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April 20, 2004
In a High-Tech World, Pacemaker Risks Rise
By ANAHAD O'CONNOR
As high-tech gadgets and devices proliferate, people who use pacemakers
are
finding themselves in a world that is increasingly difficult to
navigate.
Once concentrated in the workplace, devices that can disrupt pacemaker
function are now much harder to avoid. Metal detectors hidden in store
entrances and exits, for example, can be impossible to spot. Magnetic
resonance imaging techniques, often considered a danger to those with
pacemakers or implanted defibrillators, have become a common diagnostic
procedure.
But sometimes, doctors have found, the culprit can even be something
that
appears relatively innocuous. In a letter to The New England Journal of
Medicine on Thursday, three Swiss doctors reported the case of a
52-year-old
man with a pacemaker who was experiencing sporadic bouts of dizziness.
The doctors were puzzled. But a detailed history revealed that the
patient
had been using a little-known alternative medicine device called a
Zapper,
which generated electrical impulses when held in both hands. Each time
the
patient tried to use it, the doctors said, his pacemaker would stop
working
and start up again only when the man fainted and dropped the device.
"This went on for several months," said Dr. Osmund Bertel, a
cardiologist at
Triemli Hospital in Zurich and one of the authors of the letter. "The
modern
environment is full of these things that people don't realize can
interfere
with their pacemakers. But it's important to be aware of them."
Another little-known menace to people with pacemakers, some doctors
say, is
a popular treatment for pain relief called PENS, or percutaneous
electrical
nerve stimulation. Often used for lower back pain, the treatment, which
is
akin to acupuncture with electric current, has been shown to affect
some
pacemakers, said Dr. Sergio Pinski, a cardiologist at the Cleveland
Clinic
in Weston, Fla.
"Pretty much any device that delivers current to the body has the
potential
to cause problems," Dr. Pinski said.
More than two million Americans have permanent implanted pacemakers.
Some of
the more traditional threats to the devices, experts say, can be safe
if
precautions are followed. Cellphones, for example, should not be
carried in
the breast pocket or held to the ear closest to the pacemaker.
Metal detectors can be safe as long as the patient walks through
without
lingering.
"The interference is very transient," Dr. Pinski said.
M.R.I. machines, usually considered off limits because they operate on
powerful magnets, can also be safe in some instances, new research
suggests.
In a study published in The Journal of the American College of
Cardiology on
April 7, doctors who monitored 54 patients with pacemakers as they
underwent
M.R.I.'s found that they almost always emerged relatively unscathed.
But the
researchers cautioned that doctors should follow a number of safety
guidelines in cases where a patient with a pacemaker needs an M.R.I.
"First, the patient needs to understand that there are small risks
involved," said Dr. Edward T. Martin, director of the cardiovascular
M.R.I.
center at the Oklahoma Heart Institute and lead author of the study.
"There
should also be a cardiologist and someone who is trained in advanced
cardiac
life support present."
In case something does go wrong, he said, a physician who knows how to
program or adjust a pacemaker should be nearby. It is also a good idea
to
monitor patients' heartbeats with a heart rhythm strip, and to speak
with
them while they are in the scanner, Dr. Martin said.
"It's a controversial topic, but I think we've shown that if the
patient
must have an M.R.I. and another imaging technique can't be used,
there's an
acceptable benefit-to-risk profile here," he added.
In a High-Tech World, Pacemaker Risks Rise
By ANAHAD O'CONNOR
As high-tech gadgets and devices proliferate, people who use pacemakers
are
finding themselves in a world that is increasingly difficult to
navigate.
Once concentrated in the workplace, devices that can disrupt pacemaker
function are now much harder to avoid. Metal detectors hidden in store
entrances and exits, for example, can be impossible to spot. Magnetic
resonance imaging techniques, often considered a danger to those with
pacemakers or implanted defibrillators, have become a common diagnostic
procedure.
But sometimes, doctors have found, the culprit can even be something
that
appears relatively innocuous. In a letter to The New England Journal of
Medicine on Thursday, three Swiss doctors reported the case of a
52-year-old
man with a pacemaker who was experiencing sporadic bouts of dizziness.
The doctors were puzzled. But a detailed history revealed that the
patient
had been using a little-known alternative medicine device called a
Zapper,
which generated electrical impulses when held in both hands. Each time
the
patient tried to use it, the doctors said, his pacemaker would stop
working
and start up again only when the man fainted and dropped the device.
"This went on for several months," said Dr. Osmund Bertel, a
cardiologist at
Triemli Hospital in Zurich and one of the authors of the letter. "The
modern
environment is full of these things that people don't realize can
interfere
with their pacemakers. But it's important to be aware of them."
Another little-known menace to people with pacemakers, some doctors
say, is
a popular treatment for pain relief called PENS, or percutaneous
electrical
nerve stimulation. Often used for lower back pain, the treatment, which
is
akin to acupuncture with electric current, has been shown to affect
some
pacemakers, said Dr. Sergio Pinski, a cardiologist at the Cleveland
Clinic
in Weston, Fla.
"Pretty much any device that delivers current to the body has the
potential
to cause problems," Dr. Pinski said.
More than two million Americans have permanent implanted pacemakers.
Some of
the more traditional threats to the devices, experts say, can be safe
if
precautions are followed. Cellphones, for example, should not be
carried in
the breast pocket or held to the ear closest to the pacemaker.
Metal detectors can be safe as long as the patient walks through
without
lingering.
"The interference is very transient," Dr. Pinski said.
M.R.I. machines, usually considered off limits because they operate on
powerful magnets, can also be safe in some instances, new research
suggests.
In a study published in The Journal of the American College of
Cardiology on
April 7, doctors who monitored 54 patients with pacemakers as they
underwent
M.R.I.'s found that they almost always emerged relatively unscathed.
But the
researchers cautioned that doctors should follow a number of safety
guidelines in cases where a patient with a pacemaker needs an M.R.I.
"First, the patient needs to understand that there are small risks
involved," said Dr. Edward T. Martin, director of the cardiovascular
M.R.I.
center at the Oklahoma Heart Institute and lead author of the study.
"There
should also be a cardiologist and someone who is trained in advanced
cardiac
life support present."
In case something does go wrong, he said, a physician who knows how to
program or adjust a pacemaker should be nearby. It is also a good idea
to
monitor patients' heartbeats with a heart rhythm strip, and to speak
with
them while they are in the scanner, Dr. Martin said.
"It's a controversial topic, but I think we've shown that if the
patient
must have an M.R.I. and another imaging technique can't be used,
there's an
acceptable benefit-to-risk profile here," he added.
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