Elsevier

Journal of Endodontics

Volume 40, Issue 2, February 2014, Pages 277-280
Journal of Endodontics

Basic Research
Interference of Electronic Apex Locators with Implantable Cardioverter Defibrillators

https://doi.org/10.1016/j.joen.2013.07.027Get rights and content

Abstract

Introduction

The purpose of this in vitro study was to evaluate the potential electromagnetic interference of electronic apex locators (EALs) on implantable cardioverter defibrillators (ICDs).

Methods

Four different EALs were tested for their ability to interfere with the correct function of 3 different ICDs. Each ICD was placed in a plastic container with 1.5 L physiological saline, and the EAL unit was placed at a distance of 2.5 cm from the ICD. The file electrode and lip clip were placed directly against the ICD. The EAL was turned on for 30 seconds while continuously showing the “APEX” mark. As a negative control, the ICD was tested without EAL for 30 seconds. An electrosurgical unit served as a positive control. During each test, the ICD output was monitored continuously by real-time telemetry, and after completion of the experiment, intracardiac electrocardiograms were printed. The tests were repeated 3 times for each device. The electrocardiograms were examined for interference on ICD ventricular activity.

Results

All EALs tested and the negative control failed to produce electromagnetic interference in each of the ICDs tested. The electrosurgical unit induced interference in the ICDs, which were detected as episodes of ventricular tachycardia and led to the initiation of electrical shocks in all ICDs.

Conclusions

The 4 EALs tested did not interfere with the correct functioning of ICDs in vitro.

Section snippets

Material and Methods

Four different EALs (Table 1), the Root ZX Mini (Morita Corp, Irvine, CA), Apit 11 (Osada Electric Co, Ltd, Tokyo, Japan), Root ZX II (Morita Corp), and VDW Gold (VDW, Munich, Germany), were tested for their ability to interfere with the correct function of 3 commonly used ICDs. The ICDs selected (Fig. 1) for testing were the Biotronik Lumax 540 VR-T (Biotronik SE & Co KG, Berlin, Germany), Boston Scientific Cognis 100-D (Boston Scientific Co, Natick, MA), and Medtronic Protecta XT CRT-D

Results

All 4 different types of EALs and the negative control failed to produce EMI in each of the ICDs tested (Fig. 2A) and in all repetitive tests (Table 3). These results were categorized as EMI-0. This is in contrast to the results with the electrosurgical unit that served as a positive control. During the operation of the surgical unit, each ICD detected interference in all repeated tests that were misdiagnosed as episodes of ventricular tachycardia and resulted in the delivery of shocks in all

Discussion

Pacemakers and ICDs are an effective treatment for life-threatening arrhythmias, and ICDs reduce mortality caused by sudden cardiac death in high-risk patients (19). In the United States, 2.9 million patients received a permanent pacemaker between 1993 and 2009, and the number of pacemakers implanted per year is still increasing (20). More than 66.000 ICDs are implanted annually in the United States (21). In Europe, the number of new implants of pacemakers ranged from 121–1,134 per million and

Acknowledgments

The authors thank Noortje Bijvoet and Mariska de Blaauw for their technical assistance with this experiment and to Arjen van Wijk for his valuable advice.

The authors deny any conflicts of interest related to this study.

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