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Safety of Screening Procedures With Hand-Held Metal Detectors Among

Patients With Implanted Cardiac Rhythm Devices

Article  in  Annals of Internal Medicine · November 2011

DOI: 10.1059/0003-4819-155-9-201111010-00005 · Source: PubMed

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Annals of Internal Medicine
Safety of Screening Procedures With Hand-Held Metal Detectors
Among Patients With Implanted Cardiac Rhythm Devices
A Cross-sectional Analysis
Clemens Jilek, MD; Stylianos Tzeis, MD, PhD; Hrvoje Vrazic, MD, PhD; Verena Semmler, MD; Georgios Andrikopoulos, MD, PhD;
Tilko Reents, MD; Stephanie Fichtner, MD; Sonia Ammar, MD; Ioannis Rassias, MD; Georgios Theodorakis, MD, PhD;
Stefan Weber, MD, PhD; Gabriele Hessling, MD, PhD; Isabel Deisenhofer, MD, PhD; and Christof Kolb, MD, PhD
Background: Case reports suggest that the hand-held metal detec-
tors used for security screening generate electromagnetic fields that
may interfere with pacemaker and implantable cardioverter-
defibrillator (ICD) function.
Objective: To assess changes in function of pacemakers and ICDs
after exposure to hand-held metal detectors.
Design: Cross-sectional study.
Setting: Two medical centers in Europe.
Patients: 388 patients (209 with pacemakers and 179 with ICDs)
presenting for routine follow-up of device function between Sep-
tember 2009 and December 2010.
Measurements: Abnormalities on electrocardiography suggestive of
rhythm device malfunction (pacing inhibition, loss of capture, inap-
propriate mode switch, ventricular oversensing, and spontaneous
reprogramming) after 30 seconds of exposure to 2 widely used
P acemakers and implantable cardioverter-defibrillators
(ICDs) are routinely used to treat arrhythmias. Func-
tion of these cardiac rhythm devices can be impaired by
electromagnetic interference from devices and systems
emitting magnetic fields, such as cellular phones (1); MP3
players; 50- or 60-Hz alternating current, induction ovens;
and antitheft devices (2– 8). As security screening measures
have intensified in the past decade, metal detectors are rou-
tinely used in many settings to detect ferrous items. Metal
detectors create a magnetic field that might interfere with
the function of cardiac rhythm devices, and patients with
pacemakers and ICDs are often advised to avoid screening
with metal detectors because of the risk for electromagnetic
interference.
We previously showed that metal detector gates are
safe for patients with cardiac rhythm devices (9). However,
security protocols often dictate that once metal detector
gates indicate the presence of ferrous material, hand-held
metal detectors should be used to verify and locate the
suspected object of interest. The U.S. Food and Drug Ad-
ministration has reported 44 instances of possible interfer-
ence between hand-held metal detectors or antitheft pro-
tection devices and cardiac rhythm device systems between
1988 and 1998 (10), which may result in oversensing of
the device and inhibition of antibradycardia therapies or
delivery of antitachycardia therapies (11). To more system-
atically assess this risk, we evaluated device function in
Original Research
hand-held metal detectors with a maximal electromagnetic flux
density of 6.3 ␮T.
Results: No change in device function, including pacing or sensing
abnormalities or device reprogramming, was observed in any
patient.
Limitations: The study included a convenience sample of patients,
and the number of different device models tested was small. Test-
ing was conducted in 2 clinic settings.
Conclusion: Hand-held metal detectors did not affect the function
of pacemakers or ICDs in this sample. The use of hand-held metal
detectors for security screening is probably safe for patients with
pacemakers and ICDs, but these findings require confirmation.
Primary Funding Source: None.
Ann Intern Med. 2011;155:587-592. www.annals.org
For author affiliations, see end of text.
patients with various cardiac rhythm devices exposed to 2
common hand-held metal detectors.
METHODS
Participants
Patients presenting for routine follow-up of pacemaker
or ICD function at the German Heart Center Munich,
Germany, and Henry Dunant Hospital, Athens, Greece,
between September 2009 and December 2010 were
screened for participation. Of 1713 such patients, 1286
were not scheduled for follow-up in rooms set up for test-
ing, 20 declined to participate, 17 met exclusion criteria
(atrial or ventricular sensing abnormalities that could not
be avoided by reprogramming of device variables, pre-
dicted battery life ⬍3 months, or intrinsic heart rate ⬎120
beats/min), and 2 were excluded for other reasons, for a
final sample of 388 participants (Figure).
See also:
Print
Editors’ Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 588
Summary for Patients. . . . . . . . . . . . . . . . . . . . . . . I-32
Web-Only
Appendix Tables
Conversion of graphics into slides
© 2011 American College of Physicians 587
Original Research Hand-Held Metal Detectors and Implanted Cardiac Rhythm Devices
Context
Metal detectors used for security screening create mag-
netic fields that could interfere with the function of cardiac
rhythm devices.
Contribution
The investigators used 2 common hand-held metal detec-
tors to conduct prolonged security screening–like examina-
tions in 388 patients with pacemakers and implantable
cardioverter-defibrillators presenting for routine care. They
observed no device malfunction during or after exposure
to this screening.
Caution
The investigators used a convenience sample of patients
and rhythm devices, and the study was done in a clinical
setting.
Implication
The use of common hand-held metal detectors in security
screening of patients with pacemakers and implantable
cardioverter-defibrillators is probably safe. The findings
require confirmation with a broader array of devices in
real-world security screening settings.
—The Editors
We included patients with all types of implantable
cardiac rhythm devices, including single- and dual-
chamber devices and cardiac resynchronization therapy de-
vices. Informed consent was obtained from all patients be-
fore the hand-held metal detectors were tested. The study
was approved by the local ethics committee of each
hospital.
Hand-Held Metal Detectors
As part of routine clinical care, we confirmed appro-
priate device function by using a standardized follow-up
protocol that comprised evaluation of battery status, assess-
ment of pacing and sensing function of implanted leads
through atrial and ventricular capture and sensing thresh-
olds, and review of arrhythmia diagnostics. We then tested
interference caused by 2 commercially available hand-held
metal detectors that are widely used in Europe: a PD140
device (CEIA, Arezzo, Italy), which is usually used at air-
ports and is the most popular in the worldwide market,
and an MH5 device (Vallon, Eningen, Germany), which is
mainly used in public services. We programmed both at
maximal sensitivity (maximal electromagnetic flux density,
3.82 ␮T for PD140 and 6.3 ␮T for MH5). We tested
interference from both devices at the German Heart Cen-
ter Munich; only the PD140 was tested at the Henry Du-
nant Hospital in Athens (Appendix Table 1, available at
www.annals.org).
Test Protocol
At the German Heart Center Munich, the test setting
with the hand-held metal detectors was installed in 1 of the
588 1 November 2011 Annals of Internal Medicine Volume 155 • Number 9
4 rooms used for routine examination of patients with
pacemakers and ICDs. All patients who presented for rou-
tine follow-up were allocated to 1 of the 4 rooms by a
nurse who was not involved in the study. The allocation
was such that every fourth patient was examined in the
room where the test setting was installed. Patients who had
given informed consent and were eligible were then in-
cluded and tested.
At Henry Dunant Hospital, the test setting was in-
stalled in 1 of the 2 rooms used for patient examination.
The allocation process was the same as at the German
Heart Center Munich.
Patients were examined in a supine position under
continuous 12-lead electrocardiographic (ECG) monitor-
ing. We documented initial pacemaker settings and lead
performance and ensured permanent ventricular pacing
during testing by increasing the basic pacing rate in single-
chamber devices and adjusting the atrioventricular delay in
dual-chamber devices; we did not alter preprogrammed
sensitivity settings. In patients with ICDs, we programmed
antibradycardia therapy as described for pacemakers and
set the detection threshold for tachyarrhythmias as low as
possible; we inactivated antitachycardia therapies to pre-
vent inappropriate discharge or overdrive pacing.
During continuous ECG recording, we swiped the ac-
tivated hand-held PD140 metal detector on the skin above
the cardiac rhythm device and along the leads to the car-
diac apex for 30 seconds or longer. After interrogation for
detection of possible interference and after validating ap-
propriate function of the device, the test protocol was re-
peated with the hand-held MH5 metal detector. We did
Figure. Study flow diagram.
Patients presenting for routine
follow-up (n = 1713)
Not allocated to the
examination room with the
test setting (n = 1286)
Assessed for eligibility (n = 427)
Excluded (n = 39)
Did not meet inclusion criteria
(n = 17)
Declined to participate (n = 20)
Other reasons (n = 2)
Included (n = 388)
Interference testing and analysis
completed (n = 388)
www.annals.org
 Hand-Held Metal Detectors and Implanted Cardiac Rhythm Devices Original Research

