A Prospective Pediatric Clinical Trial of Digital Music Players: Do They Interfere with Pacemakers?

Christine C. Chiu, M.Sc.; June Huh, M.D., Ph.D.; Laura De Souza, B.Sc.; Armando Alfaro-Ramirez, M.D.; Robin Clegg, M.D.; Laura Fenwick, B.Sc.; Robert M. Hamilton, M.D., M.H.Sc.; Joel A. Kirsh, M.D.; Gil J. Gross, M.D.; Dongsheng Gao, Ph.D.; Elizabeth A. Stephenson, M.D., M.Sc.


J Cardiovasc Electrophysiol. 2009;20(1):44-49. 

In This Article

Abstract and Introduction

Background: There has been recent concern in the media about iPod™ interference with pacemakers. We systematically tested two types of digital music players (DMP) on pacemaker or ICD function in children.
Methods/Results: Patients were monitored by a 6-lead ECG and programmer telemetry. The pacemaker was tested in bipolar and unipolar sensing at normal and maximal sensitivities. The order of DMP tested was randomized. Each DMP was placed on top of the pacemaker pocket, put into "play" mode three times (5 seconds each), with and without programmer wand placed one cm adjacent to DMP. Pacemaker interference was defined as: pacing inhibition, inappropriate pacing, oversensing, or detection of high-rate episodes associated with the use of DMP. Of the 67 patients (mean age 12 ± 5 years), 62 had pacemakers and five had ICDs; 39 endocardial and 28 epicardial systems. Patients were tested with Sansa™ (67), iPod™ 30 GB (51), and other DMPs (43). There was no evidence of interference with pacemaker function by any DMP under any of the study conditions (each performed in triplicate). Reproducible programmer telemetry interference was shown in 11 cases (Medtronic 6/47, St. Jude Medical 5/18, Guidant 0/2) related to use of iPod™ (6), Sansa™ (1), or others (4). None of these were associated with any evidence of pacemaker malfunction.
Conclusion: Interference with pacemaker function could not be shown with iPod™ or MP3 players. No additional precaution beyond standard is necessary for patients with pacemakers when they are using these players.

Digital music players (DMP) such as Apple iPod™ or MP3 players are popular among children and adolescents; however, the digital circuits in these DMP may radiate weak electromagnetic interference (EMI). A recent study performed by Thaker et al. on adult patients showed a controversial finding of frequent interference between iPod™ and pacemaker function.[1] Thaker et al. found that interference with pacemaker function occurred in 50% of patients tested, although none of the patients reported any symptoms. The study lacked a clear definition of interference as well as what findings they considered to be of clinical importance. Subsequently, a case report published by the same group assessed for pacemaker interference by placing the iPod™ directly over the programmer telemetry wand.[2] This method may be problematic since the proximity of the iPod™ to the radiofrequency (RF) telemetry link may enhance the potential for EMI interference.[3] In both instances, it was not recognized that interference of programmer telemetry does not necessary imply interference with pacemaker function. This study was noted by the media and widely publicized, causing anxiety among pacemaker patients and their families.

In our study, we sought to systematically evaluate if EMI from two types of DMP can interfere with implanted pacemaker or cardioverter defibrillator (ICD) function in children.


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