Potential interference of small neodymium magnets with

cardiac pacemakers and implantable cardioverter-debrillators

Thomas Wolber, MD,* Salome Ryf, PhD,

Christian Binggeli, MD,* Johannes Holzmeister, MD,*

Corinna Brunckhorst, MD,* Roger Luechinger, PhD,

Firat Duru, MD*

From the *Cardiovascular Center, Cardiology, University Hospital, Zurich,

Institute for Biomedical Engineering,
University and ETH, Zurich, and

Federal Ofce of Public Health, Berne, Switzerland.
BACKGROUND Magnetic elds may interfere with the function
of cardiac pacemakers and implantable cardioverter-debrilla-
tors (ICDs). Neodymium-iron-boron (NdFeB) magnets, which
are small in size but produce strong magnetic elds, have
become widely available in recent years. Therefore, NdFeB mag-
nets may be associated with an emerging risk of device inter-
ference.
OBJECTIVE We conducted a clinical study to evaluate the poten-
tial of small NdFeB magnets to interfere with cardiac pacemakers
and ICDs.
METHODS The effect of four NdFeB magnets (two spherical mag-
nets 8 and 10 mm in diameter, a necklace made of 45 spherical
magnets, and a magnetic name tag) was tested in forty-one
ambulatory patients with a pacemaker and 29 patients with an
ICD. The maximum distance at which the magnetic switch of a
device was inuenced was observed.
RESULTS Magnetic interference was observed in all patients. The
maximum distance resulting in device interference was 3 cm. No
signicant differences were found with respect to device manu-
facturer and device types.
CONCLUSION Small NdFeB magnets may cause interference
with cardiac pacemakers and ICDs. Patients should be cau-
tioned about the interference risk associated with NdFeB mag-
nets during daily life.
KEYWORDS Magnet; Pacemaker; Implantable cardioverter-debril-
lator; Electromagnetic interference; Neodymium
(Heart Rhythm 2007;4:14) 2007 Heart Rhythm Society. All
rights reserved.
Interference of environmental factors with cardiac pace-
makers and implantable cardioverter-debrillators (ICDs)
may cause temporary or permanent changes of device func-
tion. The vast majority of interactions in clinical practice
may be attributed to electromagnetic interference, which
may result from a wide spectrum of sources in everyday life
and at the workplace.
1
Common permanent magnets for
household or ofce use are generally associated with low
risk due to low magnetic eld strength. However, very
strong magnets made from neodymium-iron-boron
(Nd
2
Fe
14
B) have recently become available. Because of
high magnetic eld strength and low production costs,
NdFeB magnets are increasingly being incorporated into
various articles for household and ofce use, for example, in
toys, jewelry, and even clothes. The aim of this study was to
determine the risk of magnetic interference caused by small
commercially available NdFeB magnets in patients with
cardiac pacemakers and ICDs.
Methods
Consecutive patients with pectorally implanted cardiac
pacemakers or ICDs were recruited during regular device
follow-up visits at the outpatient pacemaker service at the
University Hospital of Zurich. Tests were performed using
NdFeB magnets of different sizes and congurations, which
included a single small (8 mm) and a larger (12 mm)
spherical magnet, a necklace made of 45 spherical magnets
of three different sizes, and a magnetic name tag (Figures 1
and 2).
After initial device interrogation, NdFeB magnets were
placed in direct skin contact over the implanted device. Magnet
position and orientation were varied systematically until mag-
net interference was noted. Then, starting fromthe center of the
area of magnet interference during direct skin contact, magnets
were elevated from the skin in 1-cm increments. The occur-
rence of magnet interference was evaluated at each distance
until cessation of interference was observed. The same proce-
dure was repeated using four different kinds of NdFeB mag-
nets. In pacemakers, magnet effect documented by continuous
electrocardiogram monitoring was used to evaluate magnet
interference. In ICDs, interference was dened as emission of
audible tones or annotation of magnet detection during marker-
channel recording. Recording of marker channels was used in
ve devices, which could not be programmed to emit acoustic
Address reprint requests and correspondence: Thomas Wolber, M.D.,
Cardiovascular Center, Cardiology, University Hospital Zurich, Raemistr.
100, CH-8091 Zurich, Switzerland. E-mail address: thomas.wolber@
usz.ch. (Received August 31, 2006; accepted September 8, 2006.)
1547-5271/$ -see front matter 2007 Heart Rhythm Society. All rights reserved. doi:10.1016/j.hrthm.2006.09.012
signals. In these devices, programmer heads, which did not
contain built-in magnets, were placed eccentrically to allow
continuous telemetry during the test. No special programming
of the device was performed before the test. After comple-
tion of all measurements, devices were reinterrogated to
check for inadvertent programming during the test proce-
dure, and regular testing and programming were performed
as indicated clinically.
Data were analyzed with SPSS for Windows, version
13 (SPSS, Chicago, IL). Categorical data are presented as