Table 1. Pacemakers and ICDs Tested With Hand-Held Table 1—Continued

Metal Detectors PD140 and MH5
Manufacturer* and Device Family Type of Device
Manufacturer* and Device Family Type of Device St. Jude Medical
Biotronik Accent Pacemaker
Atlas ICD
Cylos Pacemaker
Current ICD
Entovis Pacemaker
Entity Pacemaker
Lexos ICD
Epic† ICD
Lumax ICD
Fortify ICD
Philos Pacemaker Frontier Pacemaker
Protos Pacemaker Identity Pacemaker
Talos Pacemaker Integrity Pacemaker
Promote ICD
Boston Scientific Unify ICD
Altrua Pacemaker Verity Pacemaker
Cognis ICD Victory Pacemaker
Contak Renewal ICD Zephyr Pacemaker
Discovery Pacemaker
Insignia Pacemaker Vitatron
Livian† ICD C Series Pacemaker
Diamond Pacemaker
Teligen ICD
PreventAF Pacemaker
Vitality ICD
T Series Pacemaker

Ela Medical
ICD ⫽ implantable cardioverter-defibrillator.
Ovatio ICD * Manufacturer locations are as follows: Biotronik SE & Co., Berlin, Germany;
Symphony Pacemaker Boston Scientific, Natick, Massachusetts; Ela Medical, Montrouge, France; En-
Path Medical, Minneapolis, Minnesota; Guidant, Natick, Massachusetts; Inter-
Guidant medics, Natick, Massachusetts; Medtronic, Minneapolis, Minnesota; Osypka,
Pulsar Max Pacemaker Rheinfelden-Herten, Germany; Pacesetter, St. Paul, Minnesota; Siemens, Munich,
Germany; Sorin, Milano, Italy; St. Jude Medical, St. Paul, Minnesota; Teletronics,
Ventak Prizm ICD St. Paul, Minnesota; Vitatron Holding, Arnhem, the Netherlands; Ventritex, St.
Paul, Minnesota.
Intermedics † Only the PD140 hand-held metal detector was tested with this device.
Nexus Pacemaker

