Electroacupuncture passes a pulsed electrical current between pairs of needles; transcutaneous electrical nerve stimulation (TENS) and transcutaneous electrical acupoint stimulation pass it between pads on the skin, and Electroacupuncture describes the methods. A pacemaker or an implantable cardioverter-defibrillator (ICD) works by sensing the heart’s own electrical signals. Pulses from a stimulator that reach the device can be read as heartbeats: a pacemaker may then stop pacing, and a defibrillator may deliver a shock the heart did not need. Cardiologists call this electromagnetic interference. The sources on this page report when that has happened, how far the current travels from a pair of needles, and what device makers and regulators say. Brain and spinal stimulators, cochlear implants and metal joint replacements raise different questions and have their own sections.
Pacemakers and defibrillators: the case reports
A report in 1980 by Fujiwara and colleagues, examining a patient during an operation on the neck, found that low-frequency electroacupuncture caused electromagnetic interference with a demand pacemaker, one that paces only when it senses no heartbeat of the heart’s own. In 2005 cardiologists in Ottawa reported a 72-year-old man with an ICD who had needles inserted into the front of the chest with current passed through them. The device recorded short bursts of interference, read them as a dangerous heart rhythm and shocked him twice in quick succession; the acupuncturist did not know the first shock had happened and continued. In 2007 Graf and Pruvot described a man whose ICD recorded 10 Hz discharges and delivered a shock while he tried out an electroacupuncture device with two metal wands, at his physiotherapist’s request; the device’s own labelling warned against use with an ICD or pacemaker. A 2020 systematic review of 37 case reports and case series of adverse events after electroacupuncture names ICD shocks and cardiac emergencies among the events specific to the electrical stimulation.
Two reports describe the opposite outcome. A 2011 case report from Greece describes a 50-year-old woman with a pacemaker who had many courses of electroacupuncture for low back pain over two years without complications. In a 2026 pilot study at a tertiary hospital, 11 patients with dual-chamber pacemakers had current passed between three pairs of needles placed so that the current crossed the device, starting at 1.6 mA and raised towards 16 mA as tolerated, with the pacemaker, the heart’s rhythm and blood pressure monitored throughout; the authors found no interference and no inappropriate response from any pacemaker, and call for larger studies.
What measurement studies found
| Study | Who and what | Finding |
|---|---|---|
| Chen and colleagues, Chicago, 1990 | 2 pacemaker patients using TENS for chronic pain | A standard ECG during the TENS trial showed nothing; 24-hour Holter monitoring showed interference with the pacemaker in both, which stopped after the pacemakers’ sensitivity was reprogrammed |
| Holmgren and colleagues, 2008 | 30 ICD patients, TENS at the level of the nipples and of the hips | Interference in 16 patients; the ICD read it as a dangerous ventricular rhythm in 8 (27%) and as extra beats in 14 (47%) |
| Badger and colleagues, Salisbury, 2017 | Systematic review of 18 papers on electrical stimulation in people with pacemakers or ICDs | The risk could not be estimated; people stimulated in the lower limb were less susceptible to interference |
The authors draw different conclusions. Chen and colleagues write that people with pacemakers should not be excluded from TENS, but should have extended heart monitoring. Holmgren and colleagues do not recommend TENS for anyone with an ICD, because interference could both trigger shocks that are not needed and stop the device delivering one that is. Badger and colleagues advise caution until a large study can estimate the risk; two of the three authors hold shares in a company that makes stimulation devices.
Current across the chest
In 2008 Thompson and Cummings recorded the paths of electroacupuncture currents on their own bodies with an oscilloscope. With the two needles in nearby points on one limb, they detected little or no current spreading along the limb or into the chest, and pairs below the knee or elbow produced no detectable current in the chest. With one needle in each arm, the current recorded over the chest muscles was of an order that, in their words, might trigger an abnormal rhythm in a susceptible heart or activate an ICD. They write that their results confirm the British Medical Acupuncture Society’s guideline that electroacupuncture should not be applied so that the current is likely to cross the heart. The WHO’s 1999 Guidelines on basic training and safety in acupuncture go further and list a pacemaker as a contraindication to electrical stimulation, together with pregnancy, loss of skin sensation, poor circulation, severe arterial disease, undiagnosed fever and severe skin lesions.
