Topics

1. What you need to know about EMIEveryday questions about appliances and equipment that may interact with your device

2. Topics • What is EMI? • How can EMI affect my device? • What about magnets? • To Use or Not Use – How do I know? • Who can I call with specific questions? EMI

3. What is EMI? Electromagnetic interference: invisible lines of force • Produced by combination of voltage (electricity) and current flow (magnetism) • Signals may interfere with intended device operation The strength of EMI is proportional to the distance from the source. The closer you are, the more of an effect EMI will have. EMI

4. What is EMI? Electric fields • Produced by voltage • Reduced in strength with increasing distance from the source EMI

5. What is EMI? Magnetic fields • Produced by flow of current • Electric field also present • Reduced in strength with increasing distance from the source EMI

6. How can EMI affect my device? • Implanted device may interpret EMI as rapid signal from heart • Pacemaker: may withhold pacing • ICD: may deliver unneeded shock • Effects of EMI are temporary • Does not usually harm device EMI

7. How can EMI affect my device? Most household appliances are not operated very close to the body. Elementary physics states that if you double the distance from the magnet, the magnetic field strength will be reduced (roughly) by a factor of 8. At a distance of 12 in (30 cm) the EMI fields surrounding most household appliances are more than 100 times lower than recommended guidelines for public safety A magnetic field of 10 G or more will be detected by an implanted device. World Health Organization, What is EMF? EMI

8. What about magnets? Magnets do the following things: Attract certain materials - such as iron, nickel, cobalt, certain steels and other alloys Have an effect on electrical conductors when the magnet and conductor are moving in relation to each other Within six inches, a magnet may cause implanted devices to respond differently Pacemaker will respond by pacing at different, pre-set rate ICD will respond based on programming ICD may beep; move away from object causing beep, call doctor Pacemakers ICDs EMI

9. To Use or Not Use – How do you know? • Implanted devices are designed to work properly around most appliances and equipment. • Most things you handle or work near every day will not cause a problem. • Topics to be covered: • Personal Items • Kitchen, Tabletop, Household Items • Office, Shop and Yard Equipment • Entertainment Items • Travel/Environment • Dental and Medical Tests and Procedures EMI

10. Definitions • Safe under normal use: • Only considered safe when used normally in accordance with their intended use. • Check with your doctor for any additional restrictions that you may have for these items. • Use precaution: • Getting too close to these items could affect your device; when you are near any of these items, you should use precautions. • Check with your doctor for detailed information before using these items. • Do not use: • Strong electromagnetic and magnetic fields may affect your device. • Talk to your doctor. For specific brand items, consult the original manufacturer for any interaction with implantable devices. EMI

11. Personal Items Safe under normal use Electric blankets, toothbrushes Hair dryers Heating pads Pagers Patient alert devices Personal digital assistants (PDAs, unless used as cell phone, see cell phone) Use precaution Cell phones Keep 6 inches from device Keep 12 inches from device if transmits more than 3 watts Hold phone to ear on the opposite side of body from device Do not carry phone in breast pocket or belt within 6 inches of device Cordless phones, Electric razors Safe as long as not placed directly over device Hand-held massagers Safe as long as not placed directly over device EMI

12. Kitchen, Tabletop, Household Items Safe under normal use • Air purifiers • Blenders • Clothes dryers • Convection ovens • Electric can openers • Electric ovens and stoves • Food processors • Gas ovens and stoves • Microwave ovens • Portable space heaters • Vacuum cleaners • Washing machines EMI

13. Office, Shop and Yard Equipment Safe under normal use Copy machines Electric invisible fence Fax machines Personal computers Use precaution Keep 24 inches from device Arc welding equipment Running motors and alternators, especially those found in vehicles Avoid leaning over running motors and alternators of a running vehicle Keep 12 inches from device: Battery-powered cordless power tools Chainsaws Corded drills and power tools Lawn mowers Leaf blowers Shop tools (drills, table saws, etc.) Snow blowers EMI

14. Entertainment Items Safe under normal use AM/FM radios CD/DVD players Hot tubs/whirlpools (with doctor’s permission) Laser tag games Multimedia players iPods, MP3 players Remote controls TV, garage door, stereo, camera/video equipment Tanning beds TVs and VCRs Video games Use precaution Bingo game magnetic wands Keep 6 inches from device CB and police radio antennas Keep 24 inches from device Slot machines Keep 12 inches from device Stereo speakers Keep 12 inches from device EMI

