Elsevier

Journal of Endodontics

Volume 32, Issue 9, September 2006, Pages 847-852
Journal of Endodontics

Clinical research
Safety of Electronic Apex Locators and Pulp Testers in Patients With Implanted Cardiac Pacemakers or Cardioverter/Defibrillators

https://doi.org/10.1016/j.joen.2006.03.005Get rights and content

Abstract

The purpose of this study was to determine if electronic apex locators (EAL) or electric pulp testers (EPT) interfere with the function of implanted cardiac pacemakers (ICP) or cardioverter/defibrillators (ICD). Twenty-seven patients with ICPs or ICDs had continuous electrocardiogram monitoring and device interrogation to detect interferences during the use of two types of EALs and one EPT. No interferences were detected by any ICP or ICD. In six patients, with intermittent pacing, a significant increase in pacing was observed during EAL/EPT stimulation (p < 0.05). Examination of RR intervals (a measure of intrinsic heart rate) demonstrated significantly longer RR intervals (slower intrinsic heart rate) during EAL/EPT stimulation (p < 0.05). Evaluation of the electrocardiograms for each patient failed to show any abnormalities in pacing during testing. These findings led us to conclude that the increased pacing frequency observed was related to a slower intrinsic heart rate and not electrical interference with the cardiac devices. In conclusion, the two EALs and one EPT used in this study did not interfere with the functioning of any of the cardiac devices tested.

Section snippets

Patient Recruitment

The study protocol was approved by the Oregon Health & Science University Institutional Review Board before enrolling patients. All patients aged 18 to 90 of any race or gender with working ICPs or ICDs were eligible for enrollment. The first five patients were recruited before their scheduled operation for their ICP/ICD generator change in the electrophysiology laboratory, where ready cardiovascular support and physical access to the device were available. The remaining patients were recruited

Patients

Approximately half of the patients declined to participate, either because of unwillingness, pacemaker dependence, or inability to give informed consent. Twenty-seven patients were included in the study, five in the electrophysiology laboratory, and 22 in the cardiology clinic.

The details of the patient population with average settings for tachycardia therapies and bradycardia pacing are listed in Table 2. All patients were able to complete the testing protocol and no patient complained of

Discussion

The patient population in this study represents patients coming to a university electrophysiology service and not necessarily those in a typical endodontic practice. The majority of the devices tested were ICDs. This reflects the fact that ICDs require more frequent generator replacement, that they receive more regular follow up in clinic, and that we excluded patients who were pacemaker dependent. Many of the devices we tested were newly implanted. Although one device was 14 yr old, it is

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