Technical Services

15900 Valley View Court

Sylmar, CA 91342-3577
800 722 3774

Effect of 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

Rev 09/11
 Technical Services
15900 Valley View Court
Sylmar, CA 91342-3577
800 722 3774

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 patients 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 anterior/posterior).
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.

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.

Rev 09/11