Medtronic
Adapta Pacemaker not randomize the order of application of the 2 metal de-
Advisa Pacemaker tectors because we did not believe that this would influence
AT† Pacemaker
device function.
Concerto ICD
Consulta ICD We documented any ECG abnormalities, such as in-
EnPulse Pacemaker hibition of pacing, loss of capture, or inappropriate mode
Enrhythm Pacemaker switch, during testing. We also interrogated the device
Ensura Pacemaker
EnTrust Escudo ICD Holter monitor to double-check for ventricular oversensing
Gem ICD resulting in inappropriate detection of tachycardia. Online
InSync ICD monitoring of the signal channels was performed in devices
Intrinsic ICD
Kappa Pacemaker with wireless telemetry features to detect subtle signal
Legend Pacemaker noise.
Marquis–Maximo ICD After completion of testing, we compared device set-
Maximo II ICD
Protecta ICD tings with the initial settings to identify spontaneous
Relia†–Sensia Pacemaker reprogramming.
Sigma Pacemaker
Versa Pacemaker Role of the Funding Source
Virtuoso ICD
The study did not receive external funding.
Pacesetter
Regency Pacemaker
RESULTS
Siemens Elema
Dialog Pacemaker The 388 patients had a mean age of 66 years (SD, 15);
76% were men. At the German Heart Center Munich, we
Sorin
Paradym ICD
tested 162 patients with pacemakers and 155 with ICDs,
Reply Pacemaker including 69 patients with cardiac resynchronization ther-
apy devices. At Henry Dunant Hospital, we tested 47 pa-
Continued on next column tients with pacemakers and 24 with ICDs, including 4
patients with cardiac resynchronization therapy devices.
www.annals.org 1 November 2011 Annals of Internal Medicine Volume 155 • Number 9 589
Original Research Hand-Held Metal Detectors and Implanted Cardiac Rhythm Devices

