Influence of electrical stimulation therapy on permanent pacemaker function

Wien Klin Wochenschr. 2019 Jul;131(13-14):313-320. doi: 10.1007/s00508-019-1494-5. Epub 2019 Apr 25.


Background: Electrical stimulation therapy (EST) and transcutaneous electrical neuromuscular stimulation (TENS), a modality of EST, have become widely applied, accepted and effective methods for the treatment of musculoskeletal and other pain conditions. According to the rising number of permanent pacemaker (PM) wearers the number of potential candidates for EST with concomitant device implantation is growing. Contradictory recommendations exist regarding the application of EST or TENS on PM wearers.

Aim: The study was carried out to evaluate the impact of EST on PM function.

Methods: A full size model mimicking the electrical characteristics of the human body was used to evaluate the application of EST on permanent PM devices. Various configurations with respect to energy modality, position of the stimulation electrodes and PM device models were evaluated. Intracardiac PM electrogram tracings (iEGM) were analyzed for the interference of EST with PM function.

Results: Unilateral EST application did not cause interference with PM function in any of the configurations (0%; n = 700). On the contrary, bilateral stimulation (350 configurations in total) caused either ventricular inhibition or switch to V00 back-up pacing due to electrical interference in 165 cases (47.1%) depending on the applied stimulation parameters.

Conclusion: The use of EST potentially interferes with PM therapy, especially if the electrodes are positioned bilaterally; however, unilateral EST application appeared to be safe in all tested configurations.

Keywords: Chronic pain; Device interaction; Ex-vivo; Full-size model; Transcutaneous electrical neuromuscular stimulation.

MeSH terms

  • Electric Stimulation Therapy* / instrumentation
  • Electric Stimulation Therapy* / methods
  • Humans
  • Pacemaker, Artificial* / standards
  • Transcutaneous Electric Nerve Stimulation*