Wireless Sensor Network, 2010, 2, 206-207
doi:10.4236/wsn.2010.23027 Published Online March 2010 (http://www.scirp.org/journal/wsn)
Cardiac Pacemaker and Wireless Capsule Endoscopy
Interference: Case Report in a Patient with Gastric
Vascular Ectasias
A. G. Gravina1, R. Bozzi2, I. J. Romano3, E. Pezzullo3, A. Miranda1, M. G. Merola1,
M. Romano1, A. Pezzullo1
1Dipartimento Medico Chirurgico di Internistica Clinica e Sperimentale, Gastroenterologia e C.I.R.A.N.A.D.,
Seconda Università degli Studi di Napoli, Napoli, Italy
2U.O.C. Chirurgia ed Endoscopia Digestiva e, Napoli, Italy
3Cardiologia A.O.R.N. V. Monaldi, Napoli, Italy
Received December 29, 2009; revised January 13, 2010; accepted January 17, 2010
Abstract
Wireless capsule endoscopy is a new endoscopic tool for the diagnosis and management of small bowel dis-
eases. The main indication at present is the evaluation of GI bleeding of obscure origin, Crohn’s disease,
coeliac disease and small bowel tumors. Studies suggest that capsule endoscopy is associated with few ad-
verse events. Whether cardiac pacemaker may interfere with capsule endoscopy is still a controversial issue.
We here report a case showing that there is a possibility of interference between the two procedures, cardiac
pacemaker affecting the proper functioning of capsule endoscopy and that this is related to the distance be-
tween the pacemaker and the recorder.
Keywords: Capsule Endoscopy, Cardiac Pacemaker, Interference, Vascular Ectasias
1. Summary
Wireless capsule endoscopy is a new endoscopic tool for
the diagnosis and management of small bowel diseases.
The main indication at present is the evaluation of GI
bleeding of obscure origin, Crohn’s disease, coeliac dis-
ease and small bowel tumors. Studies suggest that cap-
sule endoscopy is associated with few adverse events.
Whether cardiac pacemaker may interfere with capsule
endoscopy is still a controversial issue. We here report a
case showing that there is a possibility of interference
between the two procedures, cardiac pacemaker affecting
the proper functioning of capsule endoscopy and that this
is related to the distance between the pacemaker and the
recorder.
2. Case Report
A 75 year old man with ischemic cardiopathy with dila-
tative evolution treated with aorto-coronaric bypass,
complicated by cardiac cirrhosis and mild ascites and
renal failure came to our observation because of melena.
He had been implanted a cardiac pacemaker because of a
complete atrioventricular block (pacemaker model
Biotronik-Kalos 05 VVI n/s 36012460 with electrode
Biotronik HL 150, n/s 56756B). Conventional diagnostic
interventions, including upper and lower endoscopy, fai-
led to identify the site of bleeding. An enteroclysis was
performed and resulted normal. The patient underwent a
small bowel study by wireless capsule endoscopy (En-
docapsule Olympus ®). The recorder was positioned ne-
xt to external abdominal sites near the pulse generator
while the electrocardiogram was continuously recorded
and reviewed by a cardiologist, to confirm the absence of
pacing inhibition by the video transmission. During vid-
eocapsule examination, we revealed an interference last-
ing 20 minutes (Figure 1), with complete absence of any
image on the real time viewer. The interference with
videocapsule proper recording was subsequently con-
firmed after downloading on the workstation. In particu-
lar, we found this interference only when the recorder
was positioned near the cardiac pacemaker while no in-
terferences were found when the recorder was positioned
at a distance from the pacemaker. The patient had con-
tinuous cardiac monitoring for the duration of the proce-
dure and no arrhythmias or other adverse cardiac events

A. G. Gravina ET AL.207
were noted during videocapsule endoscopy. Wireless
capsule endoscopy revealed the presence of two vascular
lesions in the gastric antrum (Figure 2), suggestive for
gastric vascular ectasias. This was confirmed by an
EGDS, performed on the same day (Figure 3).
3. Discussions
There is a theorical risk of electromagnetic interference
between the UHF digital radiofrequency of the wireless
videocapsule (433.8 MHz), and mobile phones, im-
planted cardiac pacemaker or defibrillator devices.
However, interference between wireless capsule endo-
scopy and cardiac pacemaker has been observed only in
one case [1], but has not been confirmed by others [2–5].
Figure 1. Workstation screen showing significant interfer-
ence in the capsule recording.
Figure 2. Wireless videocapsule imaging of the stomach
showing two gastric lesions suggestive of vascular ectasias.
Figure 3. Esophagogastroduodenoscopy showing two vas-
cular ectasias in the gastric antrum.
In our case, which is the first described using Endocap-
sule Olympus ®, we show that cardiac pacemaker may
interfere with videocapsule proper functioning leading in
our case to a “blank” period of approximately 20 minutes
and this depends upon the distance between the recorder
and the cardiac pacemaker. In particular no interferences
were observed when a distance of about 20 cm between
the two devices was maintained. Also, we confirm that
wireless capsule endoscopy does not interfere with the
correct function of cardiac pacemaker as assessed by
continuous cardiac monitoring of the patient. Interest-
ingly, wireless capsule endoscopy helped identify the
gastric source of the bleeding then confirmed by a sub-
sequent EGDS.
4. References
[1] Y. Guyomar, L. Vandeville, S. Heuls, et al., “Interference
between pacemaker and video capsule endoscopy,” Pac-
ing and Clinical Electrophysiology, Vol. 27, pp. 1329–
1330, 2004.
[2] J. A. Leighton, V. K. Sharma, K. Srivathsan, et al.,
“Safety of capsule endoscopy in patients with pacemak-
ers,” Gastrointestinal Endoscopy, Vol. 59, pp. 567, 2004.
[3] G. Payeras, J. Piquersas, V. J. Morena, et al., “Effects of
capsule endoscopy on cardiac pacemakers,” Endoscopy,
Vol. 37, pp. 1181–1185, 2005.
[4] M. H. Dirks, F. Costea, and E. G. Seidman, “Successful
videocapsule endoscopy in patients with an abdominal
cardiac pacemaker,” Endoscopy, Vol. 40, pp. 73–75,
2008.
[5] D. Bandorski, W. Irnich, M. Bruck, et al., “Capsule en-
doscopy and cardiac pacemaker: Investigation for possi-
ble interference,” Endoscopy, Vol. 40, pp. 36–39, 2008.