and 2.6 mV (SD, 1.1) for right ventricular leads. In total,

Table 2. Leads Tested With Hand-Held Metal Detectors
99% of the atrial and 92% of the right ventricular leads
PD140 and MH5*
were programmed in bipolar mode; the rest of the leads
were programmed in unipolar mode.
Biotronik Osypka
Arox† Exact name unknown One hundred seventy nine patients had ICDs, com-
Corox prising 61 devices of 26 model families from 7 manufac-
Kentrox Pacesetter turers (76% of the ICD families available in the past 10
Linox 1300 family
Polyrox 1400 family years) (Table 1). Devices included 44 dual-chamber, 64
Selox–Setrox Membrane single-chamber, and 71 biventricular ICDs, which were
Siello implanted for primary prevention (115 patients) and sec-
SL family Siemens
TIR family Elema ondary prevention (64 patients) of sudden cardiac death.
Y-53 family The ICD systems were connected to 111 atrial leads (10
St. Jude Medical models of 6 model families from 3 manufacturers), 179
Boston Scientific 1472 family
Acuity† Durata right ventricular leads (36 models of 10 model families
Endotak IsoFlex from 8 manufacturers), and 71 left ventricular leads (18
Flextend Optisense models of 7 model families from 5 manufacturers) (Table
Quartet
Ela Medical QuickFlex 2). The mean sensitivity programmed at the time of testing
Focus† Quicksite was 0.3 mV (SD, 0.2) for atrial leads and 0.5 mV (SD,
Swift Riata 0.4) for right ventricular leads. All leads were programmed
Tendril
EnPath in bipolar mode.
1084 Sorin
Interference With Device Function
Guidant Beflex
4000 family† Isoline We observed no ECG abnormalities, abnormal pace-
EASYTRACK S family maker or ICD function, or spontaneous reprogramming
Endotak
FINELINE Teletronics
of devices during or after exposure to hand-held metal
FLEXTEND† 030 family† detectors.
SELUTE†
Ventritex
Medtronic TVL family DISCUSSION
4000 family
Attain Vitatron In this assessment of interference between commonly
CapSure Crystalline used hand-held metal detectors and various cardiac rhythm
SureFix 5072 Excellence devices in a convenience sample of patients assessed at 2
Sprint Slimtine†
medical centers, we found no adverse effects from use of
* For manufacturer locations, see Table 1. hand-held detectors on cardiac device function. We aimed
✝ Only the PD140 hand-held metal detector was tested with this lead. to maximize the likelihood of interference by using the
highest possible magnetic field of 2 commonly used hand-
Device Types held metal detectors and by increasing the duration of ex-
Two hundred nine patients had pacemaker systems, posure to 30 seconds per test, which far exceeds the dura-
comprising 81 devices of 37 model families from 11 man- tion of conventional screening. In addition, we analyzed
ufacturers (73% of all pacemaker families available in the the intracardiac tracings of rhythm devices with wireless
past 10 years). Table 1 shows an overview of device fami- transmission features in real time and did not identify even
lies, and Appendix Tables 1 to 4 (available at www.annals subtle signal noise caused by the hand-held metal detector.
.org) provide more detailed descriptions. Devices included Devices with conventional telemetry features could not be
165 dual-chamber, 41 single-chamber, and 3 biventricular monitored in real time because telemetry creates a mag-
pacemakers, which were implanted for atrioventricular netic field that interferes with that of the hand-held metal
block (94 patients), sinus node dysfunction (59 patients), detector, occasionally resulting in different types of te-
bradyarrhythmia (25 patients), combined sinus and atrio- lemetry interference, such as loss of communication or
ventricular node dysfunction (14 patients), the tachycardia– “pseudo-oversensing.” These types of telemetry interfer-
bradycardia syndrome (9 patients), and neurocardiogenic ence have no clinical significance and have been shown to
syncope or the carotid sinus syndrome (8 patients). The have no effect on proper device function or patient safety
pacemaker systems were connected to 168 atrial leads (47 (12–14). To increase the generalizability of our results, we
lead models of 21 model families from 10 manufacturers), tested 2 commercially available, widely used hand-held
209 right ventricular pacemaker leads (41 lead models of metal detectors with different strengths of magnetic field
26 model families from 11 manufacturers), and 3 left ven- and technical characteristics similar to those of other hand-
tricular leads (2 lead models of 2 model families from 2 held metal detector systems used for screening procedures.
manufacturers) (Table 2). Mean sensitivity programmed at Our results are consistent with those of previous stud-
the time of testing was 0.5 mV (SD, 0.2) for atrial leads ies showing no electromagnetic interference when device
590 1 November 2011 Annals of Internal Medicine Volume 155 • Number 9 www.annals.org
 Hand-Held Metal Detectors and Implanted Cardiac Rhythm Devices
recipients walked through metal detector gates, which cre-
ate an electromagnetic field of higher strength than that of
hand-held metal detectors (9, 15). In a previous study (13),
we documented the occurrence of electromagnetic inter-
ference when the Medtronic Kappa 401 pacemaker
(Medtronic, Minneapolis, Minnesota) was exposed ex vivo
to a magnetic field of 0.1 T. We found no interference
caused by the hand-held metal detector in 7 patients with
Kappa 401 devices in the current study; thus, this discrep-
ancy is probably attributable to the different strength of the
magnetic field in the 2 studies.
The risk that hand-held metal detectors will cause
clinically significant interference with implanted cardiac
rhythm devices seems unlikely for several reasons. First,
pacemaker function may be inhibited when inappropriate
signal detection (oversensing) exceeds the programmed
threshold of sensitivity. In pacemaker-dependent patients,
inhibition of pacing may cause loss of consciousness if the
