <50 bpm causing symptoms; dasystole or haemodynamically relevant bradycardia during electrocautery. (B) Algorithm for perioperative management of ICD including CRT-D during surgery: areprogramming/magnet application is optional, if surgery is performed below the iliac crest and no full-body return electrodes are used; basynchronous mode and inactivation of tachycardia detection and/or therapy; rate response may be inactivated to avoid rapid pacing with patient mobilization or respiratory monitoring (if the PM has a minute-ventilation sensor); cabsence of intrinsic escape rhythm or heart rate <50 bpm causing symptoms; dBoston Sci, Medtronic: acoustic signal; Abbott: acoustic from Galant series (none for older ICD); Microport/Sorin: pacing at 96 bpm in programmed mode; Biotronik: no magnet response.
Figure 3
Figure 3
Flowchart for evaluating magnetic resonance imaging in CIED patients. MRI, magnetic resonance imaging; SAR, specific absorption rate. aConsider only if there is no imaging alternative and the result of the test is crucial for applying life-saving therapies for the patient. Adapted from the 2021 ESC guidelines on cardiac pacing and CRT.
Figure 4
Figure 4
Programming of device parameters and timing of device check before and after MRI: (A) PM and CRT-P patients. (B) ICD and CRT-D patients; AF, atrial fibrillation; CRT,  cardiac resynchronization therapy; MRI, magnetic resonance imaging. aIf available. bRate hysteresis; atrial anti-tachycardia pacing; CRT-triggered ventricular pacing; premature ventricular complex and premature atrial contraction triggered pacing; atrial fibrillation therapies—rate smoothing; overdrive pacing; conducted AF response. cIn CIED with automatic MRI mode activation, the scan may be performed electively after the pre-scan follow-up and reprogramming after the intervention may not be necessary; adapted from ESC guidelines for cardiac pacing and CRT 2021.
Figure 4
Figure 4
Programming of device parameters and timing of device check before and after MRI: (A) PM and CRT-P patients. (B) ICD and CRT-D patients; AF, atrial fibrillation; CRT,  cardiac resynchronization therapy; MRI, magnetic resonance imaging. aIf available. bRate hysteresis; atrial anti-tachycardia pacing; CRT-triggered ventricular pacing; premature ventricular complex and premature atrial contraction triggered pacing; atrial fibrillation therapies—rate smoothing; overdrive pacing; conducted AF response. cIn CIED with automatic MRI mode activation, the scan may be performed electively after the pre-scan follow-up and reprogramming after the intervention may not be necessary; adapted from ESC guidelines for cardiac pacing and CRT 2021.
Figure 5
Figure 5
Algorithm for the management of CIED patients during RT: RT, radiotherapy; RM, remote monitoring; *can be discussed on an individual basis or in case of symptoms
Figure 6
Figure 6
Checklist for the management of emergencies and complications due to interference.
Figure 7
Figure 7
Chest X-ray to identify the type of CIED: typical X-ray pictures of the single-chamber PM (AAI, VVI), dual-chamber PM, single-chamber ICD, dual-chamber ICD, CRT device (PM and ICD), an S-ICD, a leadless PM, an epicardial PM and an implantable loob recorder (ILR) are shown; importantly, generators of transvenous devices can be implanted in a left and right pectoral pocket, a leadless PM is not equipped with a generator and the can of an S-ICD and an ILR are located on the left lateral thorax.
Figure 8
Figure 8
Identification of the CIED manufacturer based on X-ray markers: X-ray opaque symbols of individual manufacturers marked with a red ellipse and enlarged on the background of the CIED silhouette. (A) CIED manufactured by Biotronik, (B) by Medtronic, (C) by St Jude Medical/Abbott, (D) by Boston Scientific, and (E) by Ela/Sorin.
See this image and copyright information in PMC

References

    1. Driessen S, Napp A, Schmiedchen K, Kraus T, Stunder D. Electromagnetic interference in cardiac electronic implants caused by novel electrical appliances emitting electromagnetic fields in the intermediate frequency range: a systematic review. Europace 2019;21:219–29. - PMC - PubMed
    1. Misiri J, Kusumoto F, Goldschlager N. Electromagnetic interference and implanted cardiac devices: the medical environment (part II). Clin Cardiol 2012;35:321–8. - PMC - PubMed
    1. von Olshausen G, Rondak IC, Lennerz C, Semmler V, Grebmer C, Reents T, et al. Electromagnetic interference in implantable cardioverter defibrillators: present but rare. Clin Res Cardiol 2016;105:657–65. - PubMed
    1. Hours M, Khati I, Hamelin J. Interference between active implanted medical devices and electromagnetic field emitting devices is rare but real: results of an incidence study in a population of physicians in France. Pacing Clin Electrophysiol 2014;37:290–6. - PubMed
    1. Nazarian S, Beinart R, Halperin HR. Magnetic resonance imaging and implantable devices. Circ Arrhythm Electrophysiol 2013;6:419–28. - PubMed