Active implantable medical devices -- Electromagnetic compatibility -- EMC test protocols for implantable cardiac pacemakers, implantable cardioverter defibrillators and cardiac resynchronization devices

This document specifies test methodologies for the evaluation of the electromagnetic compatibility (EMC) of active implantable cardiovascular devices that provide one or more therapies for bradycardia, tachycardia and cardiac resynchronization in conjunction with transvenous lead systems. NOTE This document was designed for pulse generators used with endocardial leads or epicardial leads. At the time of this edition, the authors recognized the emergence of technologies that do not use endocardial leads or epicardial leads for which adaptations of this part will be required. Such adaptations are left to the discretion of manufacturers incorporating these technologies. It specifies performance limits of these devices, which are subject to interactions with EM emitters operating across the EM spectrum in the two following ranges: — 0 Hz ≤ ? — 385 MHz ≤ ? ≤ 3 000 MHz This document also specifies requirements for the protection of these devices from EM fields encountered in a therapeutic environment and defines their required accompanying documentation, providing manufacturers of EM emitters with information about their expected level of immunity.

Dispositifs médicaux implantables actifs -- Compatibilité électromagnétique -- Protocoles d'essai EMC pour pacemakers cardiaques implantables, défibrillateurs implantables et dispositifs de resynchronisation cardiaque

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Status
Published
Publication Date
02-Sep-2019
Current Stage
6060 - International Standard published
Start Date
05-Jun-2019
Completion Date
03-Sep-2019
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ISO 14117:2019 - Active implantable medical devices -- Electromagnetic compatibility -- EMC test protocols for implantable cardiac pacemakers, implantable cardioverter defibrillators and cardiac resynchronization devices
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INTERNATIONAL ISO
STANDARD 14117
Second edition
2019-09
Active implantable medical devices —
Electromagnetic compatibility —
EMC test protocols for implantable
cardiac pacemakers, implantable
cardioverter defibrillators and cardiac
resynchronization devices
Dispositifs médicaux implantables actifs — Compatibilité
électromagnétique — Protocoles d'essai EMC pour pacemakers
cardiaques implantables, défibrillateurs implantables et dispositifs de
resynchronisation cardiaque
Reference number
ISO 14117:2019(E)
ISO 2019
---------------------- Page: 1 ----------------------
ISO 14117:2019(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2019

All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may

be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting

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Published in Switzerland
ii © ISO 2019 – All rights reserved
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ISO 14117:2019(E)
Contents Page

Foreword ..........................................................................................................................................................................................................................................v

Introduction ................................................................................................................................................................................................................................vi

1 Scope ................................................................................................................................................................................................................................. 1

2 Normative references ...................................................................................................................................................................................... 1

3 Terms, definitions, symbols and abbreviated terms ....................................................................................................... 1

3.1 Terms and definitions ....................................................................................................................................................................... 1

3.2 Acronyms and abbreviations ...................................................................................................................................................... 3

4 Test requirements for the frequency band 0 Hz ≤ ƒ ≤ 3 000 MHz ....................................................................... 4

4.1 General requirements for all devices ................................................................................................................................... 4

4.2 Induced lead current .......................................................................................................................................................................... 5

4.2.1 General requirements .................................................................................................................................................. 5

4.2.2 Pacemakers and CRT-P devices ......................................................................................................................... 5

4.2.3 ICDs and CRT-D devices ............................................................................................................................................. 9

4.3 Protection from persisting malfunction attributable to ambient electromagnetic fields ...12

4.3.1 General requirements ...............................................................................................................................................12

4.3.2 Pacemaker and CRT-P devices .........................................................................................................................12

4.3.3 ICDs and CRT-D devices ..........................................................................................................................................17

4.4 Protection from malfunction caused by temporary exposure to CW sources ...............................23

4.4.1 Pacemaker and CRT-P device' response to temporary continuous wave

sources in the frequency range 16,6 Hz to 167 kHz .......................................................................23

4.4.2 ICDs and CRT-D devices ..........................................................................................................................................25

4.5 Protection from sensing EMI as cardiac signals ......................................................................................................26