duration of the resulting pause exceeds 6 seconds (16). This
duration is not reached during a routine screening procedure,
where the device is exposed to the electromagnetic field of the
hand-held metal detector for a maximum of 3 seconds.
Second, in patients with ICDs, inappropriate detec-
tion of ventricular fibrillation and delivery of shocks would
require repeated oversensing to satisfy detection criteria.
Inappropriate sensing of signals would have to continue
during charging of the capacitor (for devices that sense
during the period of charging) or to be present during
reconfirmation (for devices that verify the tachyarrhythmic
sensed event after completion of charging). The duration
of charging is approximately 6 seconds, which is also lon-
ger than the duration of device exposure to the electromag-
netic field during routine screening procedures.
Finally, in patients with ICDs, inappropriate detection
of ventricular tachycardia and therapy delivery would re-
quire a stable oscillating signal with a frequency of 100 to
230 beats/min. This is unlikely to be induced by the elec-
tromagnetic field of a hand-held metal detector.
Nevertheless, our negative findings cannot be consid-
ered definitive because the study used a convenience sam-
ple of patients and devices; the number of each model
device tested was small and often consisted of a single de-
vice in a single patient. In addition, we tested detector–
device interference in isolated clinic rooms, and we cannot
exclude that interference could occur in airports or other
security settings, where many electronic devices are emit-
ting electromagnetic radiation. We believe that this scenario is
unlikely, however, given that the strength of magnetic fields is
inversely related to their distance from the source. We encour-
age device manufacturers and other investigators to repeat our
protocol in order to more systematically evaluate the interac-
tion between metal detectors and cardiac rhythm devices, and
possibly to confirm these findings.
In summary, hand-held metal detectors did not affect the
function of pacemakers and ICDs in our patient cohort. Our
results suggest that using hand-held metal detectors for secu-
www.annals.org
Original Research
rity screening in patients with pacemakers and ICDs is prob-
ably safe, but these findings require confirmation.
From Deutsches Herzzentrum und 1. Medizinische Klinik des Klinikum
rechts der Isar, Faculty of Medicine, Technische Universität München,
München, Germany; Henry Dunant Hospital, Athens, Greece; Univer-
sity Hospital Dubrava, Zagreb, Croatia; and Klinik und Poliklinik für
Innere Medizin II, Universität Regensburg, Regensburg, Germany.
Grant Support: Dr. Vrazic was supported by an educational fellowship
of the European Heart Rhythm Association.
Potential Conflicts of Interest: Disclosures can be viewed at www
.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum⫽M11
-1345.
Reproducible Research Statement: Study protocol, statistical code, and
data set: Not available.
Requests for Single Reprints: Clemens Jilek, MD, Deutsches Herzzen-
trum München, Elektrophysiologie, Lazarettstrasse 36, 80636 München,
Germany; e-mail, research@jilek.de.
Current author addresses and author contributions are available at
www.annals.org.
References
1. Trigano A, Blandeau O, Dale C, Wong MF, Wiart J. Reliability of electro-
magnetic filters of cardiac pacemakers tested by cellular telephone ringing. Heart
Rhythm. 2005;2:837-41. [PMID: 16051120]
2. Pinski SL, Trohman RG. Interference in implanted cardiac devices, Part I.
Pacing Clin Electrophysiol. 2002;25:1367-81. [PMID: 12380774]
3. Kolb C, Deisenhofer I, Weyerbrock S, Schmieder S, Plewan A, Zrenner B,
et al. Incidence of antitachycardia therapy suspension due to magnet reversion in
implantable cardioverter defibrillators. Pacing Clin Electrophysiol. 2004;27:
221-3. [PMID: 14764174]
4. Kolb C, Zrenner B, Schmitt C. Incidence of electromagnetic interference in
implantable cardioverter defibrillators. Pacing Clin Electrophysiol. 2001;24:
465-8. [PMID: 11341083]
5. Thaker JP, Patel MB, Jongnarangsin K, Liepa VV, Thakur RK. Electromag-
netic interference with pacemakers caused by portable media players. Heart
Rhythm. 2008;5:538-44. [PMID: 18329961]
6. Rickli H, Facchini M, Brunner H, Ammann P, Sagmeister M, Klaus G, et al.
Induction ovens and electromagnetic interference: what is the risk for patients
with implanted pacemakers? Pacing Clin Electrophysiol. 2003;26:1494-7.
[PMID: 12914627]
7. Mugica J, Henry L, Podeur H. Study of interactions between permanent
pacemakers and electronic antitheft surveillance systems. Pacing Clin Electro-
physiol. 2000;23:333-7. [PMID: 10750133]
8. Santucci PA, Haw J, Trohman RG, Pinski SL. Interference with an implant-
able defibrillator by an electronic antitheft-surveillance device. N Engl J Med.
1998;339:1371-4. [PMID: 9801398]
9. Kolb C, Schmieder S, Lehmann G, Zrenner B, Karch MR, Plewan A, et al.
Do airport metal detectors interfere with implantable pacemakers or cardioverter-
defibrillators? J Am Coll Cardiol. 2003;41:2054-9. [PMID: 12798581]
10. Burlington B. Important Information on Anti-Theft and Metal Detector
Systems and Pacemakers, ICDs, and Spinal Cord Stimulators. September 1998;
last updated 11 February 2011. Accessed at www.fda.gov/MedicalDevices/Safety
/AlertsandNotices/PublicHealthNotifications/ucm062288.htm on 28 June 2011.
11. Pinski SL, Trohman RG. Interference in implanted cardiac devices, part II.
Pacing Clin Electrophysiol. 2002;25:1496-509. [PMID: 12418748]
12. Shah AJ, Brunett JD, Thaker JP, Patel MB, Liepa VV, Jongnarang-
sin K, et al. Characteristics of telemetry interference with pacemakers
caused by digital media players. Pacing Clin Electrophysiol. 2010;33:712-
20. [PMID: 20059718]
1 November 2011 Annals of Internal Medicine Volume 155 • Number 9 591
Original Research Hand-Held Metal Detectors and Implanted Cardiac Rhythm Devices