frequencies (%), continuous variables are presented as
mean standard deviation (SD). Fishers exact test was
used to compare rates. Continuous variables were com-
pared using Students t-test or analysis of variance with
post hoc analysis. Two-sided P-values .05 were con-
sidered signicant.
The study was conducted according to specic institu-
tional and regional ethics guidelines. All participants pro-
vided written informed consent.
Results
A total of 280 measurements were performed in 70 consec-
utive patients. Baseline characteristics of the study patients
and devices are listed in Table 1. The NdFeB magnets used
for the tests are depicted in Figure 1, and physical charac-
teristics are presented in Table 2. The necklace was made of
20 small, 20 medium-sized, and ve larger spheres. Mag-
netic interference was observed in all patients. Occurrence
rates of magnetic interference at various distances are
shown in Figure 3. The maximum distance of interference
was 3 cm. Pacemakers were affected at greater distances
[mean distance (SD), 2.1 (0.6) cm] compared with ICDs
[1.7 (0.6) cm; P .007]. There was no signicant differ-
ence between single-chamber [1.9 (0.7) cm] and dual-cham-
ber devices [2.0 (0.6) cm; P .6] or between manufacturers
(P .4). Magnetic interference was dependent on the size,
conguration, and shape of the magnets (Table 3). While
the larger sphere and the chain of spheres caused magnetic
interference with virtually all devices, the name tag inter-
fered with 57% of the devices. No patient experienced any
symptoms during magnet testing. All devices resumed reg-
ular function immediately after magnet removal.
Discussion
The ndings of this study suggest that small, commercially
available NdFeB magnets may cause interference with mod-
ern cardiac pacemakers and ICDs. All devices were suscep-
tible to interference within a distance of up to 3 cm. Nota-
bly, only small magnets weighing up to 8 g were tested.
Larger NdFeB magnets are likely to cause interference at
greater distances, but no such magnets were investigated
because those magnets have to be handled with care on
account of their strong adhesive force.
Interference may occur if the magnetic switch of an
implanted device is affected by an external magnetic eld.
Reed switches incorporated in many pacemakers and ICDs
are typically closed by a 0.9 mT magnetic eld and reopen
at 0.7 mT.
2
In recent years, Hall sensors or semiconductor-
based magnetic switches are increasingly being used, in
which opening and closure occur at the same eld strength.
Magnet switch closure results in temporary asynchronous
pacing in pacemakers and in temporary suspension of tachy-
arrhythmia detection in most ICDs, whereas bradycardia
pacing functions remain unaffected in most ICDs.
Figure 1 NdFeB magnets used for evaluation of magnetic interference
with cardiac devices. A: Small and large sphere. B: Small spheres rmly
sticking to both sides of a thumb. C: Magnetic name tag.
2 Heart Rhythm, Vol 4, No 1, January 2007
During daily life, transient magnet reversion has been
reported to occur at a rate of 11% per patient per year.
3
Most
patients with cardiac devices are unlikely to recognize
short-lasting magnetic interference. Many individuals with
an implanted pacemaker remain asymptomatic during asyn-
chronous pacing, and brief episodes of asynchronous pacing
seem to be associated with very low clinical risk, although
competitive pacing during spontaneous rhythm may result
in stimulation of the ventricle during its vulnerable period
and may induce ventricular arrhythmias, especially in high-
risk patients, such as those with ischemia.
4
Initiation of
reentrant pacemaker tachycardia, atrial utter, or brillation
by magnet application to a pacemaker has also been de-
scribed.
57
Some ICDs emit alarm tones during the occur-
rence of magnet interference. If this function is unavailable
or deactivated, magnet effects may be identied by use of a
programmer and recording of the marker channel, but this
will not be recognized by the patient.
All devices tested in the current study resumed normal
function after removal of the magnetic eld. However, per-
manent or recurring magnetic inuence might be caused by
prolonged exposure to magnetic name tags, brooches, or
other jewelry or apparel with magnetic closures. In Guidant
devices, ICD functions may be permanently disabled by a
magnet applied for 30 seconds if the change tachy mode
with magnet feature is programmed on. Unintentional
Figure 2 NdFeB magnets forming a necklace (A), a triangle (B), and a row (C). Shape and extension of the magnetic eld resulting from the assembly
of multiple magnets are demonstrated with iron powder.
Table 1 Baseline characteristics of 70 study patients and
devices.
Age (years) 65 (17)
Male sex 50 (71%)
Body mass index (kg/m
2
) 27 (4)
Pacemakers 41
- Single chamber 7
- Dual chamber 34
ICDs 29
- Single chamber 15
- Dual chamber 14
Device manufacturer
- Guidant 25
- St. Jude Medical 22
- Pacesetter 3
- Medtronic 19
- Vitatron 1
Time since implantation (months) 27 (28)
Numbers are counts or mean (SD).
Table 2 Physical characteristics of tested magnets.
Size/
Diameter
(mm)
Weight
(g)
Adhesive
