Use of Transcutaneous Electrical Nerve Stimulation for a Patient with a Cardiac Pacemaker

Abstract

Transcutaneous electrical nerve stimulation (TENS), like any other modality, has certain indications and contraindications for its use. Traditionally, TENS has been contraindicated in conjunction with cardiac pacemakers because it is a source of external interference.1 Jones described external interference as a change noted in pacemaker rate, rhythm, output, slope, and decay of the impulse and any disturbances that lead to halting of pacemaker activity.2 External interference affects pacemakers in the following three ways3: 1. Its signal overrides the detection circuit. This applies only to the demand pacemaker. 2. It interferes with the normal circuit functions of the generator, thus affecting the timing cycle. This interference could cause the generator to stop completely. 3. It can completely alter or damage the pacemaker. Two types of pacemakers must be considered—the asynchronous pacemaker and the demand or synchronous pacemaker that is either inhibited or triggered by the QRS-complex.4