CLINICAL RESEARCH
Europace (2016) 18, 726–731
doi:10.1093/europace/euv374
Sudden death and ICDs
Low risk of electromagnetic interference between
smartphones and contemporary implantable
cardioverter defibrillators
Haran Burri*, Louis Paulin Mondouagne Engkolo, Nicolas Dayal, Abdul Etemadi,
Anne-Marie Makhlouf, Carine Stettler, and Florence Trentaz
Cardiology Service, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, Geneva 1205, Switzerland
Received 7 September 2015; accepted after revision 15 October 2015; online publish-ahead-of-print 8 February 2016
Aims
Manufacturers of implantable cardioverter defibrillators (ICDs) recommend that cell phones be maintained at a distance of 15 cm from the implanted device in order to avoid risk of dysfunction due to electromagnetic interference
(EMI). Data relating to this issue are outdated and do not reflect modern technology. Our aim was to evaluate whether
EMI is still an issue with contemporary ICDs and smartphones.
.....................................................................................................................................................................................
Methods
Consecutive patients implanted with a wireless-enabled ICD were tested for potential interference with two models of
and results
recent 4G smartphones in conditions intended to maximize risk of EMI. A magnet effect (due to the phone speakers)
was tested by placing the smartphones in the standby mode directly over the ICD generator. The presence of EMI
artefacts on the real-time electrograms was evaluated by placing the smartphones in the standby, dialling, and operating
modes directly over the generator casing and over the parasternal region in the vicinity of the ventricular lead. A total of
63 patients equipped with 29 different models of single, dual, or biventricular ICDs from five major manufacturers were
included. None of the patients showed any evidence of interference with the smartphones during any of the 882 tests.
.....................................................................................................................................................................................
Conclusion
The risk of EMI between modern smartphones and contemporary ICDs is low. This is probably due to the filters incorporated in the ICDs and low emission by the phones, as well as the small size of the magnets in the smartphones
tested.
.....................................................................................................................................................................................
Study
NCT02330900 (http://www.clinicaltrials.gov).
registration
----------------------------------------------------------------------------------------------------------------------------------------------------------Keywords
Mobile phone † Smartphone † Implantable cardioverter defibrillator † Electromagnetic interference †
Magnet effect
Introduction
The telecommunications industry has been the stage of remarkable
technological advances in the last decade, notably within the domain
of mobile phones. With the advent of third- (3G) and fourth
(4G)-generation communication standards, their use has grown
exponentially. According to the International Telecommunications
Union (www.itu.int), the number of active mobile phone subscriptions in 2015 is estimated at 1.2 per inhabitant in the developed
world.
Mobile phones generate two different types of electromagnetic
radiation (EMR) fields: a static field produced by the magnets
located in the speakers (in the earpiece and loudspeaker), and a
dynamic field resulting from the emission of radiofrequency necessary for communication. Numerous reports in the 1990s have
shown electromagnetic interference (EMI) between cell phones
and pacemakers, although this is less of an issue with modern devices.1,2 Implantable cardioverter defibrillators (ICDs) potentially
have a higher risk of interference than pacemakers due to the high
programmed sensitivity. Electromagnetic radiation may cause oversensing with inhibition of pacing or inappropriate therapy, as well as
temporary inactivation of antitachycardia therapy due to a magnet
response. Previous in vitro and in vivo studies have shown EMI between mobile phones and ICDs.3,4 Based on these results and
* Corresponding author. Tel: +41 22 372 37 46; fax: +41 22 372 72 29. E-mail address: [email protected]
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2016. For permissions please email: [email protected].
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Electromagnetic interference between smartphones and contemporary ICDs
What’s new?
† No cases of electromagnetic interference (EMI), either with
signal artefacts or a magnet effect, were found between two
popular models of smartphones and contemporary ICDs
from five major device manufacturers.
† The risk of EMI seems to be currently negligible, and the recommendations made to patients to hold their cell phones at
15 cm from their implantable device should be revised in order to avoid unnecessary stress and allow them to lead lives
that are as normal as possible.
also on regulations for testing electromagnetic compatibility of implanted devices,5 all manufacturers of cardiovascular implantable
electronic devices (CIED) currently recommend a safety distance
of 15 cm between mobile phones and the implanted device. However, these reports date from at least a decade and may not reflect
current risk due to the presence of filters in more recent CIEDs as
well as a lower emission power of more recent mobile phones. It
should also be noted that all these studies were limited to previous
generation cell phones operating on the GSM (2G) bandwidth of
900 MHz and most were carried out with the protective effect of
the programmer head placed over the generator. Current smartphones use the UMTS (3G) standard (which has different signal
properties compared with GSM) for phoning and LTE (4G) standard
for data transfer (see Table 1). To the best of our knowledge, the risk
of EMI of contemporary mobile phones and ICDs has not yet been
published. Due to the growth of numbers of ICD patients exposed
to cell phones, this issue has reached public health proportions. We
therefore sought to evaluate the risk of EMI between contemporary
smartphones and ICDs.
