Study of Pacemaker and Implantable Cardioverter Defibrillator Triggering by Electronic Article Surveillance Devices (SPICED TEAS)

Abstract

The magnetic fields emitted by electronic article surveillance (EAS) systems (shoplifting gates) are a source of interference for implanted medical devices. In the Study of Pacemaker and Implantable Cardioverter Defibrillator Triggering by Electronic Article Surveillance Devices (SPICED TEAS), 25 adult volunteers with ICDs and 50 with pacemakers were exposed to the fields of six different EAS systems. These EAS systems used three modes of operation: magnetic audio frequency, swept radiofrequency, and acoustomagnetic technology. No ICD exhibited interference mimicking sensing of tachyarrhythmias with any EAS system. Pacemakers interacted variably, depending on the type of EAS system. Swept radiofrequency systems produced no interaction with any implanted medical device. One magnetic audio frequency system interacted with 2 of 50 pacemakers. The acoustomagnetic system interacted with 48 of 50 pacemakers. Interactions included asynchronous pacing, atrial oversensing (producing "EAS induced tachycardia" in the ventricle), ventricular oversensing (with pacemaker inhibition), and paced beats resulting from the direct induction of current in the pacemaker ("EAS induced pacing"). These interactions produced symptoms in some patients (palpitations, presyncope) only while patients were in the EAS field. No pacemaker was reprogrammed. We conclude that high energy, pulsed low frequency EAS systems such as acoustomagnetic systems interfere with most pacemakers. Pacemaker patients should be advised to minimize exposure to the fields of such systems to prevent the possibility of serious clinical events.

Interactions Between Electronic Article Surveillance Systems and Implantable Cardioverter-Defibrillators

“…A single study has evaluated interactions in patients with ICDs and surveillance systems. 8 In this study, no interference was found in 25 subjects despite close and protracted exposure. No pacing was done in this study; therefore, minor interference might not have been recognized.…”

“…8 Because of the presence of a noise reversion mode in Ventritex ICDs, what was considered a clinically relevant interaction might only result in pacing output inhibition and not lead to an inappropriate ICD shock. ICDs manufactured by CPI also have a noise-sensing window that could influence electromagnetic interference.…”

“…It is likely that other systems using similar electromagnetic fields would interact similarly. 8 No testing of swept-radiofrequency surveillance systems was done. A sin- …”

“…These systems were chosen for 3 reasons: (1) case reports implicating electronic article surveillance equipment as a cause of inappropriate defibrillator shocks have occurred with 2 of these systems (2 with Ultra-Max and 1 with Aislekeeper); (2) other studies have shown interactions with pacemakers and these systems; and (3) these electronic article surveillance systems are commonly used worldwide. [1][2][3][4][5][6][7][8] ICD sensing parameters for tachyarrhythmia detection were left as clinically programmed but with the actual delivery of therapies inactivated. Continuous ECG monitoring in the presence of a standby external defibrillator was used during the time period that therapies were inactivated.…”

Electromagnetic Interference of the Pacemakers

“…For example, 58-kHz acoustomagnetic Electronic article surveillance systems are capable of inducing 3.7 V in pacemaker leads leading to isolated premature paced beats (but no sustained rapid pacing) as observed by McIvor et al, (1998). Oversensing of EMI by the atrial channel of a pacemaker programmed to a tracking mode (DDD, VDD) can trigger ventricular pacing at or near the upper tracking rate limit.…”