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Abstract

Tasers are electroshock weapons used for incapacitating aggressive persons by disrupting superficial muscle functions through administering electric shocks. The number of taser users and also taser related deaths are increasing every year. Taser effects on humans vary a lot depending on taser associated factors (voltage, wave-length, firing distance, type of use - contact or from the distance) but also on human variability (skin thickness, salinity, associated pathology, etc). A single discharge usually is not usually associated with severe adverse reactions or death, but these can happen in various risk groups (pregnant women, elderly, small children). This review presents the spectra of clinical signs and symptoms associated with taser use and a synthesys of the suggested protocoles for the management of forensic cases.
Rom J Leg Med 16 (3) 187 - 193 (2008)
© 2008 Romanian Society of Legal Medicine
________________________
*) Corresponding author: Professor, MD, PhD, National Institute of Legal Medicine “Mina
Minovici”, Sos. Vitan Birzesti 9, Sector 4, 042122 Bucharest, e-mail: journal@legmed.ro
187
Electroshock weapons: physiologic and pathologic effects -
literature review
Dan Dermengiu*, Sorin Hostiuc, George Cristian Curcă
Received: 17 April 2008 / Accepted: 1 August 2008
_____________________________________________________________________
Abstract: Tasers are electroshock weapons used for incapacitating aggressive persons by disrupting
superficial muscle functions through administering electric shocks. The number of taser users and also taser
related deaths are increasing every year. Taser effects on humans vary a lot depending on taser associated factors
(voltage, wave-length, firing distance, type of use - contact or from the distance) but also on human variability
(skin thickness, salinity, associated pathology, etc). A single discharge usually is not usually associated with
severe adverse reactions or death, but these can happen in various risk groups (pregnant women, elderly, small
children). This review presents the spectra of clinical signs and symptoms associated with taser use and a
synthesys of the suggested protocoles for the management of forensic cases.
Key words: electroshock weapons, taser related death, physiologic effects, risk groups
aser ®, a registered Taser Inc. Trademark [1], is a type of electroshock weapon that
is using thin, flexible, metallic wires to conduct the needed energy (CED –
conductive energy device). An electroshock weapon is a type of incapacitated weapon used
for subduing a person by disrupting superficial muscle functions through administering
electric shocks. Other electroshock weapons such as stun guns, stun batons, and electroshock
belts administer an electric shock by direct contact.
The number of electroshock weapons is growing exponentially nowadays because
there is an increasing need of nonlethal weapons for crowd control. In 2005 it was estimated a
number of 260.000 electroshock weapon users in USA only. Between 2003 and 2005 there
are 1095 arrest associated deaths. Between 1999 and 2005 there have been described 167
taser associated deaths in US and Canada only according to www.raidh.org [2,3,4]
Taser classification
1st generation (1970’s): TF-76 had an action ray of about 5 meters; they were
shooting two darts, connected to the device with metallic wires; propulsion was
realized by using gun powder, being for that included in the firearms category.
T
Dermengiu Dan et al Electroshock weapons: physiologic and pathologic effects
188
2nd generation (1994): TASER 34000 used compressed air instead of gunpowder as
propellant, not being included for this reason in the firearms category; they had
implemented a new technology called AFID (Anti Felon IDentification) which used
serialized confetti tags dispersed from every cartridge for misuse identification. The
biggest problem of this device to be solved in future generations was its low
efficiency on people with high pain tolerance.
3rd generation (1999): ADVANCED TASER M26 was the first one to inflict electro-
muscular disruption - EMD - in order to incapacitate event the most pain resistant
people. EMD technology paralyzes the skeletal muscular system for a limited,
controlled by the user, period of time. The only affected structure is the skeletal
muscular system; there is no loss of consciousness and no internal organ involvement.
In addition to the AFID system, they’ve implemented a new control technology - the
dataport which is recording the time and date of every trigger pull in order to better
monitor the use of this device. This weapon can be used in two ways – with or
without a launching device. If it hasn’t the launching device installed it can only be
used in direct contact. If a launching device is present the weapon is sending two
metallic darts, connectd to the device by thin metallic wires. The darts, in contact
with the skin or conductive clothes will immediately discharges an electron beam to
paralyse the agressor in less than one second.
