Physiotherapy and cardiac rhythm devices: a review of the current scope of practice

Several case reports have demonstrated negative interactions between various physiotherapy modalities and cardiac rhythm devices (CRD). Fear of these potential interactions may lead to suboptimal utilization of physiotherapy treatments in CRD patients. No prior review of available guidelines, or management strategies, on the interaction between physiotherapy modalities and CRD patients has been reported. To review existing guidelines regarding the use of physiotherapy modalities in patients with pacemakers and/or implantable cardioverter-defibrillators (ICDs). To retrospectively analyse CRD patient encounters at a local physiotherapy facility during a period of 2 years.

A review of the literature regarding the potential interactions between physiotherapy modalities and CRDs was performed. Next, a 2 year retrospective analysis of patient encounters at a physiotherapy facility was conducted. In addition, seven international physiotherapy societies and four CRD manufacturers were surveyed with respect to recommendations regarding physiotherapy treatments in device patients. The local physiotherapy facility treated 25 patients with CRD (22 pacemaker and 3 ICD patients) for a total of 230 visits (9.2 visits/patient). Five patients received transcutaneous electrical nerve stimulation (TENS) and all 25 were administered additional treatment in the form of ultrasound (15), acupuncture (19), Laser (7), traction/manual therapy (12), exercise (8), education (18), taping (5), and/or moist heat (5). No complications occurred. Meanwhile, international societies and device manufacturers offered few specific or consistent recommendations.

There are no specific international policies regarding the administration of physiotherapy modalities in CRD patients and, thus, there are no specific guidelines to be implemented at the local level. Review of the literature and of recommendations from CRD manufacturers suggests that TENS, Diathermy, and Interferential Electrical Current Therapy are best avoided in patients with CRDs. However, there is no consensus and it may be possible to safely deliver these modalities in a proper setting with device and patient monitoring. Although further research is required in this regard, active collaboration between physiotherapists and CRD clinic physicians should allow for the safe application of most physiotherapy modalities.