Methods
Patients and devices
We enrolled consecutive outpatients scheduled for routine ICD followup at our centre. All types of ICDs were included in our study (single
chamber, dual chamber, biventricular). The only inclusion criterion
was the presence of a wireless-enabled ICD, as this allowed continuous
communication between the programmer and the implanted device
during all tests, without the necessity of maintaining the programming
head on the generator (which may have a shielding effect, cause loss
of telemetry, or generate trains of artefacts).6,7
Patients who were pacemaker dependent or aged ,18 years, as well
as those unable to sign a consent form, were excluded from the study.
The study was approved by the institutional ethics committee, and all
patients provided written informed consent.
Study protocol
Two popular models of smartphones were used: the Samsung Galaxy S4
with an emission Specific Absorption Rate (SAR) of 0.5 W/kg and the
Apple iPhone 6 (SAR 0.9 W/kg), both operating on the same mobile
network (Sunrise Switzerland). Both smartphones were quad band, operating at 850/900/1800/1900 MHz. The static magnetic field strengths
of the cell phone speakers were measured using the magnetic sensor of
a Samsung Galaxy SIII phone and the Sensor Kinetics Android App.
In the standby mode with good network field strength, a mobile
phone has negligible emission. The emission is considerably increased
in case of low network with automatic switching of bands by the phone
to search for a better signal. In order to increase the emission power of
the mobile device (and hence the risk of EMI), all tests were conducted
in a room with a weak mobile network located in the hospital basement
adjacent to the electrophysiology lab. The smartphones displayed a
maximum of 1 bar on the reception indicators, and the field strength
was consistently measured as being less than 2100 dBm using an Android application on the Samsung device (KAIBITS Software v 2.70.15,
Frankfurt, Germany). The presence of a magnet effect was evaluated
by placing each smartphone in the standby mode over the ICD generator and noting the response shown in Table 2. Routine ICD interrogation was performed and included assessment of background noise on
the electrograms (EGMs). All tachyarrhythmia therapies were then inactivated to avoid inappropriate therapy in case of oversensing of EMI,
without changing pacing parameters. In order to increase the risk of
interference, the sensitivity of the atrial and ventricular leads was set
to the maximum programmable level (see Table 2). Evaluation of EMI
on the EGMs consisted of placing the smartphone directly over the generator casing in the standby mode, during ringing and during operation
of a call. The same sequence was repeated with the smartphone placed
in the left parasternal region, at proximity to the right ventricular lead.
During all the tests, the intracardiac EGMs were monitored and printed
in real time to assess for visible artefacts (comparing the tracing with the
Table 1 Overview of cell phone transmission technology (shown for current standards in Switzerland)
Generation
Voice
Data
Carrier band (MHz)
Pulsing (Hz)
Max. power (W)
2G
GSM
EDGE
900
1800
2 (900 Hz)
1 (1800Hz)
3G
UMTS
HSPA+
4G
VoLTE
LTE
2100
(900)
800
1800
2600
2
8
217
1733
100
1500
1000
...............................................................................................................................................................................
0.25
0.20
GSM, global system for mobile communications; LTE, long-term evolution; EDGE, enhanced data rates for GSM; HSPA +, high-speed packet access plus; VoLTE, voice over LTE
(only available in very recent devices).
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H. Burri et al.
Table 2 Maximum programmable sensitivity and magnet response according to device manufacturer
Atrial (mV)
Right ventricle (mV)
Left ventricle (mV)
Magnet response
Biotronik
0.2
0.4/0.5
0.5
Episode lista
Boston Scientific
Medtronic
0.15
0.15
0.15
0.15
0.15
N/A
Audible alert
Audible alert
...............................................................................................................................................................................
St-Jude Medical
0.15
0.15
N/A
Vibratory alert
Sorin
0.2
0.4
N/A
Pacing at 96 bpm
Different models of the same manufacturer may have different sensitivity settings.