4.5.1 General requirements ...............................................................................................................................................26

4.5.2 Protection from sensing EMI as cardiac signals in the frequency range of

16,6 Hz to 150 kHz ......................................................................................................................................................27

4.5.3 Protection from sensing EMI as cardiac signals in the frequency range of

150 kHz to 10 MHz ......................................................................................................................................................30

4.5.4 Protection from sensing EMI as cardiac signals in the frequency range of

10 MHz to 385 MHz ....................................................................................................................................................33

4.6 Protection from static magnetic fields of flux density up to 1 mT...........................................................35

4.6.1 General requirements ...............................................................................................................................................35

4.6.2 Pacemakers and CRT-P devices ......................................................................................................................35

4.6.3 ICDs and CRT-D devices ..........................................................................................................................................36

4.7 Protection from static magnetic fields of flux density up to 50 mT .......................................................37

4.7.1 General requirements ...............................................................................................................................................37

4.7.2 Pacemakers and CRT-P devices ......................................................................................................................37

4.7.3 ICDs and CRT-D devices ..........................................................................................................................................37

4.8 Protection from AC magnetic field exposure in the range of 1 kHz to 140 kHz ...........................37

4.8.1 General requirements ...............................................................................................................................................37

4.8.2 Pacemakers and CRT-P devices ......................................................................................................................37

4.8.3 ICDs and CRT-D devices ..........................................................................................................................................38

4.9 Test requirements for the frequency range of 385 MHz ≤ ƒ ≤ 3 000 MHz .........................................38

4.9.1 General requirements ...............................................................................................................................................38

4.9.2 Test setup ............................................................................................................................................................................39

4.9.3 Test procedure ................................................................................................................................................................40

4.9.4 Performance criteria .................................................................................................................................................42

4.10 Transient exposure to stationary low-frequency electromagnetic field sources in

the frequency range 16,6 Hz to 167 kHz .......................................................................................................................43

5 Testing above frequency of 3 000 MHz .......................................................................................................................................43

6 Protection of devices from EM fields encountered in a therapeutic environment .......................43

6.1 Protection of the device from damage caused by high-frequency surgical exposure ............43

6.1.1 General requirements ...............................................................................................................................................43

© ISO 2019 – All rights reserved iii
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ISO 14117:2019(E)

6.1.2 Pacemakers and CRT-P devices ......................................................................................................................44

6.1.3 ICDs and CRT-D devices ..........................................................................................................................................44

6.2 Protection of the device from damage caused by external defibrillators .........................................45

6.2.1 General requirements ...............................................................................................................................................45

6.2.2 Pacemakers and CRT-P devices ......................................................................................................................45

6.2.3 ICDs and CRT-D devices ..........................................................................................................................................48

7 Additional accompanying documentation ..............................................................................................................................49

7.1 Disclosure of permanently programmable sensitivity settings .................................................................49

7.2 Descriptions of reversion modes..........................................................................................................................................49

7.3 Known potential hazardous behaviour ..........................................................................................................................49

7.4 Minimum separation distance from hand-held transmitters ......................................................................49

Annex A (informative) Rationale ...........................................................................................................................................................................50

Annex B (informative) Rationale for test frequency ranges .....................................................................................................63

Annex C (informative) Code for describing modes of implantable generators .....................................................64

Annex D (normative) Interface circuits ..........................................................................................................................................................66

Annex E (informative) Selection of capacitor C ....................................................................................................................................71

Annex F (normative) Calibration of the injection network (Figure D.5) ......................................................................74

Annex G (normative) Torso simulator .............................................................................................................................................................76

Annex H (normative) Dipole antennas ............................................................................................................................................................80

Annex I (normative) Pacemaker/ICD programming settings ..................................................................................................82

Annex J (normative) Simulated cardiac signal ........................................................................................................................................84

Annex K (normative) Calculation of net power into dipole antenna ...............................................................................85

Annex L (informative) Loop area calculations.........................................................................................................................................90

Annex M (informative) Correlation between levels of test voltages used in this document

and strengths of radiated fields .........................................................................................................................................................96

