Study: iPods, Similar Devices Don't Affect Pacemakers

Last May, a widely reported study concluded that errant electronic noise from iPods can cause implantable cardiac pacemakers to malfunction. This just didn't sound right to the cardiac electrophysiologists at Children's Hospital Boston, who've seen hundreds of children, teens and young adults with heart conditions requiring pacemakers.

"Many of our pacemaker patients have iPods and other digital music players, and we've never seen any problem," says Dr. Charles Berul, MD, director of the Pacemaker Service at Children's. "But kids and parents bring up this concern all the time, prompting us to do our own study."

Between September and December, 2007, Gregory Webster, MD, a cardiac fellow in training at Children's, along with the electrophysiology nurses and physicians, ran tests on 51 patients coming in for appointments. Whereas last year's study was done in patients averaging 77 years of age, the average age in the Children's study was 22 (ranging from 6 to 60). All patients had active pacemakers or implantable cardioverter-defibrillators (ICDs), which were tested against four digital music players -- two kinds of iPods (Apple Nano and Apple Video), SanDisk Sansa and Microsoft Zune. All patients were lying down during the tests (in case an arrhythmia occurred, causing them to faint), and each digital player was placed directly over the pacemaker or ICD.

As reported in the April 2008 issue of the journal Heart Rhythm, accompanied by an editorial, there was no interference with intrinsic device functioning - patients' EKG (electrocardiographic) recordings showed no change in any of 255 separate tests, and no patients had symptoms. "This provides reassuring evidence that should allay the fears of people using iPods and other digital music players," says Berul, the study's senior investigator.

However, in 41 percent of patients, the music players interfered with telemetry, or communications between the programmer and the pacemaker or ICD itself. (The programmer is a computerized device used by physicians to check and recalibrate the pacemaker/ICD - patients do not carry it.) This interference, picked up in 29 of 204 tests, went away when the digital player was moved six inches or more from the device, and did not compromise device function. The larger digital players (Zune and Apple Video) caused more interference with telemetry than the small players.

Patients should not use digital music players while the doctor is trying to reprogram their device, Webster and the electrophysiology team conclude. "If the iPod is right in the field, the programmer might not be able to communicate with the pacemaker or ICD effectively," Webster says.

The findings of interference with the pacemaker itself, reported last May, are published and updated in the same issue of Heart Rhythm. The editorial discusses possible reasons for the discrepancy between the two studies, which mainly relate to the testing methods and interpretation of the pacemaker recordings. Importantly, the music players did not stop pacemakers from pacing (regulating the heartbeat) in either the Children's study or the previously reported study, though the previous study did find interference with pacemaker sensing.

Berul and colleagues are reassured by their own findings, but acknowledge that their testing was only short-term. "We can't conclude that it's completely safe to have an iPod right on top of the device for hours at a time," Berul says. "That's why we suggest the precaution of keeping it at least six inches away."

The study was supported by the Boston Children's Heart Foundation.

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Eat Seafood, See Weight Loss, Fish Advocates Say

Recent news reports confirm that obesity rates continued to climb in over 30 states in 2006, so it might be surprising to learn that there are some foods Americans need to eat more of. Currently only 20 percent of the general population and 18 percent of pregnant moms are eating two weekly servings of seafood as recommended by experts, including the American Heart Association (AHA) and American Dietetic Association (ADA). More people might dive in to seafood if they knew that in addition to being low in fat and high in protein, fish contains other components that may boost weight loss.

A study published recently in the International Journal of Obesity finds that in young adult men, a low-calorie diet that includes fish results in slightly more weight loss than a similar low-calorie diet without fish. The study is part of SEAFOODplus, a large multicenter project sponsored by the European Union to explore the benefits of seafood. Researchers think seafood can enhance weight loss because of the omega-3 fatty acids, which may decrease growth of fat cells, and special fish proteins, which may reduce body fat mass.

"Seafood is a smart choice not only for a fit lifestyle, but a busy schedule. Many people don't know that seafood is quick and easy to prepare and that it is also inexpensive. There are many new products on the market like flavored canned and pouched tuna, flash frozen shrimp that cooks up in minutes and pre-marinated fresh tilapia fillets that come ready to throw on
the grill," says Jennifer Wilmes, nutritionist with The National Fisheries Institute. The institute is an advocate for the fish industry.

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Study: MRI and Echocardiography Together Can ID More Causes of Stroke Before They Strike

Based on a new study released today, researchers urge more comprehensive imaging for patients presenting to hospitals with stroke symptoms. Using both MRI and echocardiography to image the heart greatly enhances the detection of thecause and selection of the best treatment of cardioembolic strokes, the"meanest" type of stroke.

A cardioembolic stroke occurs when a thrombus (clot) dislodges from the heart, travels through the cardiovascular system and lodges in the brain, first cutting off the blood supply and then often causing a hemorrhagic bleed -- a double whammy of both types of stroke, ischemic first and then hemorrhagic. The study found that MRI detected nearly twice as many sources of stroke in the heart than echocardiogram alone. It also showed theability of MRI to reveal more heart disease conditions that contribute to clot formation in the first place. Echocardiography, however, was strong inthe detection of heart valve lesions. Combined, these imaging systems can more clearly identify underlying causes of future stroke, helping doctors decide the best initial therapy and the best treatment to prevent asecondary stroke.

The research was presented today at the Society of Interventional Radiology's 32nd Annual Scientific Meeting.

"This can revolutionize patient care because we can detect the underlying cause of the stroke and prevent it from occurring again," says lead author John Sheehan, M.D., an interventional radiologist at Northwestern University and Northwestern Memorial Hospital. "A potential cardiac source should be considered in all patients presenting with ischemic strokes. All stroke patients should routinely have an MRI and ultrasound of their heart, in addition to having their brain and carotids imaged with CT and MRI. It's nice to be on the front end of a stroke --able to stop it, than on the back end, figuring out how to deal with its damage."

Stroke teams generally consist of emergency room physicians, neurologists and interventional radiologists. Interventional radiologistsare a critical part of the stroke team because they can diagnose and treatischemic stroke with clot-busting drugs, or open a blocked carotid artery nonsurgically. They are also actively involved in creating more stroke teams across the country.

Cardioembolic strokes, which account for 20 percent of embolic strokes,have a worse prognosis, producing larger, more disabling strokes that aremore likely to recur compared to other types of stroke. Blood clots can betreated with drugs before they can leave the heart, in conjunction with treating identified heart conditions, to prevent another life-threatening stroke. In the United States stroke is the leading cause of adult disability and the third leading cause of death; only heart disease and cancer cause more deaths annually.

In the study, of the 93 patients who had an MRI and echocardiogram oftheir heart after a stroke, MRI detected nearly twice as many potential causes of stroke originating from the heart compared to echocardiography. MRI also detected significant heart conditions that predispose a patient tostroke in 30 percent of patients compared to echocardiography. These additional findings included acute myocardial infarction, myocardial scarring and left ventricular aneurysms. Echocardiography was, however,more sensitive to detecting potential embolic lesions on prosthetic cardiacvalves and strokes related to a hole in the heart.

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