Force (kg)
Remanence
(T)
Small sphere 8 2.1 0.9 1.221.26
Medium sphere 10 4.0 1.5 1.261.29
Large sphere 12 8.1 2.9 1.291.32
Name tag 40 11 4 8.3 NA NA
Adhesive force and remance values were obtained from the distributor
of the magnets. NA information not available
Figure 3 Percentage of devices exhibiting magnetic interference during
exposure to NdFeB magnets at various distances.
3 Wolber et al Magnets and Pacemaker Interference
ICD deactivation with potentially fatal consequences has
been reported.
810
In newer devices, magnet application is
being used to trigger specic functions, including storage of
event markers and electrograms. Thus, in these devices,
magnet interference may lead to eccentric, although innoc-
uous, device behavior.
11
Because of higher magnetic eld strength, NdFeB magnets
are much smaller in size than conventional permanent mag-
nets. The eld strength of a specic magnet, as well as the
extension and shape of the magnetic eld of multiple magnets
that have been put together, may not be easily predicted with-
out performing B-eld measurements. Our measurements
demonstrated that the necklace, which was made of 25 spheres,
did not cause interference at greater distance than the one
observed with a single sphere. However, changes in the con-
guration of the magnets result in very different shape and
extension of the magnetic eld (Figure 2). Furthermore, vari-
ous coatings or incorporation into pieces of jewelry or apparel
may make these magnets less recognizable, and the risk of
interference may be underestimated by patients. Although
magnet interference may only cause xed-rate pacing in pace-
maker patients, such interference may suspend tachycardia
detection in ICDs with potentially life-threatening conse-
quences. Therefore, the use of name tags, jewelry, or reading
glasses containing NdFeB magnets should generally be con-
sidered to be contraindicated. Magnetic toys and NdFeB
magnets for home and ofce use should be handled with
caution in patients with pacemakers and ICDs.
Conclusion
Small NdFeB magnets may cause interference with modern
pacemakers and ICDs. Patients should be cautioned about
the interference risk associated with NdFeB magnets during
everyday life, and product declarations should include in-
formation on the potential hazard that may be associated
with the use of these magnets.
References
1. Pinski SL, Trohman RG. Interference in implanted cardiac devices. Part II.
Pacing. Clin Electrophysiol 2002;25:14961509.
2. Luechinger R, Duru F, Zeijlemaker VA, Scheidegger MB, Boesiger P, Candinas
R. Pacemaker reed switch behavior in 0.5, 1.5, and 3.0 Tesla magnetic resonance
imaging units: are reed switches always closed in strong magnetic elds? Pacing
Clin Electrophysiol 2002;25:14191423.
3. Kolb C, Deisenhofer I, Weyerbrock S, Schmieder S, Plewan A, Zrenner B, Schmitt
C. Incidence of antitachycardia therapy suspension due to magnet reversion in
implantable cardioverter debrillators. Pacing Clin Electrophysiol 2004;27:221
223.
4. Bilitch M, Cosby RS, Cafferky EA. Ventricular brillation and competitive
pacing. N Engl J Med 1967;276:598604.
5. Barold SS, Falkoff MD, Ong LS, Heinle RA. Paradoxical induction of endless
loop tachycardia by magnet application over a DDD pacemaker. Pacing Clin
Electrophysiol 1986;9:503510.
6. van Gelder LM, El Gamal MI. Magnet application, a cause of persistent ar-
rhythmias in physiological pacemakers. Report of 2 cases. Pacing Clin Electro-
physiol 1982;5:710714.
7. Furman S, Cooper JA. Atrial brillation during A-V sequential pacing. Pacing
Clin Electrophysiol 1982;5:133135.
8. Bonnet CA, Elson JJ, Fogoros RN. Accidental deactivation of the auto-
matic implantable cardioverter debrillator. Am Heart J 1990;120:696
697.
9. Rasmussen MJ, Friedman PA, Hammill SC, Rea RF. Unintentional deactivation
of implantable cardioverter-debrillators in health care settings. Mayo Clin Proc
2002;77:855859.
10. Ferrick KJ, Johnston D, Kim SG, Roth J, Brodman R, Zimmerman J, Fisher JD.
Inadvertent AICD inactivation while playing bingo. Am Heart J 1991;121:206
207.
11. Levine PA, Moran MJ. Device eccentricity: postmagnet behavior of DDDR
pacemakers with automatic threshold tracking. Pacing Clin Electrophysiol 2000;
23:15701572.
Table 3 Frequencies of interference of various NdFeB magnets with single- and dual- chamber pacemakers and ICDs
Single-chamber
pacemaker
(n 7)
Dual-chamber
pacemaker
(n 34)
Single-chamber
ICD (n 15)
Dual-chamber
ICD (n 14)
Total
(n 70)
Chain of spheres 7 (100%) 33 (97%) 15 (100%) 13 (93%) 68 (97%)
Large sphere 7 (100%) 33 (97%) 15 (100%) 14 (100%) 69 (99%)
Small sphere 4 (57%) 28 (82%) 11 (73%) 7 (50%) 50 (71%)
Name tag 3 (43%) 24 (71%) 7 (47%) 6 (43%) 40 (57%)
4 Heart Rhythm, Vol 4, No 1, January 2007
BBC NEWS | Health | Fridge magnets 'can be a killer' http://news.bbc.co.uk/2/hi/health/6160731.stm
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UK version International version | About the versions Low graphics | Accessibility help
Noedymium magnets are very strong
There is a real danger.
These magnets are
everywhere
Ian Asquith, director of
Neodymium Magnets UK
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Last Updated: Friday, 1 December 2006, 01:01 GMT
