经皮神经电刺激应用于植入式除颤器时对感知功能产生电磁干扰的风险。

Risk of occurrence of electromagnetic interference from the application of transcutaneous electrical nerve stimulation on the sensing function of implantable defibrillators.

机构信息

Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Hindenburgdamm 30, 12203 Berlin, Germany.

Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.

出版信息

Europace. 2023 Jul 4;25(7). doi: 10.1093/europace/euad206.

BACKGROUND

Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief. But electrical TENS currents are also a source of electromagnetic interference (EMI). Thus, TENS is considered to be contraindicated in implantable cardioverter-defibrillator (ICD) patients. However, data might be outdated due to considerable advances in ICD and cardiac resynchronization therapy (CRT) filtering and noise protection algorithm technologies. The aim of this pilot safety study was to re-evaluate the safety of TENS in patients with modern ICDs.

METHODS AND RESULTS

One hundred and seven patients equipped with 55 different models of ICD/CRT with defibrillators from 4 manufacturers underwent a standardized test protocol including TENS at the cervical spine and the thorax, at 2 stimulation modes-high-frequency TENS (80 Hz) and burst-mode TENS (2 Hz). Potential interference monitoring included continuous documentation of ECG Lead II, intracardiac electrograms and the marker channel. Electromagnetic interference was detected in 17 of 107 patients (15.9%). Most frequent were: interpretations as a premature ventricular beats (VS/S) in 15 patients (14%), noise reversion in 5 (4.6%) which resulted in temporary asynchronous pacing in 3 (2.8%), interpretation as ventricular tachycardia/ventricular fibrillation in 2 (1.9%), and premature atrial beat in 2 (1.9%) patients. Electromagnetic interference occurrence was influenced by position (chest, P < 0.01), higher current intensity (P < 0.01), and manufacturer (P = 0.012).

CONCLUSION

Overall, only intermittent and minor EMI were detected. Prior to the use of TENS in patients with ICDs, they should undergo testing under the supervision of a cardiac device specialist.

背景

经皮神经电刺激（TENS）是一种已被证实的止痛方法。但是，电 TENS 电流也是电磁干扰（EMI）的来源。因此，TENS 被认为在植入式心脏复律除颤器（ICD）患者中是禁忌的。然而，由于 ICD 和心脏再同步治疗（CRT）滤波和噪声保护算法技术的显著进步，数据可能已经过时。本研究旨在重新评估现代 ICD 患者中 TENS 的安全性。

方法和结果

107 例配备了来自 4 家制造商的 55 种不同型号 ICD/CRT 除颤器的患者接受了标准化测试方案，包括颈椎和胸部的 TENS，使用 2 种刺激模式：高频 TENS（80 Hz）和爆发模式 TENS（2 Hz）。潜在的干扰监测包括连续记录心电图导联 II、心内电图和标记通道。在 107 例患者中有 17 例（15.9%）检测到电磁干扰。最常见的是：15 例（14%）患者被解读为室性早搏（VS/S），5 例（4.6%）出现噪声反转，导致 3 例（2.8%）暂时异步起搏，2 例（1.9%）患者被解读为室性心动过速/室颤，2 例（1.9%）患者出现房性早搏。电磁干扰的发生与位置（胸部，P < 0.01）、电流强度（P < 0.01）和制造商（P = 0.012）有关。