Needling the chest carries the separate risk of a needle reaching the lung or the heart, which Needling over the chest covers.
What device makers say
Medtronic, a maker of pacemakers and ICDs, rates procedures for its heart-device patients in an electromagnetic compatibility guide. It rates acupuncture with no electrical stimulus as acceptable, meaning no known risk when the equipment is used as intended. It rates acupuncture with an alternating-current stimulus, TENS, neuromuscular electrical stimulation and other devices that send current into the body as acceptable with precautions, meaning the patient should tell the treating practitioner about the device or consult the heart clinic. Diathermy, high-frequency heating of tissue, is not recommended. The company’s patient answer on acupuncture says acupuncture is no problem as long as it has no electrical stimulus, which a device could detect, and that the patient should tell the acupuncturist about the device. A 2024 Medtronic technical letter on TENS, covering several of its pacemaker models, does not recommend TENS for use at home because of the risk of oversensing, inappropriate therapy and inhibited or disturbed pacing, and asks clinicians who judge TENS necessary to contact the company.
Brain and spinal stimulators and cochlear implants
The warnings for implants with leads in the brain, the spine or the inner ear concern diathermy, not acupuncture. In 2001 Nutt and colleagues in Portland reported that pulsed radiofrequency diathermy to the upper jaw of a patient with deep brain stimulation electrodes for Parkinson’s disease caused permanent damage in the brain and brainstem and left the patient in a vegetative state. The US Food and Drug Administration’s 2002 public health notification reported two patients with deep brain stimulators who died after diathermy, and warned that shortwave and microwave diathermy can injure anyone with an implanted metal lead, even when the device is switched off. It named cardiac pacemakers and defibrillators, cochlear implants, bone growth stimulators, deep brain stimulators and spinal cord stimulators among the systems at risk.
Medtronic’s safety information for deep brain stimulation lists diathermy as contraindicated and warns that sources of electromagnetic interference may damage the device or injure the patient; it does not mention TENS or acupuncture. Cochlear’s 2013 warnings for its CI500 implants say not to use neurostimulation directly over the implant, because high currents induced in the electrode lead can damage the cochlea, the brainstem or the implant. The searches behind this page found no published case of electroacupuncture or TENS in a person with a brain stimulator, a spinal cord stimulator or a cochlear implant.
Joint replacements and other metal implants
The reports about metal implants concern infection, not current. A 2026 case report from Japan describes an 81-year-old woman who noticed redness and warmth over her hip several days after acupuncture, four years after a hip replacement; she developed an infection around the implant that needed surgical cleaning and continuous local antibiotics, and the authors advise that patients with artificial joints be told about the risk of infection from acupuncture. In a 2010 case from Japan, permanent acupuncture needles left in a knee joint were associated with an infection of a later knee replacement, which had to be revised. A 2020 report from North Carolina describes a knee replacement infected shortly after dry needling around the knee, and its authors advocate avoiding needle-based therapies around the knee after a knee replacement. Infection after needling generally is on Infection and clean needles. None of the sources found addresses passing current near a metal plate or joint replacement.
What the sources cannot tell you
The evidence on cardiac devices is a few case reports, two small measurement studies of TENS, one review that could not estimate the risk and one pilot study of 11 patients; none tells you how often electroacupuncture interferes with a given pacemaker or ICD. Chen’s two patients stopped showing interference once their pacemakers were reprogrammed, and Medtronic’s TENS letter applies only to the models it names, so a finding for one device and setting may not hold for another. The case reports seldom give the stimulator settings, and the 2020 review notes that the conditions behind electroacupuncture-specific adverse events cannot be identified because reporting is poor. AcuiQ records the modality a study used, electroacupuncture included, but not the stimulation settings or whether participants had an implanted device; What AcuiQ does not do sets out that limit.