4th generation (2004): TASER X26 – is uses a new technology called „Shaped-
Pulse” which allows it to be more efficient but also smaller and lighter by up to 60%.
Prototypes
There are currently in various stages of development a few new electroshock weapon
technologies like:
XREP (eXtended Range Electro-muscular Projectile) – a wireless weapon with a
range of up to 100m.
Electrified water cannon - are using streams of fluid instead of metallic wires.
Plasma taser (Rheinmetall W&M) uses an aerosol as the conductive medium.
Electrolaser - uses blooming of a laser beam to create a conductive channel of ionized
air (plasma) to carry the electric shock.
Mode of action
Tasers have two dart-like electrods (metallic probes) which are remaining attached to
the main unit by metallic wires; nowadays the propulsion is made with compressed nitrogen;
the cartrigde contains compressed nitrogen and electrods, replaceable after each use. There
are more cartridge types, classified by their range: for law inforcement agents the maximum
range is set to 10,6 m and for civilian use to 4,5 m. The electrods are able to penetrate clothes
(4th generation tasers are even able to penetrate trough a level three bulletproof vest).
Maximum effect areas for taser guns are: the upper shoulder, lower toracic cage,
superior thigh. In order to overcome the human body resistance tasers are using a low
intensity but high voltage electric current. Usually a higher voltage means an increased risk
for adverse reactions. The internal circuitry of a taser is composed of an oscillator, a resonant
circuit, and an step-up transformer or a diode-capacitor voltage multiplier to achieve the
continuous, direct, or alternating high-voltage discharge. The needed power is given by one
or more batteries. The output voltage without external load, aka the target's body) is claimed
to about 50 to 1000 kV, but most common values tend to be in the 200 to 300 kV range,
depending on various skin type, salinity target's resistance, moisture, clothing, the
Romanian Journal of Legal Medicine Vol. XVI, nr. 3, 2008
189
electroshock weapon's internal circuitry, or battery [3]. The energy released by a single pulse
is of about 0,8 J; from the contact point the energy travels inside the body throught minimum
energy conducts (usually neuromuscular packages).
Taser effects
Effects depending on the exposure time:
0.5 sec – retropulsion;
1 – 2 sec – generalized skeletal muscle tetany
3 – 5 sec – the affected person is incapacitated for about 15 min; after that will have
muscular rigidity and muscle pain.
Effects on different organs and systems:
1. Cutaneous. Frecvently the electrod darts are making paired, dot-like lesions; surrounding
them (or, if the dot-like lesions are not present instead of them) are noticeable 0,5–1 cm
erythematous areas [1] sometimes papulous [3] distanced about 5 cm; in time these
erytematous areas are becoming pale and then aquiring the surrounding skin colour.
Sometimes in contact areas may be noticeable first and second degree burns; the
histological examination reveals in these cases electrical mark-like lesions. SEM (Scanning
Electron Microscopy) and EDS (Energy Dispersive X-Ray Spectrometer) examinations are
showing in contact areas metallic deposits; their quantity gives informations about the
shooting distance and discharge time and their composition hints the type of weapon [7].
2. Ocular. Hitting the eyeball with taser darts may result in scleral wounds or cataract [8].
3. Musculoskeletal system. Taser electrical discharge is able to induce skeletal tetany with
subsequent incapacitation, transient postagresional palsy, muscular pain; taser related
fractures can be determined by:
(1) direct taser dart stroke (it was described a thoracic vertebrae fracture determined
by taser darts [9]) or
(2) fall secondary to muscular incapacitation (there have been described cranial
fractures) [8].
4. Cardiovascular system. In order for a electrical current to induce a ventricular fibrillation
it must be of minimum 0,1A at the ventricular level and must be applied for minimum 0,5 sec.
An electrical current applied on skin must have a much higher intensity that can’t be achieved
by only one taser discharge. An ECG study realized in 2008 on healthy subjects showed that a
0.5 sec discharge is not enough to produce electrical malignant ventricular anomalies [10].
The only noticeable alterations were (1) short PR and QT and increased heart rate for non-
obese subjects and (2) short PR for obese subjects.