E-mail this to a friend Printable version
Fridge magnets 'can be a killer'
Fridge magnets and
decorative jewellery could
be a killer if you have a
weak heart, experts warn.
A strong type of magnet used
in many new commercial
products can interfere with
pacemakers and implanted
heart devices with deadly
consequences.
Close contact - within about 3cm - with a neodymium
magnet is enough to destabilise these life-saving heart
devices, Heart Rhythm journal reports.
The authors suggest manufacturers include a health
warning on products.
Ordinary iron or ferrite magnets, which are a dull grey
colour with a low magnetic strength, are of little concern.
Very strong magnets made from neodymium-iron-boron,
which are shiny and silver in colour, have only recently
become available.
But because of their high magnetic field strength and low
production costs, they are being used in computer hard
drives, headphones and hi-fi speakers, as well as toys,
jewellery and even clothes.
Swiss researchers at the University Hospital of Zurich
tested the effect of neodymium magnets in 70 heart
patients - 41 with pacemakers and 29 with implantable
cardioverter defibrillators.
Magnetism
The small 8g magnets tested interfered with all of the
patients' devices, regardless of their make or type, when
they were in a maximum range of 3cm.
The researchers said larger
neodymium magnets would
be likely to cause
interference at greater
distances than this.
Although the devices worked normally again once the
magnet was removed, the authors warned permanent
damage might occur with prolonged exposure - if
someone were to wear a magnetic name badge, for
example.
Lead researcher Thomas Wolber said: "Physicians should
caution patients about the risks associated with these
SEE ALSO
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pacemaker
10 Nov 04 | Science/Nature
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28 May 04 | Southern Counties
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off pacemakers'
18 May 00 | Health
RELATED INTERNET LINKS
Heart Rhythm journal
British Heart Foundation
Neodymium Magnets UK
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magnets.
"We also recommend that the packaging includes
information on the potential risks."
Warnings
Ian Asquith, director of Neodymium Magnets UK, a
supplier of neodymium magnets to product
manufacturers, said his company was aware of the risks
and sends warnings out with every magnet.
But consumers were generally unaware, he said, and
manufacturers had a responsibility to warn consumers of
any risks.
"There is a real danger. These magnets are everywhere.
They are in lots of badges, fridge magnets and mobile
phones. If you were on a busy bus and someone you are
squashed up against had a magnet in their top pocket
you could easily come within 3cm of it.
June Davison, of the British Heart Foundation, said
anyone with concerns should contact their pacemaker
clinic.
"Pacemakers are manufactured to the highest standards,
are rigorously tested, and most have a protective case to
shield them from outside interference. Problems are
rare."
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Ekstra Bladet http://ekstrabladet.dk/nyheder/samfund/article248896.ece
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Livsfarlige
kleskabsmagneter
Kleskabsmagneter kan koste
menneskeliv, lyder advarslen fra
schweiziske forskere
Michael Winther-Rasmussen - 16:29 - 02. dec. 2006
En meget strk type magnet, der blandt andet kan
bruges i kleskabsmagneter, kan have fatale
konsekvenser for personer med pacemaker. Kort afstand
- hvilket vil sige op til tre centimeter - mellem magnet og
pacemaker kan f det livsvigtige apparat til at svigte.
Sdan lyder advarslen fra en gruppe forskere ved
universitetshospitalet i Zrich i Schweiz. Det skriver BBC
med baggrund i en artikel i fagbladet 'Heart Rhythm'.
Forskere har undersgt en ny kraftig type magnet, der er
ved at finde indpas i computere, telefoner, hjtalere,
legetj og smykker. De gennemfrte forsg med en lille
magnet p otte gram p 70 hjertepatienter. I samtlige
forsg havde magneten en negativ effekt p de
pacemakere og indopererede defibrillatorer patienterne
var udstyret med. Forskerne vurderer, at strre magneter
kan have effekt p strre afstande.
Alle de livsvigtige apparater fungerede normalt igen, s
snart magneten blev fjernet, men det er forskernes
opfattelse at lngevarende pvirkning kan forrsage
permanente skader.
- Lger br advarer patienter om de risisci, der er
forbundet med disse magneter, siger forskerholdets
leder, Thomas Wolber, der ogs opfordrer til, at der
placeres advarsler p produkter, der indeholder
magneterne.
Det er ikke alle magneter, der er farlige. Forskerne har
alene fundet en negativ effekt ved de nye kraftfulde
neodym-magneter.
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Det er kun de nye kraftige magnter,
der blandt andet indeholder neodym,
der er farlige. De er billige at lave og
derfor oplagte til blandt andet
kleskabsmagneter. (Foto:
Colourbox.com)
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Samfund
Rapport om
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12-12-06 14:48

