1. Video Capsule Endoscopy in Patients with Implantable Cardiac Devices: Safety, Interference and Beyond
Rabih Tabet MD, Najib Nassani MD, MSc, Boutros Karam MD, Philippe Akhrass MD, Liliane Deeb MD
Staten Island University Hospital – Northwell Health
Background
Cardiac events including arrhythmias were not seen in any case. Only 4 PMs switched to noise mode without consequences. Interference on capsule images transmission was noted in 6 cases (1 PM, 5 LVADs) where images were lost when the capsule was closest to the device. Finally, possible interference between capsule and telemetry leads was noted in 6 cases (3 PMs, 3 ICDs) leading to artifacts. Table 1 summarizes the results of studies on VCE use in the setting of implantable cardiac devices.
Type of Device
Total (n)
Brand
VCE brand
Outcome
Quality of images PM
608
Medtonic (91)
St Jude (61)
Guidant (53)
Biotronik (24)
Vitatron (10)
ELA Sorin (5)
Siemens (2)
Boston scientific (1) Osypka (1)
No specification (360)
Pillcam (519)
Endocapsule (113)
Mirocam (3)
No specification (16)
No adverse cardiac events
4 PMs (2 St Jude, 2 Biotronik) switched to noise mode (without cardiac complications)
3 cases of VCE interference with telemetry leads leading to few images loss
1 case of possible interference leading to some blank images when VCE (Pillcam) was near PM (ELA Sorin)
ICD
171
Medtronic (28)
Guidant (22)
Boston scientific (8)
St Jude (14)
ELA sorin (2)
Biotronik (1)
No specification (90)
Pillcam (133)
Endocapsule (25)
No specification (10)
1 Biotronik Belos ICD (In vitro) showed oversensing and delivery of inappropriate therapy
LVAD 92
Thoratec HeartMate II (36)
HeartWare (3)
Jarvik 2000 (2)
Berlin Heart Incor (2)
Novacor (1)
No specification (48)
Pillcam (54)
No specification (38)
5 cases of possible interference leading to images loss/artifact when VCE was near the device
Video capsule endoscopy (VCE) allows the visualization of the small intestine in the setting of obscure gastrointestinal bleeding (OGIB). The latter instance can occur in patients with implantable cardiac devices. To date, VCE use in these patients has not been approved by the Food and Drug Administration. This review assesses the safety profile of capsule endoscopy in patients with cardiac devices and the interference of cardiac devices on the capsule images transmission.
Discussion
Methods
Adverse cardiac event was not seen in any study. Loss of images can occur when the VCE is in proximity to the device or after telemetry leads installation. The limitations of the isolated studies were mainly the low power and the wide variety of available brands of cardiac devices to be tested.
PubMed and Web of Science databases were searched for peer-reviewed published studies containing “capsule endoscopy” AND “pacemaker, “defibrillator” OR “assist device” as keywords.
Results
Conclusion
A total of 893 (28 in vitro) VCE procedures were studied in patients with cardiac devices in various clinical settings (In-hospital; outpatient; with or without cardiac rhythm monitoring).
VCE is safe in patients with cardiac devices. If cardiac monitoring is required, wired systems are to be used. Imaging artifacts can be caused by electromagnetic interference.
Table 1: Summary of video capsule endoscopy procedures done in patients with implantable cardiac devices, outcomes, and possibility of interference