Transcutaneous Electrical Nerve Stimulation (TENS)

Effect of Transcutaneous Electrical Nerve Stimulation (TENS) on St. Jude Medical Implantable Cardiac Rhythm Devices

Background

Transcutaneous Electrical Nerve Stimulation (TENS) devices deliver electrical current to the body through electrode patches placed on the skin for pain management. These signals can interfere with the normal operation of pacemakers and implantable cardioverter defibrillators (ICDs). Response can vary from total inhibition to inappropriate therapy. The electrical impulses from the TENS therapy may be interpreted as “electrical noise” in ICDs and cause a noise reversion. During a noise reversion the device will not deliver therapy (therapy includes ATP, cardioversion and defibrillation). If TENS impulses are misinterpreted as cardiac events in an ICD, inhibition of bradycardia pacing and/or inappropriate arrhythmia detection and therapy delivery are possible.

Potential effects

A summary of potential effects is provided in the table below and is based on device testing at St. Jude Medical, clinical experience and/or a review of the scientific literature.

Potential Effect Estimated Frequency
  Pacemakers ICDs 
Total inhibition of pacing (Burst Mode) Common Common
Total inhibition of pacing (Non-Burst Mode) Uncommon  Uncommon
Asynchronous pacing/noise reversion Uncommon Uncommon
Inappropriate therapy delivery Not applicable Uncommon
Inhibition of therapy due to noise Not applicable Rare

 

Recommendations

Per the 2011 HRS perioperative consensus committee, TENS units should be avoided in the thoracic, cervical, shoulder, upper lumbar, and chest areas due to proximity of the ICD or pacemaker and lead system1. TENS therapy is not recommended in patients who are dependent upon their pacemaker/pacing therapy. If TENS therapy is deemed medically necessary, the risk of interference can be reduced if the following recommendations are observed. The patient should consult his or her physician regarding use of TENS therapy.

  • The patient’s heart rate should be monitored during initial TENS unit operation, especially in pacemaker dependent patients.
  • Maintain a high frequency (>30 Hz) at all times.
  • Burst mode is contraindicated and can result in total inhibition of the pacemaker or inappropriate therapy from the ICD.
  • Electrode placement should be left to right (lateral, not inferior/superior).
  • Place the electrode pads in close proximity to each other, as far from the device/lead system as possible.
  • Program the sensing polarity to bipolar in pacemakers.
  • Pacemakers utilizing impedance based sensors (like minute ventilation or stroke volume) for rate responsive pacing should be programmed to a non-rate responsive mode.

If you have any questions on this topic, please contact St. Jude Medical Technical Services at 800-722-3774.

PDF Effect of TENS on St. Jude Medical Implantable Cardiac Rhythm Devices (24.9kb)

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REFERENCES
1. Crossley, G., Poole, J., et al.: The Heart Rhythm Society Expert Consensus Statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: Facilities and patient management. Heart Rhythm, 2011.