Effects of handheld electro-shockers on cardiac implantable electronic devices.

BACKGROUND

Handheld electro-shockers are commonly used for self-defense and possibly interact with cardiac implantable electronic devices (CIEDs).

OBJECTIVE

This study aimed to evaluate the effects of handheld electro-shockers on CIEDs.

METHODS

Six pacemakers (PMs; 1 VVI-PM, 4 DDD-PM, 1 CRT-PM) and 10 implantable cardioverter-defibrillators (ICDs; 5 VVI-ICD, 1 DDD-ICD, 4 CRT-ICD) from different manufacturers were implanted in a subcutaneous and submuscular location in an isolated section of a porcine chest and connected to an interactive heart simulator. Three electro-shockers (PowerMax, 500,000 V; Electric Guard, 250,000 V; Bikenda, <50,000 V) were successively applied to the porcine chest.

RESULTS

No damage to any of the PMs or ICDs was noted during testing. Subcutaneously, the highest rate of interaction was documented with the PowerMax electro-shocker, with 16 of 16 devices (100%) inhibiting stimulation during electro-shock application and 6 of 10 ICDs (60%) storing a ventricular high-rate episode. Application of the Electric Guard electro-shocker resulted in inhibition of stimulation in 10 of 16 devices (63%) and a stored ventricular high-rate episode in 1 of 10 ICDs (10%). The rate of oversensing was lowest with the Bikenda electro-shocker, with inhibition of stimulation in 2 of 16 devices (13%) and storage of a ventricular high-rate episode in none of the 10 ICDs. There was no relevant difference between subcutaneous and submuscular device placement (risk of interaction, 39% vs 36%; P = .88).

CONCLUSION

Handheld electro-shockers pose a substantial acute risk for interaction with CIEDs. The individual risk depends on electro-shocker voltage, manufacturer, and type of cardiac device.