Annex N (informative) Connections to DUTs having ports with more than two electrode

connections .........................................................................................................................................................................................................104

Annex O (informative) Example method for evaluation of transient and permanent
malfunction of a CIED due to temporary exposure to low frequency (<167 kHz)

electromagnetic fields .............................................................................................................................................................................127

Bibliography .........................................................................................................................................................................................................................132

iv © ISO 2019 – All rights reserved
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ISO 14117:2019(E)
Foreword

ISO (the International Organization for Standardization) is a worldwide federation of national standards

bodies (ISO member bodies). The work of preparing International Standards is normally carried out

through ISO technical committees. Each member body interested in a subject for which a technical

committee has been established has the right to be represented on that committee. International

organizations, governmental and non-governmental, in liaison with ISO, also take part in the work.

ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of

electrotechnical standardization.

The procedures used to develop this document and those intended for its further maintenance are

described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the

different types of ISO documents should be noted. This document was drafted in accordance with the

editorial rules of the ISO/IEC Directives, Part 2 (see www .iso .org/directives).

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of

any patent rights identified during the development of the document will be in the Introduction and/or

on the ISO list of patent declarations received (see www .iso .org/patents).

Any trade name used in this document is information given for the convenience of users and does not

constitute an endorsement.

For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and

expressions related to conformity assessment, as well as information about ISO's adherence to the

World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT) see www .iso

.org/iso/foreword .html.

This document was prepared by Technical Committee ISO/TC 150, Implants for surgery, Subcommittee

SC 6, Active Implants.

This second edition cancels and replaces the first edition (ISO 14117:2012), which has been technically

revised.
The main changes compared to the previous edition are as follows:
— new definitions added for interference mode and transient exposure;

— the breakpoint between injected voltage testing and radiated testing reduced from 450 MHz to

385 MHz to account for new wireless services;
— modification and clarification of 4.4, temporary exposure to CW sources;

— new 4.10 concerning transient exposure to low-frequency magnetic field sources;

— recognition of multiple electrode leads such as those with IS-4 and DF-4 connectors;

— new 7.4 explicitly requiring separation distance warning when applicable;
— elimination of the table of emitters and frequencies from Annex B;

— addition of new informative Annex N describing generic nomenclature for multi-port, multi-

electrode systems;

— addition of new informative Annex O to provide a sample test method for evaluation of transient

exposure;

— overall language clarifications, corrections to minor use issues from edition 1, and updated

rationale.

Any feedback or questions on this document should be directed to the user’s national standards body. A

complete listing of these bodies can be found at www .iso .org/members .html.
© ISO 2019 – All rights reserved v
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ISO 14117:2019(E)
Introduction

The number and the types of electromagnetic (EM) emitters to which patients with active implantable

cardiovascular devices are exposed in their day-to-day activities have proliferated over the past

two decades. This trend is expected to continue. The interaction between these emitters and active

implantable cardiovascular devices (pacemakers and implantable cardioverter defibrillators, or ICDs)

is an ongoing concern of patients, industry and regulators, given the potential life-sustaining nature

of these devices. The risks associated with such interactions include device inhibition or delivery of

inappropriate therapy that, in the worst case, could result in serious injury or patient death.

In recent years, other active implantable cardiovascular devices have emerged, most notably devices

that perform the function of improving cardiac output by optimizing ventricular synchrony, in addition

to performing pacemaker or ICD functions.

Although these devices can deliver an additional therapy with respect to pacemakers and ICD devices,

most of their requirements concerning EM compatibility are similar so that, in most cases, the concepts

that apply to pacemakers also apply to CRT-P devices, and the appropriate way to test a CRT-P device is

similar to the way pacemakers are tested. Similarly, the concepts that apply to ICD devices mostly apply

to CRT-D devices as well, so the appropriate way to test a CRT-D device is similar to the way ICD devices

are tested.

Standard test methodologies allow manufacturers to evaluate the EM compatibility performance

of a product and demonstrate that the product achieves an appropriate level of EM compatibility in

uncontrolled EM environments that patients might encounter.