N/A, not available.
a
Indication of magnet application on the episode list upon ICD interrogation after having placed the phone for at least 5 min on the device.
recording prior to exposure to the smartphone to discount for background noise) or oversensing (by analysing the marker channels). The
tests were performed consecutively with each of the two smartphones
in all patients, with a total of 14 tests per patient (in addition to the baseline evaluation). At the end of the procedure, the ICD was reinterrogated and reprogrammed to the initial settings.
Results
A total of 63 patients were included, with a total of 882 tests (in addition to baseline evaluation of the ICDs). Patient characteristics are
shown in Table 3, with the 29 different ICD models from 5 major
manufacturers shown in Table 4. IS-4 connectors were present in
11 CRT-Ds and DF-4 connectors in 13 devices (Boston Scientific,
Medtronic, and St-Jude Medical models) with DF-1 and IS-1 connectors in all other devices. All generators were implanted in a left prepectoral pocket, and respective leads were implanted in the right
atrial appendage, right ventricular apex, and postero-lateral coronary sinus tributaries. The leads corresponded to the same manufacturers as the generator (with all Boston Scientific ICD leads being of
integrated bipolar design). Sensing was programmed to bipolar in
all leads, i.e. none of the left ventricular leads were programmed
to extended bipolar sensing.
For the Galaxy 4 phone, the magnetic field was measured at
1.5 mT at 0 cm and at 0.02 mT at 2 cm. For the iPhone 6, the field
was measured at 1.2 mT at 0 cm and 0.01 mT at 2 cm.
There were no cases of EMI either detected by the ICDs or visualized on the real-time EGM recordings. Furthermore, there was no
evidence of a magnet effect resulting from proximity of the smartphones in any of the patients studied.
Discussion
The main finding of the study is that the smartphones did not cause
any EMI in patients with contemporary ICDs, despite testing in the
‘worst-case’ conditions that maximized the risk of interference. Our
findings are in agreement with previous studies that showed lack of
EMI between 2G GSM cell phones and ICDs.6 – 10
All modern CIEDs have sense-amplifier filters that are centred on
the frequency range of endocavitary signals generated by atrial and
ventricular depolarization (20–100 Hz). The high-pass filters aim
to eliminate low-frequency signals (e.g. T-wave components), and
Table 3 Patient characteristics
Patient characteristics (n 5 63)
................................................................................
Age (years)
Male gender
65 + 15
54
Weight (kg)
82 + 17
Height (cm)
Heart rate (bpm)
171 + 8
77 + 12
LVEF (%)
32 + 17
Cardiopathy aetiology, n (%)
Ischaemic
28 (44)
Non-ischaemic
NYHA class
I
35 (56)
14 (22)
II
33 (52)
III
IV
15 (24)
1 (2)
ICD type, n (%)
Single chamber
Dual chamber
13 (21)
18 (29)
CRT-D
32 (51)
Device indication
Primary
Secondary
Time since implantation (months)
39 (62)
24 (38)
24 + 21
Data are expressed as mean + standard deviation. Percentages are shown in
parentheses. LVEF, left ventricular ejection fraction; NYHA, New York Heart
Association; ICD, implantable cardioverter defibrillator; CRT-D, cardiac
resynchronization therapy-defibrillator.
the low-pass filters attenuate myopotentials and EMI. Although
these filters may not eliminate 100% of the signal in the filtered
bandwidths, and EMI with frequencies within the 20–100 Hz spectrum will not be eliminated, these filters attenuate GSM signals that
are of MHz frequencies.11 However, GSM waveforms are modulated, which includes amplitude modulation and pulsing of the signal.
An in vitro study by Barbaro et al. 11 has shown that the GSM signal
may be demodulated by the pacemaker, probably by internal nonlinear elements of the circuit, yielding frequencies that may escape
filtering and be sensed by the device (see Figure 1A). In addition to
729
Electromagnetic interference between smartphones and contemporary ICDs
Table 4 Implantable cardioverter defibrillator
manufacturers and models
Manufacturer (n)
ICD type (n)
................................................................................