13. Webster G, Jordao L, Martuscello M, Mahajan T, Alexander ME, Cecchin
F, et al. Digital music players cause interference with interrogation telemetry for
pacemakers and implantable cardioverter-defibrillators without affecting device
function. Heart Rhythm. 2008;5:545-50. [PMID: 18362020]
14. Chiladakis JA, Davlouros P, Agelopoulos G, Manolis AS. In-vivo testing of
digital cellular telephones in patients with implantable cardioverter-defibrillators.
Eur Heart J. 2001;22:1337-42. [PMID: 11465966]
15. Copperman Y, Zarfati D, Laniado S. The effect of metal detector gates on
implanted permanent pacemakers. Pacing Clin Electrophysiol. 1988;11:1386-7.
[PMID: 2462212]
16. The European Society of Cardiology Guidelines for the diagnosis and man-
agement of syncope reviewed by Angel Moya, MD, FESC, Chair of the Guide-
line Taskforce with J. Taylor, MPhil. Eur Heart J. 2009;30:2539-40. [PMID:
19880943]

592 1 November 2011 Annals of Internal Medicine Volume 155 • Number 9 www.annals.org
Annals of Internal Medicine
Current Author Addresses: Drs. Jilek, Semmler, Reents, Fichtner,
Ammar, Hessling, Deisenhofer, and Kolb: Deutsches Herzzentrum
München, Elektrophysiologie, Lazarettstrasse 36, 80636 München,
Germany.
Drs. Tzeis, Andrikopoulos, Rassias, and Theodorakis: Cardiology De-
partment, Henry Dunant Hospital, 107 Mesogion Avenue, 11526
Athens, Greece.
Dr. Vrazic: Division of Cardiology, Department of Internal Medicine,
University Hospital Dubrava, Av. G. Suska 6, 10000 Zagreb, Croatia.
Dr. Weber: Klinik und Poliklinik für Innere Medizin II, Universität
Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
www.annals.org
Author Contributions: Conception and design: C. Jilek, S. Tzeis, G.
Andrikopoulos, S. Weber, C. Kolb.
Analysis and interpretation of the data: C. Jilek, S. Tzeis, H. Vrazic, V.
Semmler, G. Andrikopoulos, S. Fichtner, S. Ammar, S. Weber, C. Kolb.
Drafting of the article: C. Jilek, S. Tzeis, H. Vrazic, G. Andrikopoulos,
G. Hessling, C. Kolb.
Critical revision for important intellectual content: C. Jilek, G. Andriko-
poulos, G. Theodorakis, G. Hessling, I. Deisenhofer, C. Kolb.
Final approval of the article: C. Jilek, G. Theodorakis, S. Weber, G.
Hessling, C. Kolb.
Provision of study materials or patients: C. Jilek, S. Tzeis, I. Rassias, I.
Deisenhofer.
Statistical expertise: C. Jilek.
Administrative, technical, or logistic support: C. Jilek, G. Theodorakis,
S. Weber, I. Deisenhofer, C. Kolb.
Collection and assembly of data: C. Jilek, S. Tzeis, H. Vrazic, V. Sem-
mler, G. Andrikopoulos, T. Reents, S. Fichtner, S. Ammar, I. Rassias, C.
Kolb.
1 November 2011 Annals of Internal Medicine Volume 155 • Number 9 W-169
 Appendix Table 1. Pacemakers Tested With Hand-Held Appendix Table 1—Continued
Metal Detectors PD140 and MH5
Manufacturer* and Pacemaker Devices Tested Devices Tested
Manufacturer* and Pacemaker Devices Tested Devices Tested With PD140 With PD140, n
With PD140 With PD140, n and MH5, n
and MH5, n Pacesetter
Biotronik Regency SR⫹ 2400L 1
Cylos 990 DR-T 7
Cylos 990 SR 3 Siemens Elema
Cylos DR 1 Dialog 1
Cylos SR 1
Entovis DR-T 1 Sorin
Philos DR 1 1 Reply DR 10
Philos II DR 6 Reply SR 1
Philos II DR-T 1
Philos II SR 3 St. Jude Medical
Philos SLR 1 Accent DR 2112 1
Protos DR 1 Entity DC 5226 1
Protos VR 1 Entity DR 5326 1 1
Talos D 1 Identity ADx DR 5380 1
Identity ADx SR 5180 1 1
Boston Scientific Identity ADx XL DR 5386 6
Altrua 20 S 201 1 Identity XL DR 5376 2
Altrua 20 S 208 1 Integrity DR 5346 1
Altrua 40 S 401 4 Integrity Micro DR 5336 1
Altrua 40 S 402 1 Verity ADx XL DR 5356 2 1
Altrua 40 S 404 3 Verity ADx XL SR 5156 1
Altrua 50 S 501 1 Victory SR 5610 1
Altrua 60 S 602 2 Victory XL DR 5816 6
Altrua 60 S 604 1 Zephyr VR 5620 1
Altrua 60 S 606 3 1 Zephyr XL DR 5826 11 2
Discovery II DR 1286 2
Insignia I AVT DR 1292 3 Vitatron
Insignia I AVT SR 1192 1 C 20 SR A4 1
Insignia I Entra DR 1294 1 C 60 DR A3 6
Insignia I Ultra 1290 1 C 60 DR A4 2
Insignia I Ultra DR 1291 1 C 60 DR 1
C 70 DR 1
Ela Medical Diamond III 1
Symphony DR 2550 4 PreventAF 1
T 70 DR 4
Guidant
Pulsar Max II SR 1181 1 * For manufacturer locations, see Table 1.

Intermedics
Nexus I Entra 1398 1

Medtronic
Adapta ADDR01 1 8
Adapta ADDRL1 7 4
Adapta ADSR01 1
Advisa DR MRI A3DR01 1
EnPulse DR E2DR03 1 3
Enrhythm MRI EMDR01 2 2
Ensura DR MRI Surescan EN1DR01 5
Kappa KDR 401 6
Kappa KDR 901 1
Kappa KDR 906 1
Kappa KSR 401 1
Kappa KSR 701 1
Kappa KSR 901 1
Legend Plus 8448 1
AT 501 1
Relia REDR01 2
Sensia SEDR01 2
Sensia SEDRL1 13
Sensia SESR01 3
Sigma SDR 303 2
Versa VEDR01 2

Continued on next column

W-170 1 November 2011 Annals of Internal Medicine Volume 155 • Number 9 www.annals.org
 Appendix Table 2. ICDs Tested With Hand-Held Metal Appendix Table 3. CRT Devices Tested With Hand-Held
Detectors PD140 and MH5 Metal Detectors PD140 and MH5

Manufacturer* and ICD Devices Tested With Devices Tested Manufacturer* and CRT Device Devices Tested With Devices Tested
PD140 and MH5, n With PD140, n PD140 and MH5, n With PD140, n
Biotronik Biotronik
Lexos VR-T 2 Lumax 300 HF-T 1
Lumax 340 VR-T XL 4 Lumax 340 HF-T 1
Lumax 540 DR-T 2 Lumax 540 HF-T 7

Boston Scientific Boston Scientific

Teligen 100 F 102
Teligen 100 F 103
Teligen 100 F 110
Vitality 2 EL DR T 167
Vitality 2 T 165
Vitality VR 1870
4 1 Cognis 100-D P 106 1
2 Cognis 100-D P 107 6
1 2 Contak Renewal 4 HE H197 1
5 Contak Renewal 4 RF H235 1
1 Contak Renewal TR2 H145 1
1 Livian H240 3

Ela Medical Medtronic

Ovatio DR 6550 3 Concerto C174 AWK 2
Ovatio VR 6250 2 Consulta D234 TRK 1
InSync III 8042 2
Guidant InSync III Marquis 7279 3
Ventak Prizm 2 DR 1 InSync Maximo 7304 4
Ventak Prizm 2 VR 3 Maximo II D284TRK 17
Protecta D364TRG 8
Medtronic
EnTrust Escudo D144DRG 3 Sorin
EnTrust Escudo D144VRC 6 Paradym CRT-D 8750 2
Gem III VR 7231 Cx 2
InSync Sentry 7298 1 St. Jude Medical
Intrinsic 7288 2 1 Frontier II 1
Marquis DR 7274 1 Promote Accel RF 3215-36 2
Marquis VR 7230 Cx 2 2 Promote Quadra 3239-40Q 2
Maximo DR 7278 1 Promote RF 3213-36 2 1
Maximo II D284DRG 6 Unify 3235-40 5
Maximo VR 7232 Cx 7 1
Protecta DR D364DRG 2 CRT ⫽ cardiac resynchronization therapy.
Protecta VR D364VRG 1 * For manufacturer locations, see Table 1.
Protecta XT DR D354DRG 1
Virtuoso D164AWG 1 1
Virtuoso D164VWC 1

Sorin
Paradym DR 8550 4
Paradym VR 8250 11

St. Jude Medical

Atlas II DR V-268 1
Atlas II VR V-168 1
Atlas⫹ VR V-193 3
Current RF DR 2207-36 2
Current RF VR 1207-36 2
Current⫹ VR 1211-36 1
Epic DR V-239 2
Epic II DR V-255 1
Fortify DR 2233-40Q 1
Fortify VR 1233-40 2
Fortify VR 1233-40Q 1

ICD ⫽ implantable cardioverter-defibrillator.

