Electroacupuncture and permanent pacemaker: a study on safety and electromagnetic interference

Abstract

Electroacupuncture (EA) is widely used in Asia as an effective therapy for pain. Sterile needles are placed over acupoints with treatment delivered via an electric stimulator (ES). In patients with pacemakers (PPM), EA is avoided due to risks of electromagnetic interference (EMI). A 1980 study found that EA caused EMI in PPMs and cautioned against its use in these patients. However, Dimitrios et al reported no side effects in a patient with PPM who underwent EA. This pilot prospective study aimed to evaluate the safety and efficacy of EA in PPM patients with chronic musculoskeletal (MSK) pain and detect clinically significant EMI.

11 patients with dual chamber PPMs undergoing EA for MSK pain >1 month were studied in a tertiary hospital. We characterised their demographics, PPM details, device parameters and pain scores pre and post EA. We looked for atrial (A) and ventricular (V) high rate events, mode switch episodes and noise reversion mode activity. Baseline PPM check was performed prior to each EA session conducted by an acupuncturist. Each session involved applying currents to needles placed over 3 paired acupoints traversing the PPM. 10 other acupoints were manually stimulated by the acupuncturist based on Meridian Theory to achieve optimal pain relief. The ES generated an initial current of 1.6mA and was increased to 16mA as tolerated. Each stimulation was applied for 5 mins to each acupoint pair before a concurrent stimulation to all paired acupoints. Patients were continuously monitored by a nurse, cardiac technician and cardiologist, with blood pressure readings every 5 mins, continuous electrocardiography, and real time electrogram via the device programmer. PPM checks were done after each session to determine if any parameter had changed. Pain scores and adverse events were also documented at 1-week post EA.

11 patients (mean age 66.9±7.26, male 45.5%) were recruited. There was no evidence of EMI or inappropriate PPM response throughout all sessions. One patient felt mild pain over an acupoint after EA. PPMs were implanted for sick sinus syndrome (36.4%) and atrioventricular disease (63.6%). All patients were either A or V pacing dependent (mean Ap 47.68%±40.98%, mean Vp 50.85%±43.13%), and mean device age was 3.6±3.8 years. Mean EA time was 30±11min and a mean current of 8.5±4.11mA was delivered. All patients completed the whole EA session. No inappropriate PPM therapy nor EMI was observed on the A and V EGM channels during EA. Baseline mean pain scores of 5.0±1.55 improved immediately post EA to 2.4±1.57. There was a significant improvement of pain scores by 55.4%±23.8% (p<0.05) immediately, and 26.1±43.9% (p=0.05) at 1 week follow up (Table 1).

Our pilot study showed PPM function was not altered by EA, with no clinically significant EMI detected. All patients reported improved pain score, with relief lasting at least 1 week. Larger scale studies are required before a robust recommendation can be made.Baseline demographics and resultsElectrogram recorded during EA