Effects of electromagnetic interference produced by smartphones on patients with permanent pacemakers (EMS-PPM study)

Abstract

Abstract Background Since the 1990s, the electromagnetic field generated by mobile phones using 2G/3G communication networks has been shown to affect pacemaker functions. Over the past two decades, improvements in pacemaker technology, such as feed-through filters, combined with mobile 4G networks have significantly reduced the incidence of adverse effects. However, the safety of newer-generation mobile phones using 5G networks in patients with modern-generation pacemakers has not yet been studied. Methods We enrolled 489 patients with pacemakers from three different manufacturers. The pacemaker mode was programmed for overdrive pacing and sensing mode when an intrinsic rhythm was present. A smartphone (Samsung S21+5G) was placed directly over the pulse generator and right ear. The phone was tested under four conditions: standby mode, 5G internet connection, incoming and outgoing calls for each location. Real-time ECG monitoring and patient symptoms were recorded to determine the occurrence of electromagnetic interference. The possibility of electromagnetic interference with the interrogation telemetry was also investigated. Results A total of 4824 tests were performed on 489 patients. Most pacemakers were dual-chamber (82%) and MRI-compatible systems (83%). The average implantation duration is 4.3±3.5 years, 4.8±3.9 years, and 5.5±4.4 years for the pulse generator, right atrial lead, and right ventricular lead, respectively. No electromagnetic interference was detected either pulse generator or right ear location. Interference to telemetry was demonstrated in 11.5% of the patients. Almost (98.2%) occurred mainly during incoming calls. Single-chamber pacemakers, non-MRI compatible systems, older pulse generators, older leads, and unipolar settings were significantly related to the higher incidence of interference to interrogation telemetry. Conclusion The risk of electromagnetic interference between modern smartphones with 5G networks and pacemakers is negligible. Nevertheless, interference to interrogation telemetry may still occur. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Faculty of Medicine, Prince of Songkla University