* For manufacturer locations, see Table 1.

www.annals.org 1 November 2011 Annals of Internal Medicine Volume 155 • Number 9 W-171
 Appendix Table 4. Leads Tested With Hand-Held Metal Detectors PD140 and MH5

Manufacturer* and Device Devices Tested With Devices Tested With Type of Device Location of Sensing Polarity Connector
Both Metal 1 Metal Detector, n Lead Programmed at
Detectors, n Testing
Biotronik
Arox 60 1 PM RV BIP IS-1
Corox OTW 75 2 ICD LV BIP IS-1
Corox OTW 85 4 ICD LV BIP IS-1
Corox OTW S 2 ICD LV BIP IS-1
Kentrox RV 65 2 ICD RV BIP IS-1
Linox S 65 32 ICD RV BIP IS-1
Polyrox BP 1 PM RV BIP IS-1
Polyrox PX 1 PM RV BIP IS-1
Selox SR 1 PM A BIP IS-3
Selox SR 53 1 PM A BIP IS-3
Selox SR 60 1 PM RV BIP IS-1
Setrox S53 12 PM A BIP IS-1
Setrox S60 10 PM RV BIP IS-1
ISello S53 31 PM ⫹ ICD A BIP IS-1
SL-60/13-UP 1 PM RV UNI IS-1
TIR-60-UP 1 PM RV UNI IS-1
Y-53-BP 1 PM A BIP IS-1

Boston Scientific
Acuity Spiral 4592 2 ICD LV UNI IS-1
Acuity Steerable 4555 1 ICD LV BIP IS-1
Endotak Reliance G 0296 1 ICD RV iBIP IS-4
Endotak Reliance SG 0292 1 ICD RV iBIP IS-4
Flextend II 4096 2 2 PM A BIP IS-1

Ela Medical
Focus J83F 1 PM A UNI IS-1
Swift 1CT 4041 1 ICD RV BIP IS-1

EnPath
1084 T 2 PM RVe ⫹ Ae BIP IS-1

Guidant
4257 2 PM RV BIP IS-1
4271 1 PM A BIP IS-1
EASYTRACK 2 4517 1 ICD LV BIP LV-1
EASYTRACK 2 4518 2 ICD LV BIP LV-1
EASYTRACK 2 4542 2 ICD LV BIP IS-1
EASYTRACK 2 4543 2 ICD LV BIP IS-1
EASYTRACK 3 4549 2 ICD LV BIP IS-1
Endotak DSP 0125 1 1 ICD RV iBIP IS-1
Endotak Endurance Rx 0145 2 ICD RV iBIP IS-1
Endotak Reliance 0148 3 7 ICD RV iBIP IS-1
Endotak Reliance G 0175 2 ICD RV iBIP IS-1
Endotak Reliance G 0185 4 ICD RV iBIP IS-1
Endotak Reliance S 0128 2 ICD RV iBIP IS-1
Endotak Reliance S 0138 1 ICD RV iBIP IS-1
Endotak Reliance SG 0171 1 ICD RV iBIP IS-1
Endotak Reliance SG 0181 1 ICD RV iBIP IS-1
FINELINE II EZ Sterox 4473 1 PM A BIP IS-1
FINELINE II Sterox 4457 1 3 PM RV BIP IS-1
FINELINE II Sterox 4459 1 PM RV BIP IS-1
FINELINE II Sterox AJ 4480 7 PM A BIP IS-1
FLEXTEND II 4097 2 PM RV BIP IS-1
SELUTE 4285 1 PM RV BIP IS-1
SELUTE PICOTIP 4035 2 PM RV BIP IS-1
SELUTE PICOTIP AJ 4064 6 PM A BIP IS-1

Medtronic
4024 1 PM A BIP IS-1
CapSure SP 4024 2 1 PM RV BIP IS-1
4057M 1 PM RV UNI IS-1

Continued on following page

W-172 1 November 2011 Annals of Internal Medicine Volume 155 • Number 9 www.annals.org
 Appendix Table 4—Continued

