Sunday, May 31, 2009

Are electrotherapy & cardiac rhythm devices (CRD) really incompatible or risky?

Review of the literature and of recommendations from CRD manufacturers suggests that TENS, Diathermy, and Interferential Electrical Current Therapy are best avoided in patients with CRDs.
But several case reports have demonstrated there are no interactions between various physiotherapy modalities and cardiac rhythm devices (CRD).

However, in my graduation days it was criminal not to ask the patient whether he was having a CRD or not. I have seen students fail in practical examinations if they omitted this query while interviewing the patients. Till date I have also maintained the same precautionary measure in my set up. Here is a recent paper I am discussing which investigated on the fact that “Is there really an interaction various physiotherapy modalities with CRD that contraindicates or cautions it’s application”.

This review will help many to

1. Reduce fear of potential interactions. This may lead to not implementing a treatment strategy that would be helpful to the patients’ ailments.
2. Reduce the chances of suboptimal utilization of physiotherapy treatments in CRD patients.

Digby & Colleagues reviewed existing guidelines regarding the use of physiotherapy modalities in patients with pacemakers and/or implantable cardioverter-defibrillators (ICDs).

In a local physiotherapy facility in Ontario, Canada 25 patients ware treated with CRD (22 pacemaker and 3 ICD patients) for a total of 230 visits (9.2 visits/patient).

5 patients received TENS and all 25 were administered additional treatment in the form of ultrasound (15), acupuncture (19), Laser (7), traction/manual therapy (12), exercise (8), education (18), taping (5), and/or moist heat (5).

The results are as follows:
1. No complications occurred. It may be possible to safely deliver these modalities in a proper setting with device and patient monitoring.

Further readers:
2. There are no specific international policies regarding the administration of physiotherapy modalities in CRD patients and, thus, there are no specific guidelines to be implemented at the local level.

Digby GC et al; Europace. 2009 May 2. [Epub ahead of print]

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