15. Travel/Environment Use precaution • Security systems (i.e., airport, jail, courtroom) • Walk through security archways normally • Tell security personnel you have an implanted device and show Medical Device ID card • Security wand should not be held over device more than about 30 seconds; ask for hand-search if possible • Theft detection systems (often in store and library entrances) • Walk through theft detection systems at a normal pace • Do not lean against or linger near these systems • If you suspect interaction between your device and the theft detection systems, move away to decrease interference. EMI

16. Dental and Medical Tests and Procedures Safe under normal use Most medical and dental procedures will not affect your device. Some examples include: Dental drills and cleaning equipment Diagnostic x-rays Electrocardiogram Mammography Inform technician you have device to ensure device does not get compressed Diagnostic ultrasound Use precaution Be especially careful with the following procedures: CT Scans Electrocautery used in surgery External defibrillators Radiation therapy, lithotripsy TENS unit Boston Scientific. A Closer Look. Computed Tomography (CT) Scanning and Implantable Pacemakers and Defibrillators) August 18, 2008. EMI

17. Do Not Use • Personal Items • Body fat measuring scales (hand-held) • Magnetic mattresses or chairs • Office, Shop and Yard Equipment • Jackhammers • Dental and Medical Tests and Procedures • MRI Scans • Diathermy • Travel Entertainment • Stun guns EMI

18. Specific questions? Specific appliances, tools, medical procedures or pieces of equipment: • Contact your doctor Other resources: • Patient Handbook • Boston Scientific Patient Resources 1.866.484.3268 • www.lifebeatonline.com EMI

19. Questions? What questions do you have about electromagnetic interference?

20. Important Safety Information Cardiac Resynchronization Therapy Devices • Cardiac resynchronization therapy pacemakers (CRT-P) and defibrillators (CRT-D) are used to treat heart failure patients who have symptoms despite the best available drug therapy. These patients also have an electrical condition in which the lower chambers of the heart contract in an uncoordinated way and a mechanical condition in which the heart pumps less blood than normal. CRT-Ps and CRT-Ds are not for everyone including people with separate implantable cardioverter-defibrillators (CRT-P only) or certain steroid allergies. Procedure risks include infection, tissue damage, and kidney failure. In some cases, the device may be unable to respond to your heart rhythm (CRT-P only) or may be unable to respond to irregular heartbeats or may deliver inappropriate shocks (CRT-D only). Implantable Cardioverter Defibrillators • An implantable cardioverter defibrillator (ICD) can protect you from the effects of sudden cardiac arrest by reviving your heart rhythm. An ICD is not for everyone, including people with certain steroid allergies. Procedure risks include infection and tissue damage. In some cases, the device may not respond to irregular heartbeats or may deliver inappropriate shocks. Pacemakers • A pacemaker system can monitor and treat your heart rhythm by delivering electrical energy to pace your heart when it senses a slow rhythm. A pacemaker is not for everyone, including patients with certain steroid allergies. Patients who have additional medical conditions that may not allow the pacemaker to function appropriately should not receive a device. Procedure risks include infection, tissue damage and kidney failure. In some cases, the device may not respond to your heart rhythm. For All Devices • In rare cases severe complications or device failures can occur. Electrical or magnetic fields can affect the device. Only your doctor knows what is right for you. These devices are available by prescription only. Individual results may vary. Device Quality and Reliability • It is Boston Scientific’s intent to provide implantable devices of high quality and reliability. However, these devices may exhibit malfunctions that may result in lost or compromised ability to deliver therapy. Refer to Boston Scientific’s CRM product performance report on www.bostonscientific.com for more information about device performance, including the types and rates of malfunctions that these devices have experienced historically. While historical data may not be predictive of future device performance, such data can provide important context for understanding the overall reliability of these types of products. Also, it is important that you talk with your doctor about the risks and benefits associated with the implantation of a device. (Rev. B) EMI

21. Thank you! This presentation was sponsored byBoston ScientificCardiac Rhythm Management We work to improve the quality of life for cardiac patients and those who care for them.