These results are similar with ones obtained in 2007 by Holdes SJ who studied the
electromagnetic modelling of current flow in the heart from taser devices (M26 and X26); he
established that, although a current with an intensity 60 times higher than normal can induce
premature ventricular beats when applied during the vulnerable period to the ventricular
epicardial surface of guinea-pig isolated hearts, when applied to the ventricles in trains
designed to mimic the discharge patterns of the TASER devices, neither waveform induced
ventricular fibrillation at peak currents >70-fold (for the M26 waveform) and >240-fold (for
the X26) higher than the modelled current densities [11].
Dermengiu Dan et al Electroshock weapons: physiologic and pathologic effects
190
Studies regarding prolonged duration taser effects were made mostly on animal
models (usually pigs). Dennis AJ studied the effect of prolonged (40 sec) taser discharge on 6
pigs, of which two died from ventricular fibrillation and the rest presented tachycardia,
hipotension, marked acidosis (pH of 6.86 +/- 0,07), increased CO2 (94,5+/-14.8mmHg;
normal values: 45,3 +/- 2.6 mmHg), decreased HCO3- , lactate acidosis (22,1 +/-1,5 mmol/L;
normal values: 1,5+/-0.03 mmol/L). These values returned to normal within 24 hours [12].
The only marker that presented a moderate increase after 24 hours was I troponin.
On humans though a study on 5 sec exposure on healthy subjects showed normal I
troponin after 24 hours (< 0.3 ng /ml) with one exception (> 6 ng /ml) but without other AMI
signs [13].
Another study, realized by Valentino DJ in 2007, analyzed the effects of another type
of electroshock weapon (MK63) on Yucatan pigs – no animal died and all studied biological
markers returned to normal within 24 hours [14].
The differences between these two experiments were considered to be secondary to
different electrical discharge wave-length. Both studies showed that after prolonged taser
discharge there is a metabolic acidosis, fact confirmed on human subjects by Vilke in 2007 –
after a 5 sec discharge on normal subjects he obtained the following results: pH decreased
with 0.03 1/minute after the discharge, HCO3- decreased with 2.8 mmol/L, lactate plasma
value was double (2.8 mmol/L); in 30 minutes the values became normal.
In order to differentiate metabolic acidosis effects from those given by direct
myocardial electrical stimulation Walter PJ (2008) studied the cardiac effect of taser
discharge on pigs paralyzed with succinil-choline. One subject from the study group died by
VF and all the other presented ventricular tachycardia of 1-17 sec; no subject had acidosis
proving the fact that in arrhythmogenesis is also involved a direct, electrical mechanism [15].
Another factor associated with arrhythmogenesis is the localization of the electrical
discharge. Nanthakumar K (2006) studied the effect of 5 and 15 sec discharge exposure, both
thoracic and non-thoracic, both with and without associated adrenergic hyper stimulation; the
results showed that thoracic stimulation often produces myocardial stimulation but non-
thoracic stimulation produces no myocardial stimulation. Associated adrenergic stimulation
produced one VF and one VT [16].
Lakkiriddy D. (2008) also studied the cardiac effects of discharge location showing
that the frequency of VT is higher when the stimuli are applied closer to the heart [17].
Wu JY (2007) showed that the probability of an electrode located in a area of 1 cm2
adjacent to the left ventricle to produce ventricular fibrillation is 0.000172 [18].
5. Respiratory system. After the electric discharge there usually is an increased respiration
rate (from 19 to 29) with a moderate respiratory volume increase from 16 to 29; these values
come back to normal within 10 minutes [14]. There has also been described a hypo pharynx
traumatic lesion made by a taser dart with subsequent subcutaneous emphysema.
6. Metabolic alterations. After the electrical discharge there is a increase in pCO2 , K+,
mioglobin and a plasmatic level decrease of pH, HCO3-, proportionate with the intensity and
duration of the electric discharge [12,14].
7. Psychiatric alterations. Taser use is sometimes associated with and increase of in and
post-aggression stress; it was considered to be an aggravation factor for excited delirium (a
syndrome which associates psychosis, agitation, aggressivity, hyperthermia; sometimes the
subject has an increased mortality risk); it was proven though that taser use stress risk is not
Romanian Journal of Legal Medicine Vol. XVI, nr. 3, 2008
191
higher than the usual combative stress. In many cases of death associated with excited
delirium the cause of death is represented by hyperthermia. There is no evidence to suggest
that taser use is associated with hyperthermia [3,4,1,19,20].