It is important that manufacturers of transmitters and any other equipment that produces EM fields

(intentional or unintentional) understand that such equipment can interfere with the proper operation

of active implantable cardiovascular devices.

It is important to understand that these interactions can occur despite the conformance of the device

to this document and the conformance of emitters to the relevant human exposure safety standards

and pertinent regulatory emission requirements, e.g. those of the U.S. Federal Communications

Commission (FCC).

Compliance with biological safety guidelines does not necessarily guarantee EM compatibility with

active implantable cardiovascular devices. In some cases, the reasonably achievable EM immunity

performance for these devices falls below these biological safety limits.

See Annex M for rationale concerning the use of ICNIRP 1998 levels. See Annex M for rationale applicable

to emitters above 10 MHz.

The potential for emitter equipment to interfere with active implantable cardiovascular devices is

complex and depends on the following factors:
— frequency content of the emitter,
— modulation format,
— power of the signal,
— proximity to the patient,
— coupling factors, and
— duration of exposure.

An emitter with a fundamental carrier frequency up to 1 kHz has the potential to be sensed directly

by the pacemaker or ICD. Also, higher-frequency carriers that have baseband modulation rates below

500 Hz and that have sufficient proximity and power might be sensed by the pacemaker or ICD.

Additional details regarding this issue can be found in Annex M.
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ISO 14117:2019(E)

This document addresses the EM compatibility of pacemakers and ICDs up to 3 000 MHz and is divided

in several subclauses.
a) 0 Hz ≤ ƒ < 385 MHz

In the lower-frequency bands (<385 MHz), there are many EM emitters, such as broadcast radio

and television, and a number of new technologies or novel applications of established technologies

that can increase the likelihood of interaction between the emitters and patients’ pacemakers and

ICDs. A few examples:
— electronic article surveillance (EAS) systems;
— access control systems (radio-frequency identification, or RFID);

— new wireless services in the ultra-high-frequency and very-high-frequency bands;

— magnetic levitation rail systems;

— radio-frequency (RF) medical procedures, such as high-frequency surgery and ablation therapy;

— metal detectors;
— magnetic resonance imaging;
— experimental use of transponders for traffic control;
— wireless charging systems for electric or hybrid vehicles.
b) 385 MHz ≤ ƒ < 3 000 MHz

These are the frequencies, ƒ, that are typically associated with personal hand-held communication

devices (e.g. wireless telephones and two-way radios).

Two decades ago, relatively few pacemaker patients used hand-held transmitters or were

exposed to EM fields from portable transmitters. Hand-held, frequency-modulated transceivers

for business, public safety, and amateur radio communications represented the predominant

applications. However, the environment has changed rapidly during the past 15 years, with

wireless phone systems becoming increasingly common as this technology matured and received

widespread public acceptance. Thus, it is becoming increasingly likely that a large portion of the

pacemaker and ICD patient population will be exposed to EM fields from portable wireless phone

transmitters operated either by themselves or by others. Also, it should be expected that the

wireless technology revolution will continue to evolve new applications using increasingly higher

microwave frequencies.

Most electronic equipment, including external medical devices, has been designed for compatibility

with relatively low-amplitude EM conditions. Recognizing the wide range of EM environments

that patients could encounter, implantable devices have been designed to tolerate much higher-

amplitude EM conditions than most other electronic products. However, in some instances,

even this enhanced immunity is not sufficient to achieve compatibility with the complex electric

and magnetic fields generated by low-power emitters located within a few centimetres of the

implantable device. Studies in the mid-1990s demonstrated that some models of pacemakers and

ICDs had insufficient immunity to allow unrestricted use when in close proximity to some hand-

held emitters (e.g. wireless telephones and two-way radios). Although operating restrictions can

help prevent EM interaction with implantable devices, this approach is not viewed as an optimum

long-term solution. Rather, improved EM compatibility is the preferred method for meeting patient

expectations for using wireless services with minimal operating restrictions.