Manufacturer* and Device Devices Tested With Devices Tested With Type of Device Location of Sensing Polarity Connector
Both Metal 1 Metal Detector, n Lead Programmed at
Detectors, n Testing
4058 2 PM A ⫹ RV BIP IS-1
CapSureFix 4068 2 PM A BIP IS-1
CapSure Sense 4074 7 4 PM RV BIP IS-1
CapSureFix 4076 1 PM A BIP IS-1
CapSureFix Novus 4076 4 5 PM A ⫹ RV BIP IS-1
Capsure SP Novus 4092 43 PM A ⫹ RV BIP IS-1
Attain OTW 4193 3 ICD LV UNI IS-1
Attain OTW 4194 20 PM ⫹ ICD LV BIP IS-1
Attain Ability 4196 17 ICD LV BIP IS-1
Attain Ability 4396 1 ICD LV BIP IS-1
CapsureFix 4568 1 1 PM A ⫹ RV BIP IS-1
CapSure Sense 4574 1 7 PM A BIP IS-1
CapsureEpi 4968 3 PM Ae ⫹ RVe BIP IS-1
Capsure Z Novus 5054 2 PM RV BIP IS-1
SureFix 5072 1 PM A BIP IS-1
CapsureFix Novus 5076 46 9 PM ⫹ ICD A ⫹ RV BIP IS-1
CapSureFix MRI 5086 18 4 PM A ⫹ RV BIP IS-1
Capsure Z Novus 5554 6 PM A BIP IS-1
CapsureFix 5568 4 PM A BIP IS-1
Capsure SP Novus 5594 1 PM A BIP IS-1
Sprint Fidelis 6930 6 ICD RV BIP IS-1
Sprint Fidelis 6931 3 ICD RV BIP IS-1
Sprint 6932 2 ICD RV BIP IS-1
Sprint Quattro Secure 6935 6 ICD RV BIP IS-1
Sprint 6943 2 ICD RV BIP IS-1
Sprint Quattro 6944 10 2 ICD RV BIP IS-1
Sprint 6945 1 ICD RV BIP IS-1
Sprint Quattro Secure 6947 5 3 ICD RV BIP IS-1
Sprint Fidelis 6948 3 ICD RV BIP IS-1
Sprint Fidelis 6949 1 ICD RV BIP IS-1

Osypka
Exact name unknown 1 PM A BIP ⫺
Exact name unknown 1 PM RV BIP ⫺

Pacesetter
1388 T 50 PM ⫹ ICD A ⫹ RV BIP IS-1
1420 T 1 PM A BIP IS-1
1450 T 1 PM RV BIP IS-1
1470 T 1 1 PM RV BIP IS-1
1474 T 1 PM A BIP IS-1
1488 T 2 PM A BIP IS-1
Membrane 1 PM RV BIP IS-1

Siemens
Elema 423 S 1 PM RV UNI 6 mm

St. Jude Medical

1472 T 1 PM RV BIP IS-1
Durata 7120 5 1 ICD ⫹ PM RV BIP IS-1
Durata 7120 Q 1 ICD RV BIP IS-4
Durata 7122 27 ICD RV BIP IS-1
Durata 7122 Q 4 ICD RV BIP IS-4
IsoFlex Optim 1944 T 1 PM A BIP IS-1
IsoFlex Optim 1948 5 1 PM RV BIP IS-1
IsoFlex S 1642 T 6 PM ⫹ ICD A ⫹ RV BIP IS-1
IsoFlex S 1646 T 2 1 PM RV BIP IS-1
Optisense 1699 41 PM ⫹ ICD A BIP IS-1
Optisense 1899 1 ICD A BIP IS-1
Quartet 1458 Q 2 ICD LV MUP IS-1
QuickFlex ␮ 1258 T 4 1 ICD LV BIP IS-1
QuickFlex 1156 T 1 1 PM LV BIP IS-1

Continued on following page

www.annals.org 1 November 2011 Annals of Internal Medicine Volume 155 • Number 9 W-173
 Appendix Table 4—Continued

Manufacturer* and Device Devices Tested With Devices Tested With Type of Device Location of Sensing Polarity Connector
Both Metal 1 Metal Detector, n Lead Programmed at
Detectors, n Testing
Quicksite 1056 T 5 ICD LV BIP IS-1
Riata 1570 1 2 ICD RV BIP IS-1
Riata 1582 18 ICD RV BIP IS-1
Riata ST 7000 2 ICD RV BIP IS-1
Riata ST 7002 3 ICD RV BIP IS-1
Tendril 1888 TC 3 PM ⫹ ICD A BIP IS-1
Tendril 2088 TC 2 PM A ⫹ RV BIP IS-1
Tendril SDX 1688 T/TC 4 1 PM A BIP IS-1
Tendril ST 1782 T 1 ICD A BIP IS-1
Tendril ST Optim 1882 TC 6 PM ⫹ ICD A BIP IS-1
Tendril ST Optim 1888 TC 4 6 PM ⫹ ICD A ⫹ RV BIP IS-1

Sorin
Beflex RF46D 7 PM RV BIP IS-1
Isoline 2CR-6 1 ICD RV BIP IS-1
S 80 TB 1 PM RV BIP IS-1

Teletronics
030-242 1 PM RV UNI 5 mm

Ventritex
TVL RV06 1 ICD RV BIP IS-1

Vitatron
Crystalline Active Fixation ICQ 09B 3 PM A ⫹ RV BIP IS-1
Crystalline ICM 09JB 2 PM A BIP IS-1
Excellence PS⫹ IMK 49JB 2 PM A ⫹ RV BIP IS-1
Excellence SS⫹ IML 49B 3 PM A ⫹ RV BIP IS-1
Slimtine ITP 13 1 PM RV BIP IS-1

Unknown 47 1 PM ⫹ ICD A ⫹ RV BIP ⫹ UNI

A ⫽ atrial; Ae ⫽ epicardial atrium; BIP ⫽ bipolar; iBIP ⫽ integrated bipolar; ICD ⫽ implantable cardioverter-defibrillator; LV ⫽ left ventricular; MUP ⫽ multipolar;
PM ⫽ pacemaker; RV ⫽ right ventricular; RVe ⫽ epicardial right ventricle; UNI ⫽ unipolar.
* For manufacturer locations, see Table 1.

W-174 1 November 2011 Annals of Internal Medicine Volume 155 • Number 9 www.annals.org

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