8. Risk groups. Even though in general taser use is safe there are a few population groups to
which this doesn’t apply – small children (several authors reported taser involvement in
battered child syndrome, in utero deaths secondary to taser use, etc), elderly, pregnant
women, people with cardiac diseases, etc. [6,8,19,21,22].
Management of taser exposure
1. Medical examination is not mandatory after all CED exposures. Usually the aggressed
persons do not require an kind of treatment
2. If the darts had penetrated the skin, especially vulnerable areas of the head, face, neck,
genitals, or female breast regions or if the electroshock determined traumatic lesions
(subsequent to a fall, burns, etc) they should be appropriately treated as soon as possible.
3. Psychiatric disorders or any kind of abnormal mental status in a combative or resistive
subject may be associated with a risk for sudden death. This should be treated as a
medical emergency. In these cases, the management includes an assessment of body
temperature, obtaining and retaining blood samples and an electrocardiogram as soon as
possible. Treatment, if needed, consists of cooling, sedation and hydration as soon as
possible. Considering the strong association between drug abuse and aggressiveness, if
possible the subject must be toxicologically screened.
4. Sudden lack of responsiveness may occur at any time and may indicate a medical crisis
especially for persons included in the above mentioned risk groups or those with
psychiatric conditions and they should be provided with appropriate medical care.
5. If the aggressed person is pregnant the baby’s fetal heart rate must be closely monitored
6. Antibiotics should be given if darts had penetrated the skin or if the patient has septic
traumatic wounds. When removing embedded darts, care should be taken to avoid
exposure to blood borne pathogens
7. Darts and clothing removed during medical care should be retained for investigative
purposes and handled as evidence
Management of taser related deaths
If there is evidence that a taser use was associated with a person death the medical-
legal autopsy is compulsory, being a violent death. Even if between 1999 and 2005 there were
167 taser related deaths in US and Canada only, in most cases the coroner couldn’t find a
causal link between taser use/abuse and death, the latter one being frequently associated with
a drug overdose (usually cocaine or methamphetamine) or excited delirium.
The association taser related death – drug abuse might suggest that there might be a
direct causal link between them. Although this association seems plausible, there are
experimental evidences that cocaine increases the level at which VF appears in taser
discharges and also decreases cardiac vulnerability for as much as 200% [17,23,24].
In order for an autopsy to demonstrate a causal link between taser use and death the
coroner and the investigation team must obtain some specific information and also realize
some specific tasks before, during and after the autopsy. The investigation team should
answer and do the following before the autopsy:
1. Finding out if and how the taser was used (witness accounts, police reports, emergency
medical services records, medical and psychiatric records, and any videos, photographs or
digital images of the events.
Dermengiu Dan et al Electroshock weapons: physiologic and pathologic effects
192
2. A timeline of all events with attempts to verify, to the extent possible, the accuracy of the
dates and times of reported events, with specific emphasis on the interval between CED
use, unresponsiveness, and death.
3. The CED was used in drive stun and/or cartridge mode(s)?
4. Taser type (producer, model, waveform, range, etc. (useful for these are the AFID and
dataport systems described above but also the type of residual metallic waste).
5. Darts should not be removed from the decedent’s body or clothing before police
arrival/before autopsy.
6. What were the recent activities of the deceased? What was it’s emotional state?
7. Medical history with emphasis on cardiac events, epilepsy, psychiatric disorders
(especially excited delirium), malnutrition. Very important to know is if the deceased used
psychotropic medication, antiepileptic, or recreational drugs, including alcohol abuse. If
death occurs after arrival at a hospital, is it recommended a toxicological screening. The
investigation of the subject’s place of residence and its recent activities may also provide
information about a possible drug abuse.
8. What was doing the deceased recently before the death? What was his emotional state?
9. Measurement and documentation of body and ambient temperature at the scene and other
locations such as the hospital may provide useful information, especially if excited
delirium is a possible or definite diagnosis.
During the medical-legal autopsy (mandatory) the medical-legal MD should:
1. A complete postmortem toxicological examination is useful (including illicit drugs,
alcohol, psychiatric medication, anti-epileptic drugs, nervous system stimulants, etc)
2. Measurement of the thickness of the anterior chest wall from the skin to the rear of the
pre-pericardial sternum at intercostal space between the left fourth and fifth ribs and also
the thickness of clothing in the area(s) where CED darts or prongs were applied.
