The simultaneous use of a biventricular implantable cardioverter defibrillator (ICD) and transcutaneous electrical nerve stimulation (TENS) unit: implications for device interaction

Undesirable sensing of external sources of electromagnetic interference by ICDs is well known. A transcutaneous electrical nerve stimulation (TENS) device has been reported to interfere with an ICD resulting in an inappropriate shock and patients with implanted defibrillators or pacemakers have been cautioned about the use of such units to treat chronic pain. We describe a patient regularly using TENS therapy for pain who subsequently received a biventricular ICD for malignant ventricular arrhythmias and medically refractory cardiac failure. He underwent testing for device interaction immediately post-implant. This did not show inappropriate sensing by either ICD or pacemaker component of his heart failure device. However, six months later, the patient complained of dizziness and bradycardia with application of TENS. Further testing did reveal interference with pacemaker function. Thus, even if initial testing is negative and reassuring, patients with a biventricular ICD still require careful follow-up for potential interaction and should be cautioned against the use of TENS, especially if they are pacemaker-dependent.