Inappropriate ICD shocks induced by TECAR therapy: the first documented case report of electromagnetic interference with electrogram evidence

Background Capacitive–resistive electric transfer (TECAR) therapy is a form of endogenous diathermy delivering radiofrequency current and is increasingly used for musculoskeletal rehabilitation. However, data regarding its safety in patients with cardiac implantable electronic devices (CIEDs) are limited. Case summary A 54-year-old man with a dual-chamber implantable cardioverter-defibrillator (ICD) underwent lumbar TECAR therapy for muscular contracture. During the session, he experienced two inappropriate ICD shocks while remaining conscious and without clinical sequelae. Device interrogation revealed high-frequency, non-physiological signals simultaneously recorded on atrial and ventricular intracardiac electrograms, which were interpreted by the ICD as ventricular fibrillation and resulted in shock delivery. Discussion This report represents the first documented case demonstrating electrogram evidence of electromagnetic interference between TECAR therapy and an ICD. The findings highlight a relevant safety concern and suggest that TECAR therapy should be avoided in ICD carriers and, more broadly, used with extreme caution in patients with other CIEDs, only after careful risk–benefit assessment and discussion with an electrophysiology specialist.