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Pacemaker sensitivity to 50 Hz noise voltages.

Werner Irnich¹, Mary Kay Steen-Mueller

¹Faculty of Medicine, Justus-Liebig-University, Friederichstr. 18, Giessen DE-35392, Germany. werner@irni.ch

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology

|May 10, 2011

Summary

Pacemakers (PM) are susceptible to 50 Hz noise, potentially misinterpreting it as heart signals. Programming sensitivity settings (SS) above 2 mV is crucial for adequate protection against electromagnetic interference (EMI).

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Area of Science:

Biomedical Engineering
Electrophysiology
Medical Device Technology

Background:

European standards mandate pacemakers (PM) to resist electromagnetic interference (EMI).
Pacemaker sensitivity settings (SS) influence susceptibility to 50 Hz noise, a common EMI parameter.
Understanding SS and noise thresholds is vital for protecting PM patients from EMI.

Purpose of the Study:

To determine the borderline sensitivity setting (SS) for 50 Hz noise in pacemakers.
To evaluate the signal-to-noise ratios (S/N) of various pacemaker models against 50 Hz noise.
To provide recommendations for programming SS to ensure patient safety from EMI.

Main Methods:

Explantation and measurement of 189 pacemakers implanted in 1998 or later.
Measurement of ventricular SS and 50 Hz noise thresholds according to European standards.
Derivation of signal-to-noise ratios (S/N) from heart test and noise test signals.

Main Results:

All tested pacemakers exhibited S/N ratios below 1 for 50 Hz noise, indicating less amplification of heart signals than noise.
Medtronic pacemakers showed extreme sensitivity to continuous 50 Hz noise at low heart test amplitudes.
Noise immunity increased with higher heart test signal amplitudes.

Conclusions:

Pacemakers reacted to 50 Hz noise as if it were heart signals, leading to inhibition or asynchronous pacing.
A sensitivity setting (SS) of 2 mV does not guarantee noise tolerance up to 2 mV as required by European standards.
Programming SS to approximately 3 mV in Medtronic pacemakers is recommended for optimal protection against pulsed and continuous 50 Hz noise.