Investigation into the effect of transcranial direct current stimulation on cardiac pacemakers

Abstract

Background: Studies investigating the therapeutic applications of transcranial direct current stimulation (tDCS) in the treatment of age-related neurodegenerative disease have been promising. However, exclusion criteria for these studies invariably disqualify patients implanted with internal cardiac pacemakers, citing safety concerns. Because the majority of cardiac pacemaker implantees are over 65, this criterion may limit candidacy for tDCS based research and/or treatment of age-related neurodegenerative disease. Objective/Hypothesis: We will test the hypothesis that tDCS impacts pacemaker function. Strong electrical potentials, such as those generated by external defibrillators (~500 V,~10 A), are known to occasionally damage pacemaker circuitry and software, but it seems unlikely tDCS would damage a pacemaker because it involves about 1/200th the energy (~12 V,~2 mA) of an external defibrillator. Methods: We delivered tDCS to seven participants (ages 70e92) with bipolar non-dependent pacemakers and subsequently collected data from the internal memory of the pacemakers to assess the tDCS signal detection, as well as alterations in mode switches, impedance levels, and pacing. Subsequently, similar assessments were carried out in participants who were pacemaker-dependent (ages 89e91). Results: After a review of the recordings, it was found that tDCS had no impact on the non-dependant, as well as the dependent, pacemakers. There were zero mode switches nor any impact on impedance levels. Conclusion: Results in this small series of cases found no evidence that tDCS interferes with the function of the pacemakers and suggests tDCS can be delivered to patients equipped with a cardiac pacemaker. Further studies are needed to generalize these results to other pacemakers.

Transcranial direct current stimulation in patient with J wave syndrome and implantable cardioverter defibrillator

“…These limitations, which are largely based on data derived from transcranial magnetic stimulation (TMS) application, are not necessarily relevant for tDCS application 13 . TMS encompasses an unbounded magnetic field, while tDCS includes applying a direct current between two negative and positive electrodes 14 .…”

“…12 These limitations, which are largely based on data derived from transcranial magnetic stimulation (TMS) application, are not necessarily relevant for tDCS application. 13 TMS encompasses an unbounded magnetic field, while tDCS includes applying a direct current between two negative and positive electrodes. 14 Therefore, reassessing the exclusion criteria can be advantageous, especially for patients refractive to other treatments that may regain some levels of function from tDCS sessions.…”

“…In a previous study by Roncero et al, that investigated the effects of tDCS on internal cardiac pacemakers, they found no short-term interruptions on pacemakers. 13 Miuli et al, observed the effects of tDCS on a patient with phantom limb pain and an ICD due to multiple heart attacks. They also found this method safe in terms of ICD intereference.…”

LIVE-streaming 3D images: A neuroscience approach to full-body illusions

“…Most high-tech equipment such as HMDs heats up in use, and there are strict design limits to how much temperature increase their cooling systems can handle before overheating. Unfortunately, until now, there has been insufficient data on what added effects nearby electrical stimulation has on technical devices located close to the head (e.g., preliminary results suggest that tDCS does not influence cardiac pacemaker function (Roncero et al, 2020 )). Considering TMS or even tACS/tRNS, there are yet other reasons why intermixing this with HMDs should be avoided.…”

Workers with Active Implantable Medical Devices Exposed to EMF: In Vitro Test for the Risk Assessment

“…To date, few studies have addressed the electromagnetic compatibility of PM with ESU or TMS [21,22]. These studies focused on the effects on a patient with a PM, but did not consider the case of healthcare personnel that use such EMF sources in the work environment.…”