title: Safety of pacemakers and defibrillators in electromagnetic navigation bronchoscopy.
abstract: BACKGROUND
  Electromagnetic Navigation Bronchoscopy (ENB) (InReach iLogic system; superDimension Inc) is a relatively new discipline, with promising diagnostic and therapeutic applications in patients with lung lesions. Navigation is performed in a magnetic field and, therefore, has been considered relatively contraindicated in patients with pacemakers and automated implantable cardioverter-defibrillators (AICDs). Potential risks include altering the function and shutting off the device, device damage, lead displacement, and potential overheating. Over the past decade, there has been extensive literature about the safety of pacemakers in either the 1.5-T or 3-T magnetic fields used in current MRI scanners. Although the magnetic field used in ENB is significantly weaker, 0.0001 T or approximately equal to the earth's gravity, its safety in patients with pacemakers is yet to be elucidated. We present our initial experience with ENB in patients with cardiac implanted electrical devices.
  
  
  METHODS
  Twenty-four procedures in 24 patients with lung lesions and permanent pacemakers were performed. A cardiac electrophysiologist and programmer were present during the procedure. At baseline, the pacers were interrogated, and ECG was recorded. Continuous cardiac monitoring was performed during the procedure, and at the end, the pacer settings and function were reinterrogated to check for any changes.
  
  
  RESULTS
  The procedures were all successfully concluded. None of the patients suffered any arrhythmias or disruption to their pacemakers' function.
  
  
  CONCLUSIONS
  ENB appears to be safe when performed in patients with pacemakers and AICDs. Larger multicenter studies are needed to prove the final safety in this patient population.
authors.affiliation: Interventional Pulmonology Program, Emory University School of Medicine, Atlanta, GA.
authors.forename: Ahmed Y
authors.initials: AY
authors.lastname: Khan
authors.affiliation: Interventional Pulmonology Program, Emory University School of Medicine, Atlanta, GA.
authors.forename: David
authors.initials: D
authors.lastname: Berkowitz
authors.affiliation: Interventional Pulmonology Program, Medstar Franklin Square Medical Center, Baltimore, MD.
authors.forename: William S
authors.initials: WS
authors.lastname: Krimsky
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL.
authors.forename: D Kyle
authors.initials: DK
authors.lastname: Hogarth
authors.affiliation: Interventional Pulmonology Program, Emory University School of Medicine, Atlanta, GA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Parks
authors.affiliation: Interventional Pulmonology Program, Emory University School of Medicine, Atlanta, GA; Interventional Pulmonary Program, Cancer Treatment Centers of America at Southeastern Regional Medical Center, Atlanta, GA. Electronic address: rbechar@emory.edu.
authors.forename: Rabih
authors.initials: R
authors.lastname: Bechara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000009:adverse effects* / Q000379:methods; D017147:Defibrillators, Implantable; D004574:Electromagnetic Fields / Q000009:adverse effects*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial