title: Influence of electronic apex locators and a gutta-percha heating device on implanted cardiac devices: an in vivo study.
abstract: OBJECTIVE
  To evaluate the potential for electromagnetic interference (EMI) of electronic apex locators (EALs) and a gutta-percha heating device (HD) in patients with implantable cardiac pacemakers (ICPs) or cardioverter-defibrillators (ICDs).
  
  
  METHODS
  Two types of EALs (Romiapex A-15 and Novapex) and a HD (Touch'n Heat) were tested in patients followed in an outpatient clinic for cardiac arrhythmias. The heart rhythm was monitored on a computer screen during all experimental phases. After baseline data collection, the patient held each appliance (turned on) for 30 s, simulating their clinical use. If background noise was detected on the cardiac monitor, the sensitivity of the ICP/ICD was lowered by the cardiologist to evaluate the intensity of the detected EMI.
  
  
  RESULTS
  Twelve patients were evaluated (5 female and 7 male), and in nine instances, background noise in their cardiac devices related to the use of the endodontic devices was detected (6 patients). After lowering the sensitivity of the cardiac implants, three patients had more severe EMI in six instances, including pauses in ICP function. The presence of a symptomatic or asymptomatic pause was related to the patient's underlying heart rhythm. The HD device produced background noise more often compared to EALs. These were associated with more severe types of EMI.
  
  
  CONCLUSIONS
  The EALs and gutta-percha HD were capable of causing background noise detection or pauses in cardiac implants in vivo. The use of electronic dental devices nearby patients with cardiac implants should be carefully considered in clinical practice.
authors.affiliation: Escola de Ciências da Saúde, Universidade do Grande Rio, Duque de Caxias, Brazil.
authors.forename: A P
authors.initials: AP
authors.lastname: Moraes
authors.affiliation: Escola de Ciências da Saúde, Universidade do Grande Rio, Duque de Caxias, Brazil.
authors.forename: E J
authors.initials: EJ
authors.lastname: Silva
authors.affiliation: Escola de Ciências da Saúde, Universidade do Grande Rio, Duque de Caxias, Brazil.|Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil.
authors.forename: C C
authors.initials: CC
authors.lastname: Lamas
authors.affiliation: Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil.
authors.forename: P H
authors.initials: PH
authors.lastname: Portugal
authors.affiliation: Departamento de Odontopediatria e Ortodontia, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: A A
authors.initials: AA
authors.lastname: Neves
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000628:therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects; D003748:Dental Equipment / Q000009:adverse effects*; D004708:Endodontics / Q000295:instrumentation; D005260:Female; D006171:Gutta-Percha; D006361:Heating / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009811:Odontometry / Q000009:adverse effects* / Q000295:instrumentation; D010138:Pacemaker, Artificial / Q000009:adverse effects; D019227:Tooth Apex
chemical_list: D006171:Gutta-Percha
keywords: cardiac arrhythmias; electromagnetic interference; electronic apex locators; gutta-percha thermoplasticizer; implantable cardioverter-defibrillators; pacemakers