Background

Apple (Cupertino, USA) offers MagSafe which is a proprietary wireless charging technology with an array of magnets that has the capacity to generate magnet field strength >50 gauss. Recent discussion raised up the question if novel smartphone interferences influence cardiac implantable electronic devices (CIEDs).

Objective

The aim of this study is to assess the influence of Apple iPhone 12 Pro interferences on CIEDs using a standardized protocol.

Methods

Patients with cardiac arrhythmias and CIEDs were included in this study. Apple’s iPhone 12 Pro with the latest operating system was placed directly on the skin above the CIED, simulating a smartphone placed in the breast pocket.  Four different device modes were tested: standby; connecting; call receiving (CR); NFC (near field communication) activation using Apple Pay. Influences on electrograms, changes to magnet mode of CIED or loss of telemetry connection were detected using the programming unit. If interferences could be detected, the same procedure was repeated by placing the iPhone on the ipsilateral ear.

Results

Seventy patients (25/70 (36%) female; mean age 72,5± 13,2 years (range: 42-93) were included. In 53% of the cases, CIED was implanted less than one year before. CIEDs and leads were from five different manufacturers (71,4% Biotronik 12,9% Abbott, 10% Boston Scientific, 4,3% Medtronic, 1,4% Vitatron), and were composed of 50% pacemakers (PM), 24,3% implantable cardioverter-defibrillators (ICD), 20% cardiac resynchronization therapy defibrillators (CRT-D), 4,3% CRT pacemakers, 1,4% subcutaneous-ICD.

No back-up or magnet-modes of CIEDs were triggered. iPhone induced interferences were present in 11% of the patients (tab. 1). Interferences were detectable in CIEDs from three companies. In these cases, most of the interferences could be observed using NFC (6/8 (75%) of devices). EGM loss, EGM noise, EGM missing annotation and telemetry connection loss were detected in 1/8 (12,5%), 6/8 (75%), 2/8 (25%) and 2/8 (25%) respectively. No interferences were seen by placing the iPhone on the ipsilateral ear.

Conclusion

The use of iPhone 12 showed interferences on CIEDs from different manufacturers. No back-up or magnet mode was detected. However, these preliminary data indicate, that placement of iPhone 12 in close proximity to the device should be avoided and as already recommended by Apple, smartphone should not be placed less than 15 centimetres to the CIED.

Table 1: Characteristics of iPhone induced interferences

y=yes; n=no; SM= standby mode; CM=connecting mode; CR= call receiving; NFC = near field communication; RV= right ventricle; RA= right atrium