Medtronic (20)
Evera XT
VR (2); DR (1)
Protecta
DR (1); CRT-D (5)
Secura
Viva quad XT
VR (1); DR (1)
CRT-D (4)
Viva XT
CRT-D (5)
Boston Scientific (15)
Autogen X4
CRT-D (3)
Cognis
CRT-D (2)
Incepta
Teligen
DR (2); CRT-D (2)
VR (3); DR (2)
Vitality2
VR (1)
St-Jude (13)
Ellipse
VR (1); DR (2)
Fortify ST DR
DR (2)
Quadra Assura
Unify
CRT-D (4)
CRT-D (4)
Biotronik (11)
Ilesto 7
Iperia
VR (1); DR (2); CRT-D (2)
VR (2)
Lumax
VR (1); DR (2); CRT-D (1)
Sorin (4)
Paradym RF
VR (1); DR (3)
ICD, implantable cardioverter defibrillator; VR, single chamber; DR, dual chamber;
CRT-D, biventricular defibrillator.
the sense-amplifier bandpass filters, modern CIEDs are equipped
with a second type of filter called feedthrough capacitor filters
(see Figure 1B), which have been shown to be a major factor for reducing digital cell phone EMI with pacemakers (from 28.9 to 0.4% of
patients, P ¼ 0.01).12 These broadband filters (30 MHz –10GHz13)
avoid conduction of EMI from the CIED casing to the internal circuitry via the device header (which also occurs if the device is programmed with bipolar sensing).11 The titanium case protects the
device circuitry from EMI, but the interference may penetrate via
the unshielded header, as shown by in vitro 4 and in vivo 3 studies
with ICDs. These studies also showed that the lead tip and body
are unlikely to conduct EMI. In fact, leads placed in a conductive medium (such as blood) are poor antennas. Furthermore, recent leads
have nanomagnetic insulation to shield them from radiofrequency
and magnetic fields.14 Other factors that may contribute to reduced
risk of EMI with modern cell phones are lower maximum power
emission with the 3G and 4G standards (≤0.25 W compared
with 1–2 W with 2G, and up to 8 W used in previous studies),15 improved signal quality (and hence lower cell phone radiation) due to
better provider coverage, less low-frequency modulation of the signal, as well as higher carrier band frequencies (resulting in less tissue
penetration).
Regulations in Europe and in the USA require that device manufacturers test for possible cell phone EMI in the 450 MHz-3 GHz
bandwidth at 120 mW at 2.5 cm, which corresponds to emission
of a phone placed 15 cm from the device. Voluntary testing may
be performed at 8 W (at 450 MHz – 1 GHz) and 2 W (at 1 –
3 GHz), which renders the implanted device compatible with cell
phones without restrictions of distance. Despite the fact that this
voluntary testing is usually performed, device manufacturers still
maintain their warnings of keeping cell phones at a distance of
15 cm, in order to avoid possible legal issues.
In a series presented in abstract format, of 161 ICD patients exposed to three smartphone models operating at maximum power
output, a single case of EMI occurred in a patient with a Biotronik
Lumax 640 CRT-D with two smartphones operating in GSM and
UMTS modes.16 However, two other patients in this series implanted with an identical model showed no EMI, and none of the
11 patients in our report equipped with a Biotronik ICD had any
EMI. Reasons for these findings are unclear, but isolated cases of
EMI despite feedthrough filters may occur if (1) the filter is defective
(despite extensive testing by manufacturers), (2) leads are improperly connected to the header, and (3) the filter circuit is not properly in contact with the generator housing. These circumstances are
likely to be exceptionally rare and should not affect recommendations made to patients.
Another consideration is that CIED magnetic switches may be
activated if a magnetic field is aligned with the switch at ≥1 mT
(which is equivalent to ≥10G).17 Cell phone speakers may be
equipped with neodymium–iron– boron magnets, which are small
in size but produce strong static magnetic fields (even if the phone
is turned off). One in vitro study showed that these magnets may
activate pacemaker and ICD magnetic switches.18 However, the
magnets in mobile phones are considerably smaller than those
used in this study (which generated fields of at least 1.2 T). Another
study reported interference with clip-on (but not in-ear) headphones in 38% of ICD patients, but only if the field strength of
the headphone was ≥1 mT at a distance of 2 cm.19 During in vitro
testing, a magnet effect with ICD reed switch activation was found
to be present when a cell phone with a magnetic field strength of
28.8 mT was placed ,5 mm from the region of the casing overlying the reed switch, but did not occur during in vivo testing.9 Our
study did not show any magnet effect with newer-generation mobile phones in which the static magnetic field was measured
,0.1 mT at 2 cm.
