Inappropriate implantable cardioverter defibrillator shocks induced by capacitive–resistive electric transfer therapy: the first documented case report of electromagnetic interference with electrogram evidence

TL;DR

A man with a heart device received unexpected electric shocks during a therapy session, showing a new safety risk for patients with heart implants.

Contribution

First documented case of TECAR therapy causing electromagnetic interference with an ICD, supported by electrogram evidence.

Findings

TECAR therapy induced inappropriate ICD shocks due to electromagnetic interference.

High-frequency signals were recorded on electrograms and misinterpreted as ventricular fibrillation.

Safety concerns are raised for ICD and other CIED patients undergoing TECAR therapy.

Abstract

Capacitive–resistive electric transfer (TECAR) therapy is a form of endogenous diathermy delivering radiofrequency current and is increasingly used for musculoskeletal rehabilitation. However, data regarding its safety in patients with cardiac implantable electronic devices (CIEDs) are limited.

A 54-year-old man with a dual-chamber implantable cardioverter defibrillator (ICD) underwent lumbar TECAR therapy for muscular contracture. During the session, he experienced two inappropriate ICD shocks while remaining conscious and without clinical sequelae. Device interrogation revealed high-frequency, non-physiological signals simultaneously recorded on atrial and ventricular intracardiac electrograms (EGMs), which were interpreted by the ICD as ventricular fibrillation and resulted in shock delivery.

This report represents the first documented case demonstrating EGM evidence of electromagnetic interference between TECAR therapy and an ICD. The findings highlight a relevant safety concern and suggest that TECAR therapy should be avoided in ICD carriers and, more broadly, used with extreme caution in patients with other CIEDs, only after careful risk–benefit assessment and discussion with an electrophysiology specialist.

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