Correspondence

Interactions between Cardiac Pacemakers and Antishoplifting Security Systems

N Engl J Med 1998; 339:1394-1395November 5, 1998

Article

To the Editor:

The acoustomagnetic electronic article surveillance system is one of several types of antishoplifting gates that are now ubiquitous at the exits of retail stores. These systems emit a magnetic field that can interfere with cardiac pacemakers. The degree of interference varies according to one's proximity to the device and the duration of exposure to the magnetic field. For example, of 50 patients studied in a laboratory, 96 percent had an interaction while standing in the gates of an acoustomagnetic field, as compared with only 6 percent of those who walked briskly through the gates.1 Other types of electronic article surveillance systems pose no problem for patients with pacemakers. The question has been raised with acoustomagnetic systems whether this source of interference causes difficulty for patients with pacemakers under real-world conditions. Here we report such an interaction.

A 30-year-old woman with a Telectronics DDD-R pacemaker system (Telectronics Pacing Systems, Sydney, Australia), implanted because she had the sick sinus syndrome, reported that she had palpitations, nausea, dyspnea, and dizziness each time she passed through an electronic article surveillance system at a particular store. In speaking with the store staff, she learned she was not the only patient with a pacemaker to have these symptoms when passing through this gate. She also noticed the same symptoms when she passed through an identical gate at another store, yet she had no difficulty with other electronic article surveillance systems.

Further investigation revealed that the only gates that reproducibly interacted with her pacemaker were the acoustomagnetic systems. The woman wore an event monitor to the store, and it was documented that the electronic article surveillance system caused rapid ventricular pacing due to atrial oversensing (Figure 1Figure 1Serial Electrocardiograms of a Patient Traversing the Acoustomagnetic Field of an Electronic Article Surveillance System, Showing Atrial Oversensing (Top Panel) That Resulted in Rapid Ventricular Pacing near the Upper Rate Limit (Programmed at 175 Beats per Minute) (Middle Panel) and Returned to Normal after the Patient Exited the Field (Bottom Panel).).

Acoustomagnetic electronic article surveillance systems cause four types of interaction with pacemakers under controlled conditions: asynchronous pacing (reversion to noise mode); tachycardia (atrial oversensing that drives rapid ventricular pacing); inhibition of the pacemaker (ventricular oversensing); and system-induced pacing (direct induction of a current in the pacemaker lead by the magnetic field, resulting in extrasystoles). The case illustrates that atrial oversensing, at least, can occur under real-world conditions. We are also aware of the rare occurrence of syncopal episodes in patients with pacemakers who are exposed to acoustomagnetic gates.

Patients with pacemakers, particularly those who are dependent on them, should take care to minimize their contact with acoustomagnetic systems by passing quickly through the gates. Even so, symptomatic but brief interactions can still occur. Newer systems can be unobtrusive, located behind walls or beneath flooring, thus making it difficult for patients to know when they are in the magnetic fields of these systems. The labeling of areas within such strong magnetic fields should be considered to warn patients with pacemakers and to prevent clinically important interactions.

Michael E. McIvor, M.D.
Heart Institute of St. Petersburg, St. Petersburg, FL 33701

S. Sridhar, M.D.
Affiliated Cardiologists, Phoenix, AZ 85004

1 References

1. 1

   McIvor M, Johnson D, Reddinger J, et al. Study of pacemaker and implantable cardioverter defibrillator triggering by electronic article surveillance devices. Pacing Clin Electrophysiol (in press).
   

Citing Articles (10)

Citing Articles

1. 1

   Jay P. Thaker, Mehul B. Patel, Krit Jongnarangsin, Valdis V. Liepa, Ranjan K. Thakur. (2008) Electromagnetic interference with pacemakers caused by portable media players. Heart Rhythm 5:4, 538-544
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2. 2

   Mehul B. Patel, Jay P. Thaker, Sujeeth Punnam, Krit Jongnarangsin. (2007) Pacemaker interference with an iPod. Heart Rhythm 4:6, 781-784
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3. 3

   S. Sundar, R.P. Symonds, C. Deehan. (2005) Radiotherapy to patients with artificial cardiac pacemakers. Cancer Treatment Reviews 31:6, 474-486
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4. 4

   M. Windirsch, H. J. Hennes, B. Wolcke. (2004) Beeinflussung des Elektrokardiogramms durch elektromagnetische Felder. Notfall & Rettungsmedizin 7:6, 407-410
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5. 5

   Michael Glikson, David L. Hayes. (2001) Cardiac Pacing. Medical Clinics of North America 85:2, 369-421
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6. 6

   J. Warren Harthorne. (2001) Pacemakers and Store Security Devices. Cardiology in Review 9:1, 10-17
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7. 7

   WERNER IRNICH. (1999) Pacemaker-Related Patient Mortality. Pacing and Clinical Electrophysiology 22:9, 1279-1283
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8. 8

   (1999) Implantable Defibrillators, Pacemakers, and Electronic Antitheft Devices. New England Journal of Medicine 340:14, 1117-1119
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9. 9

   Michael E. McIvor, Robert C. Sheppard. (1999) LETTERS TO THE EDITOR. Pacing and Clinical Electrophysiology 22:3, 540-541
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10. 10

    Yuzuru SAKAKIBARA, Toshio MITSUI. (1999) Concerns about Sources of Electromagnetic Interference in Patients with Pacemakers.. Japanese Heart Journal 40:6, 737-743
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