Study limitations
A limitation of our study is the relatively small number of patients,
although the sample size is larger than all previous studies published
in ICD patients.3,6 – 9 The results of our study are applicable to the
smartphones and ICDs tested, and we therefore cannot exclude
interaction between other models of mobile phones and ICDs, although this is highly unlikely. Nevertheless, it would be of interest
to test cell phone EMI with subcutaneous ICDs. None of our
CRT-D patients had left ventricular sensing programmed to extended bipolar, but this is unlikely to have affected the results as cardiac leads have not been found to play a major role in EMI with cell
phones.3,11 We did not assess whether the smartphones interfere
with transmission of remote monitoring data, but this has been previously shown to not be an issue.20 We also did not evaluate
whether the most recent voice transfer mode (4G VoLTE) and
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H. Burri et al.
A
Modulated
signal
B
Demodulated
signal
Circuitry
Amplified
demodulated signal
Sense
amplifier
Bandpass
filter
Filtered and
rectified signal
Rectifier
Ceramic
feedthrough
capacitor
VF VF VF
Level
detector
Sensitivity
level
Sensed EMI
Sense
amplifier
Bandpass
filter
Level
detector
Rectifier
Figure 1 Schematic representation of sensing of EMI between cell phones and ICDs. (A) Situation without ceramic feedthrough capacitors. Cell
phone emission (GSM signal waveform with MHz range), which is demodulated by the ICD circuitry into a signal that includes low frequencies (in
the Hz range). The signal is then amplified by the sense amplifier before being filtered (bandpass 20 – 80 Hz), retaining only the low-frequency
components, which are then sensed by the device. (B) The leads have an insignificant antenna effect, and EMR is reflected by the titanium generator
casing. Electromagnetic radiation may, however, penetrate the device via the unprotected header and may then cause oversensing via the mechanism described in A. However, the addition of a ceramic feedthrough capacitor blocks the entry of EMR into the device circuitry and thereby
avoids oversensing.
Table 5 Simplified EMI testing procedure between cell phones and ICDs
Testing for interference with EMR
Inactivate ICD therapies.
Evaluate the strength of the network field (the lower the field, the higher the phone output power) and the carrier band (3G, 4G, etc.) on the cell phone
display.
Program maximum sensitivity of all ICD sensing channels.
Visually evaluate baseline artefacts and the presence of oversensing (e.g. of T-waves).
Place the phone in the standby mode over the generator.
Place an incoming call to the cell phone.
Evaluate for the presence of EGM artefacts and oversensing (marker channel during wireless telemetry).
Testing for a magnet effect
Place the cell phone in the standby mode over the ICD generator in a vertical axis (as when placed in a pocket).
Optionally, the phone may also be rotated over 1808 to test for different magnetic field alignments.
Move the cell phone over the ICD generator (to scan proximity with the reed switch or Hall sensor).
Evaluate the presence of a magnet response according to the manufacturer (cf. Table 2).
data transfer modes (EDGE, HSPA+, and LTE) result in EMI, but this
is highly unlikely because these modes either have similar characteristics as the voice modes (for EDGE and HSPA+) or have low
power and the absence of low-frequency signal components (for
HSPA+, VoLTE, and LTE). Likewise, Bluetooth and Near Field
Communication (NFC) were not tested for EMI but are also unlikely
to have affected results because of the very low power (1 mW
maximum power for Bluetooth and 0.1 W for NFC).
Conclusion
Our study demonstrates the absence of interference between contemporary smartphones and ICDs, which is in line with data published over the last decade. Due to technological advances, both
in mobile phone and ICD technology, the risk of EMI seems to be
currently negligible. It is likely to remain so for future generations
of telecommunication standards due to low emission power of
Electromagnetic interference between smartphones and contemporary ICDs
the phones, high signal frequencies (with reduced tissue penetration),
and effective CIED filters. As such, this study provides important
safety information, but ideally, individual testing of patients for lack
of interaction with their cell phone should be performed at device
follow-up (a simple testing protocol is shown in Table 5). However,
it should be borne in mind that the device clinic may not represent a
worst-case scenario due to a good network field strength. Lifestyle
recommendations issued to patients should be evidence based, pragmatic (and accept the fact that risk may not be zero), and should not
cause unnecessary stress. If testing does not show any EMI, patients
may be reassured regarding use of their phone, which should help
them lead lives that are as normal as possible.
Acknowledgements
The authors wish to thank Dr Hugo Lehmann (Swisscom),
Mr Guillaume Girard (Medtronic), and Mr Thomas Dörr (Biotronk)
for their replies to our technical queries and review of the manuscript.
Conflict of interest: none declared.
References
1. Censi F, Calcagnini G, Triventi M, Mattei E, Bartolini P. Interference between mobile
phones and pacemakers: a look inside. Ann Ist Super Sanita 2007;43:254 – 9.
