Wiener klinische Wochenschrift

, Volume 131, Issue 13–14, pp 313–320 | Cite as

Influence of electrical stimulation therapy on permanent pacemaker function

  • Florian EggerEmail author
  • Christian Hofer
  • Fabian P. Hammerle
  • Stefan Löfler
  • Michael Nürnberg
  • Lukas Fiedler
  • Ruxandra Kriz
  • Helmut Kern
  • Kurt Huber
original article



Electrical stimulation therapy (EST) and transcutaneous electrical neuromuscular stimulation (TENS), a modality of EST, have become widely applied, accepted and effective methods for the treatment of musculoskeletal and other pain conditions. According to the rising number of permanent pacemaker (PM) wearers the number of potential candidates for EST with concomitant device implantation is growing. Contradictory recommendations exist regarding the application of EST or TENS on PM wearers.


The study was carried out to evaluate the impact of EST on PM function.


A full size model mimicking the electrical characteristics of the human body was used to evaluate the application of EST on permanent PM devices. Various configurations with respect to energy modality, position of the stimulation electrodes and PM device models were evaluated. Intracardiac PM electrogram tracings (iEGM) were analyzed for the interference of EST with PM function.


Unilateral EST application did not cause interference with PM function in any of the configurations (0%; n = 700). On the contrary, bilateral stimulation (350 configurations in total) caused either ventricular inhibition or switch to V00 back-up pacing due to electrical interference in 165 cases (47.1%) depending on the applied stimulation parameters.


The use of EST potentially interferes with PM therapy, especially if the electrodes are positioned bilaterally; however, unilateral EST application appeared to be safe in all tested configurations.


Transcutaneous electrical neuromuscular stimulation Device interaction Chronic pain  Ex-vivo Full-size model 



Electrical stimulation therapy


Implantable cardioverter defibrillator


Intracardiac pacemaker electrogram tracing




Transcutaneous electrical nerve stimulation



This work was supported by the Association for the Promotion of Research in Atherosclerosis, Thrombosis and Vascular Biology, the Ludwig Boltzman Foundation for Cardiovascular Research and the Ludwig Boltzman Institute for Electrical Stimulation and Physical Rehabilitation.


This pece of research did not reveive any specific funding or grant. However the authors could use the facilities from the Association for the Promotion of Research in Atherosclerosis, Thrombosis and Vascular Biology, the Ludwig Boltzman Foundation for Cardiovascular Research and the Ludwig Boltzman Institute for Electrical Stimulation and Physical Rehabilitation to conduct their research. Consequently this appears to be no contradiction to the authors.

Conflict of interest

F. Egger reports personal fees from Medtronic outside the submitted work. M. Nürnberg reports personal fees from Medtronic, Biotronik, Boston Scientific, St. Jude Medical/Abbott and Sorin outside the submitted work. L. Fiedler reports personal fees from Boston Scientific and St. Jude Medical/Abbott outside the submitted work. C. Hofer, F.P. Hammerle, S. Löfler, R. Kriz, H. Kern and K. Huber have no conflicts of interest with respect to this publication.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.3rd Medical Department with Cardiology, Chest Pain Unit and Intensive Care MedicineWilhelminenspitalViennaAustria
  2. 2.Ludwig Boltzmann Institute of Electrical Stimulation and Physical RehabilitationWilhelminenspitalViennaAustria
  3. 3.2nd Department of Internal MedicineHospital Wiener NeustadtWiener NeustadtAustria
  4. 4.Medical FacultySigmund-Freud UniversityViennaAustria

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