Electromagnetic Interference in Implantable Rhythm Devices - The Indian Scenario

Implantable rhythm device (IRD) is the generic name for the group of implantable devices used for diagnosis and treatment of cardiac arrhythmias. Devices in this category include cardiac pacemakers, implantable cardioverter defibrillators and implantable loop recorders. Since these devices have complex microelectronic circuitry and use electromagnetic waves for communication, they are susceptible to interference from extraneous sources of electromagnetic radiation and magnetic energy. Electromagnetic interference (EMI) is generally not a major problem outside of the hospital environment. The most important interactions occur when a patient is subjected to medical procedures such as magnetic resonance imaging (MRI), electrocautery and radiation therapy. Two articles in this issue of the journal discusses various aspects of EMI on IRD 1,2. Together these articles provide a good review of the various sources of EMI and their interaction with IRD for the treating physician.. Prof. Seymour Furman has given an excellent suggestion during his editorial preview of these articles. He has called upon the Indian investigators to assess the situation in the local community. Shree Pacetronix Ltd., the only Indian manufacturer of pacemakers, has informed that no case of EMI has been reported in their pacemakers, though a well designed study to test this aspect has not been conducted so far. They also mention that their pacemakers incorporate EMI protection. Largest number of devices implanted in the country are from Medtronic Inc. They have not received reports of EMI from India. It is likely that most or all instances of EMI may have gone unreported. Cell phones are fast becoming the common man's commodity in Indian cities and it is likely to be the single most common source for EMI. Cell phone operators in India follow the European standards of GSM (Global System Mobile) cellular telephony. D-net (900 MHz, digital pulsed) and the E-net (1,800 MHz, digital pulsed) are being used by operators in the country. C-net (450 MHz, analogue) which was being used in European countries, is not being used by any of the major operators in the country. An IRD is most vulnerable to EMI during interrogation and programming. It is not advisable to have an activated cell phone in the vicinity during this process. Pacemaker patients really suffering from EMI due to mobile phones are very rare unless the phone is positioned in the pocket just over the pulse generator. The contralateral pocket or the belt position of the mobile phone guarantees undisturbed …