Vltede grisetransporter
undersges
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Magnets 'threat to heart patients'
By PA
Magnets used in toys, jewellery and office equipment may pose a serious risk to patients
fitted with pacemakers and other heart implants, according to researchers.
A study has found they can interfere with the operation of devices such as pacemakers and
implantable cardioverter defibrillators (ICDs).
Ordinary iron or ferrite magnets, like those used to stick messages and badges on fridges,
are of little concern.
But researchers found that more powerful
magnets made from neodymium-iron-boron
(NdFeB) may present a real problem.
NdFeB magnets are increasingly being used in
homes and offices. They can be found in the
hard drives of computers, "in-ear"
headphones, and certain hi-fi speakers, as
well as toys, jewellery and even clothing.
Scientists in Switzerland tested two spherical
NdFeB magnets of 8mm and 10mm diameter,
and a necklace made from 45 magnetic
beads, on 70 heart patients. Forty-one of the
volunteers were fitted with pacemakers and
29 with ICDs.
In all cases, being close to the magnets
caused interference which disrupted the
functioning of the devices. Normal operation was resumed as soon as the magnets were
removed.
Dr Thomas Wolber of the University Hospital of Zrich, who led the study, said: "Physicians
should caution patients about the risks associated with these magnets. We also recommend
that packaging include information on the potential risks that may be associated with these
types of magnets."
The findings were reported in the journal Heart Rhythm.
In an accompanying commentary, Dr Huagui Li, a US cardiologist at the Minnesota Heart
Clinic in Edina, Minneapolis, wrote: "This study is timely and important to attract the
attention of both the public and the medical profession about the potentially serious health
consequences of magnets used in decoration productions ... for an ICD patient, the magnetic
interference can be fatal."
He said manufacturers who used magnets should be required to place warning labels on their
products.
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