Effects of handheld electro-shockers on cardiac implantable electronic devices

Abstract

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.