Some technological factors are contributing to the expanding variety of emitters to which patients

might now be exposed:
— smaller wireless phones;
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ISO 14117:2019(E)
— the introduction of digital technology;
— peak transmitter power.

Wireless phone size has now been reduced sufficiently so that it is possible for patients to carry

a phone that is communicating or in standby mode in a breast pocket immediately adjacent to a

pectorally implanted device.

The various wireless phone standards allow for a range of power levels and modulation schemes.

Most digital wireless phones are capable of producing greater peak transmitted power than analog

phones are capable of producing. Those factors contribute to greater potential interactions with

pacemakers and ICDs.

For frequencies of 385 MHz ≤ ƒ ≤ 3 000 MHz, this document specifies testing at 120 mW net power

into a dipole antenna to simulate a hand-held wireless transmitter 15 cm from the implant. An

optional characterization test is described that uses higher power levels to simulate a hand-held

wireless transmitter placed much closer to the implant.
c) ƒ ≥ 3 000 MHz

This document does not require testing of devices above 3 GHz. The upper-frequency limit chosen

for this document reflects consideration of the following factors:
— the types of radiators of frequencies above 3 GHz;

— the increased device protection afforded by the attenuation of the enclosure and body tissue at

microwave frequencies;

— the expected performance of EMI control features that typically are implemented to meet the

lower-frequency requirements of this document ; and
— the reduced sensitivity of circuits at microwave frequencies.
Additional details can be found in Clause 5.

In conclusion, it is reasonable to expect that patients with pacemakers and ICDs will be exposed

to increasingly complex EM environments. Also, the rapid evolution of new technologies and their

acceptance by patients will lead to growing expectations for unrestricted use. In view of the changing

EM environment and customer expectations, manufacturers will need to evaluate their product designs

to assess compatibility with the complex fields, broad range of frequencies, and variety of modulation

schemes associated with existing and future applications.

Annex A provides the rationale for certain provisions of this document in order to provide useful

background information for reviewing, applying, and revising this document. This rationale is directed

toward individuals who are familiar with the subject of this document but have not participated in its

drafting. Remarks made in this annex apply to the relevant clause, subclause, or annex in this document;

the numbering therefore, might not be consecutive.
viii © ISO 2019 – All rights reserved
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INTERNATIONAL STANDARD ISO 14117:2019(E)
Active implantable medical devices — Electromagnetic
compatibility — EMC test protocols for implantable cardiac
pacemakers, implantable cardioverter defibrillators and
cardiac resynchronization devices
1 Scope

This document specifies test methodologies for the evaluation of the electromagnetic compatibility

(EMC) of active implantable cardiovascular devices that provide one or more therapies for bradycardia,

tachycardia and cardiac resynchronization in conjunction with transvenous lead systems.

NOTE This document was designed for pulse generators used with endocardial leads or epicardial leads. At

the time of this edition, the authors recognized the emergence of technologies that do not use endocardial leads

or epicardial leads for which adaptations of this part will be required. Such adaptations are left to the discretion

of manufacturers incorporating these technologies.

It specifies performance limits of these devices, which are subject to interactions with EM emitters

operating across the EM spectrum in the two following ranges:
— 0 Hz ≤ ƒ < 385 MHz;
— 385 MHz ≤ ƒ ≤ 3 000 MHz

This document also specifies requirements for the protection of these devices from EM fields

encountered in a therapeutic environment and defines their required accompanying documentation,

providing manufacturers of EM emitters with information about their expected level of immunity.

2 Normative references

The following documents are referred to in the text in such a way that some or all of their content

constitutes requirements of this document. For dated references, only the edition cited applies. For

undated references, the latest edition of the referenced document (including any amendments) applies.

ISO 14708-1:2014, Implants for surgery — Active implantable medical devices — Part 1: General

requirements for safety, marking and for information to be provided by the manufacturer

ISO 14708-2:2019, Implants for surgery — Active implantable medical devices — Part 2: Cardiac

pacemakers

ISO 14708-6:2019, Implants for surgery — Active implantable medical devices — Part 6: Particular

requirements for active implantable medical devices intended to treat tachyarrhythmia (includin

...

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