2. Hekmat K, Salemink B, Lauterbach G, Schwinger RH, Südkamp M, Weber HJ et al.
Interference by cellular phones with permanent implanted pacemakers: an update.
Europace 2004;6:363–9.
3. Barbaro V, Bartolini P, Bellocci F, Caruso F, Donato A, Gabrielli D et al. Electromagnetic interference of digital and analog cellular telephones with implantable cardioverter defibrillators: in vitro and in vivo studies. Pacing Clin Electrophysiol 1999;22:626–34.
4. Bassen HI, Moore HJ, Ruggera PS. Cellular phone interference testing of implantable cardiac defibrillators in vitro. Pacing Clin Electrophysiol 1998;21:1709 –15.
5. Calcagnini G, Censi F, Bartolini P. Electromagnetic immunity of medical devices: the
European regulatory framework. Ann Ist Super Sanita 2007;43:268 –76.
6. Chiladakis JA, Davlouros P, Agelopoulos G, Manolis AS. In-vivo testing of digital
cellular telephones in patients with implantable cardioverter-defibrillators. Eur
Heart J 2001;22:1337 –42.
731
7. Occhetta E, Plebani L, Bortnik M, Sacchetti G, Trevi G. Implantable cardioverter
defibrillators and cellular telephones: is there any interference? Pacing Clin Electrophysiol 1999;22:983 –9.
8. Sanmartin M, Fernandez Lozano I, Marquez J, Antorrena I, Bautista A, Silva L et al.
The absence of interference between GSM mobile telephones and implantable
defibrillators: an in-vivo study. Groupe Systemes Mobiles. Rev Esp Cardiol 1997;
50:715–9.
9. Fetter JG, Ivans V, Benditt DG, Collins J. Digital cellular telephone interaction with
implantable cardioverter-defibrillators. J Am Col Cardiol 1998;31:623 – 8.
10. Tandogan I, Ozin B, Bozbas H, Turhan S, Ozdemir R, Yetkin E et al. Effects of mobile
telephones on the function of implantable cardioverter defibrillators. Ann Noninvasive Electrocardiol 2005;10:409 – 13.
11. Barbaro V, Bartolini P, Calcagnini G, Censi F, Beard B, Ruggera P et al. On the mechanisms of interference between mobile phones and pacemakers: parasitic
demodulation of GSM signal by the sensing amplifier. Phys Med Biol 2003;48:
1661 –71.
12. Hayes DL, Wang PJ, Reynolds DW, Estes M 3rd, Griffith JL, Steffens RA et al.
Interference with cardiac pacemakers by cellular telephones. N Engl J Med 1997;
336:1473 –9.
13. Stevenson RA. Design and application of broadband ceramic feedthrough
capacitor EMI filters to cardiac pacemakers and implantable defibrillators. Proc
19th Ann Int Conf IEEE 1997;6:2558 –62.
14. Beinart R, Nazarian S. Effects of external electrical and magnetic fields on pacemakers and defibrillators: from engineering principles to clinical practice. Circulation
2013;128:2799 –809.
15. Naegeli B, Osswald S, Deola M, Burkart F. Intermittent pacemaker dysfunction
caused by digital mobile telephones. J Am Col Cardiol 1996;27:1471 –7.
16. Lennerz C, Pavaci H, Grebmer C, Vrazic H, Semmler V, Kottmaier M et al.
Electromagnetic interference between smartphones and current cardiac implantable electronic devices: rare but present (abstract). Europace 2015;S3:
iii119.
17. Jacob S, Panaich SS, Maheshwari R, Haddad JW, Padanilam BJ, John SK. Clinical
applications of magnets on cardiac rhythm management devices. Europace 2011;
13:1222 –30.
18. Wolber T, Ryf S, Binggeli C, Holzmeister J, Brunckhorst C, Luechinger R et al.
Potential interference of small neodymium magnets with cardiac pacemakers
and implantable cardioverter-defibrillators. Heart Rhythm 2007;4:1– 4.
19. Lee S, Fu K, Kohno T, Ransford B, Maisel WH. Clinically significant magnetic
interference of implanted cardiac devices by portable headphones. Heart Rhythm
2009;6:1432 –6.
20. Calcagnini G, Censi F, Floris M, Pignalberi C, Ricci R, Biancalana G et al. Evaluation of electromagnetic interference of GSM mobile phones with pacemakers
featuring remote monitoring functions. Pacing Clin Electrophysiol 2006;29:
380 – 5.