title: Safety of repetitive nerve stimulation in patients with cardiac implantable electronic devices.
abstract: BACKGROUND
  Pacemakers and implantable cardioverter-defibrillators (ICDs) are vulnerable to inappropriate sensing of electromagnetic interference (EMI), such as from nerve conduction studies. We conducted a prospective study to assess the safety of repetitive nerve stimulation (RNS).
  
  
  METHODS
  Fourteen patients undergoing insertion of 10 ICDs and 4 pacemakers under general anesthesia received RNS of the median, axillary, and spinal accessory nerves at 2 HZ and 50 HZ. We recorded detection of EMI and whether or not this resulted in an arrhythmia diagnosis or change in pacing output.
  
  
  RESULTS
  EMI was visible in 2 ICDs, without spurious tachyarrhythmia detection. EMI was observed in 3 of the 4 pacemakers, which led to pacing inhibition and a pause in 2, both of which were programmed to a unipolar sensing configuration.
  
  
  CONCLUSIONS
  RNS is safe in patients with ICDs. In pacemaker patients, RNS appears safe during bipolar sensing, but caution is recommended in pacemaker patients with unipolar sensing.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Edmond M
authors.initials: EM
authors.lastname: Cronin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gray
authors.forename: Bernard
authors.initials: B
authors.lastname: Abi-Saleh
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
authors.forename: Kerry H
authors.initials: KH
authors.lastname: Levin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D000075202:Contraindications; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004558:Electric Stimulation / Q000009:adverse effects; D004568:Electrodiagnosis / Q000009:adverse effects*; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010525:Peripheral Nerves; D011446:Prospective Studies