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

Background Bioelectrical impedance analysis (BIA) is widely used to assess body composition. However, its safety in patients with cardiac implantable electronic devices (CIEDs) remains uncertain owing to potential electromagnetic interference (EMI). Objective This study aimed to evaluate potential complications associated with clinical-grade BIA use in patients with CIEDs, based on currently available evidence. Methods We conducted a systematic review of studies published up to December 26, 2024, identified through PubMed, Embase, Scopus, and the Cochrane Library. The primary outcome was the occurrence of adverse events, including EMI, device malfunction, or arrhythmias. Results Of 3668 records, 6 cohort studies (n = 531 patients) met the inclusion criteria. These included patients with pacemakers (n = 175), implantable cardioverter-defibrillators (n = 268), and cardiac resynchronization therapy defibrillators (n = 154). BIA protocols varied in frequency (5–500 kHz) and current intensity (typically ≤0.8 mA). No study reported clinically significant EMI, device malfunctions, or BIA-induced arrhythmias. Device parameters (eg, lead impedance, pacing thresholds) remained stable before and after BIA exposure. Risk of bias was rated as good in 1 study and fair in 5. Conclusion Current evidence suggests that clinical-grade BIA is safe in patients with CIEDs, with no reported adverse effects or device interferences. These findings contribute to informing and potentially updating previous recommendations that discouraged BIA in this population. However, further high-quality studies are needed to confirm safety across different BIA protocols and device types. Importantly, these findings apply to clinical-grade BIA and should not be extrapolated to consumer-grade wearables, which may present a theoretical risk of CIED interference.