Safety of bioelectrical impedance analysis in patients with cardiac implantable electronic devices: A systematic review

BACKGROUND: Bioelectrical impedance analysis is widely used in clinical settings to assess body composition, contributes to the management of various health conditions. However, for patients with cardiac implantable electronic devices, such as pacemakers and implantable cardioverter-defibrillators, concerns about electromagnetic interference have led to longstanding recommendations against using bioelectrical impedance analysis. In this systematic review, we aimed to assess the available evidence regarding the safety of cardiac implantable electronic devices (CIEDs) during bioelectrical impedance analysis procedures. METHODS: Following PRISMA guidelines, we searched PubMed, IEEE Xplore, Embase, and CINAHL for studies reporting on bioelectrical impedance analysis safety in patients with cardiac implantable electronic devices. Inclusion criteria focused on human studies reporting CIED function outcomes during BIA measurements. Data on BIA frequencies, types of CIEDs and BIA, and observed electromagnetic interference effects were extracted. The quality and bias of the studies were assessed using the Oxford Levels of Evidence and ROBINS-I tools. RESULTS: Out of 2003 records screened, 8 studies were included, encompassing 866 BIA measurements across frequencies ranging from 5 to 500 kHz. No studies reported electromagnetic interference or adverse events affecting CIED functionality. CONCLUSION: No evidence of electromagnetic interference or adverse effects on CIED function was identified in the available studies evaluating BIA in patients with CIEDs. These findings support reconsideration of clinical recommendations that discourage BIA use in this population.