Electromagnetic Interference from Swimming Pool Generator Current Causing Inappropriate ICD Discharges

Abstract

Electromagnetic interference (EMI) includes any electromagnetic field signal that can be detected by device circuitry, with potentially serious consequences: incorrect sensing, pacing, device mode switching, and defibrillation. This is a unique case of extracardiac EMI by alternating current leakage from a submerged motor used to recycle chlorinated water, resulting in false rhythm detection and inappropriate ICD discharge. A 31-year-old female with arrhythmogenic right ventricular cardiomyopathy and Medtronic dual-chamber ICD placement presented after several inappropriate ICD shocks at the public swimming pool. Patient had never received prior shocks and device was appropriate at all regular follow-ups. Intracardiac electrograms revealed unique, high-frequency signals at exactly 120 msec suggestive of EMI from a strong external source of alternating current. Electrical artifact was incorrectly sensed as a ventricular arrhythmia which resulted in discharge. ICD parameters including sensing, pacing thresholds, and impedance were all normal suggesting against device malfunction. With device failure and intracardiac sources excluded, EMI was therefore strongly suspected. Avoidance of EMI source brought complete resolution with no further inappropriate shocks. After exclusion of intracardiac interference, device malfunction, and abnormal settings, extracardiac etiologies such as EMI must be thoughtfully considered and excluded. Elimination of inappropriate shocks is to “first, do no harm.”

Electromagnetic force from electric vehicles: Potential electromagnetic interference source for subcutaneous implantable defibrillator

“…ICDs may encounter undesired shocks caused by the 60 Hz frequency of alternating current. This potential issue is also applicable to S‐ICDs 3,11,12 . Despite manufacturers implementing specific measures and precautions to address EMI in CIEDs, numerous case studies have reported instances where CIEDs administer inappropriate shocks due to EMI interference.…”

“…Numerous instances of ICD malfunctions have been documented in the literature, underscoring the importance of comprehensively examining these occurrences for proper identification and proactive prevention 3,11,12 . An electromagnetic field may generate currents in the lead, resulting in local fibrillation or heating in the heart or induce voltage in the lead.…”

“…Electromagnetic interference (EMI) refers to any electromagnetic field signal that can be identified by the circuitry of a device. EMI can lead to incorrect sensing, pacing, mode‐switching or inappropriate therapy 3 and can potentially affect the function of cardiac devices, including pacemakers and implantable cardioverter‐defibrillators (ICDs) 4 . EMI can be emitted from common sources such as cell phones, airport screening tools, hand power tools, and proximity to high voltage field.…”

21st century medicine and emerging biotechnological syndromes: a cross-disciplinary systematic review of novel patient presentations in the age of technology

“…Furthermore, given the growth of the Internet of Things (IoT), the potential for EM interactions is increasing. Sources of EM interference that caused patient illness included wireless networks [20], swimming pool generators [85], water pumps [86], electrostatic discharge from fleece clothing [87], co-existing implanted devices [88], surgical equipment [89], plastic toys [90], hot tubs [91], electrical installations [92] and consumer devices such as Fitbits [93]. Asher et al describe a case of a patient's e-cigarette interacting with an implantable cardioverter-defibrillator (ICD), and a 55F with an ICD which reverted to magnet mode due to interference with the patient's fitness watch [93].…”

Swimming pool saline chlorination units and implantable cardiac devices: A source for potentially fatal electromagnetic interference

“…Electromagnetic interference (EMI) resulting in inappropriate implantable cardioverter-defibrillator (ICD) shocks or pacemaker inhibition is particularly dangerous while swimming 1 . Although incidents of EMI from alternating current (AC) electrical faults in pools have been described in the literature, they have been sporadic 2, 3, 4, 5. In this series, we describe a new source of EMI within saline chlorination/electrolytic pool cleaning systems.…”