3. Documentation of the CED dart’s barb length(s), manufacturer, etc Metallic residues
analysis (if possible by SEM or EDS)
4. Consideration of unusual or atypical current flow paths, such as body to ground, body to
water, body to metal, etc.
5. Determination of the nature of any other forms of subdual or restraint that were employed
in the case in question. Traumatic lesion complete description.
6. A skin histological examination may provide further info regarding skin lesions
determined by the darts.
Conclusions
Even if in Romania alegations of taser abuse are not very frequent and taser related
deaths are exceptional, the forensic MD should be prepared to handle such cases (both in
clinical legal medicine and in the autopsy room/ crime scene).
It is essential to There are specific techniques and proceedings needed to be done in
order In all taser related death cases a drug overdose or excited delirium must be ruled out as
they are the most frequent causes of death associated with taser use before taking into
consideration the hypothesys that taser use contributed or determined the death.
Special check-up list of information must be gathered before the autopsy and a
forensic special procedure should follow the steps suggested in the text.
Romanian Journal of Legal Medicine Vol. XVI, nr. 3, 2008
193
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The TASER is a conducted electrical weapon (CEW) that has been used on people in custody. Individuals occasionally die unexpectedly while in custody, proximal to the application of a CEW. In this study, the authors sought to examine the effects of CEW application in resting adult volunteers to determine if there was evidence of induced electrical dysrhythmia or direct cellular damage that would indicate a causal relationship between application of the device and in-custody death. Human subjects (N = 66) underwent 24-hour monitoring after a standard CEW application. Blood samples were collected before and after exposure and again at 16 and 24 hours after exposure. A subpopulation (n = 32) had 12-lead electrocardiography performed at similar time intervals. Blood samples were analyzed for markers of skeletal and cardiac muscle injury and renal impairment. The electrocardiograms were read by a cardiologist blinded to the study. Data were analyzed using descriptive statistics. There was no significant change from baseline at any of the four time points for serum electrolyte levels and the blood urea nitrogen/creatinine ratio. An increase in serum bicarbonate and creatine kinase levels was noted at 16 and 24 hours. An increase in serum lactate level was noted immediately after exposure that decreased at 16 and 24 hours. Serum myoglobin level was increased from baseline at all three time points. All troponin levels measured were < 0.3 ng/mL, except for a single value of 0.6 ng/mL in a single subject. This subject was evaluated, and no evidence of acute myocardial infarction or disability was identified. At baseline, 30 of 32 electrocardiograms were interpreted as normal. The two abnormal electrocardiograms were abnormal at baseline and remained the same at all four time points. In this resting adult population, the TASER X26 CEW did not affect the recordable cardiac electrical activity within a 24-hour period following a standard five-second application. The authors were unable to detect any induced electrical dysrhythmias or significant direct cardiac cellular damage that may be related to sudden and unexpected death proximal to CEW exposure. Additionally, no evidence of dangerous hyperkalemia or induced acidosis was found. Further study in the area of the in-custody death phenomenon to better understand its causes is recommended.
Article
This study sought to assess cocaine's effects on Taser-induced ventricular fibrillation (VF) threshold in a pig model. Stun guns are increasingly used by law enforcement officials to restrain violent subjects, who are frequently intoxicated with cocaine and other drugs of abuse. The interaction of cocaine and the stun gun on VF induction is unknown. We tested five adult pigs using a custom device built to deliver multiples of standard neuromuscular incapacitating (NMI) discharge that matched the waveform of a commercially available electrical stun gun (Taser X-26, Taser International, Scottsdale, Arizona). The NMI discharges were applied in a step-up and step-down fashion at 5 body locations. End points included determination of maximum safe multiple, minimum VF-inducing multiple, and ventricular fibrillation threshold (VFT) before and after cocaine infusion. Standard NMI discharges (x1) did not cause VF at any of the 5 locations before or after cocaine infusion. The maximum safe multiple, minimum VF-inducing multiple, and VFT of NMI application increased with increasing electrode distance from the heart. There was a 1.5- to 2-fold increase in these values at each position after cocaine infusion, suggesting decreased cardiac vulnerability for VF. Cocaine increased the required strength of NMI discharge that caused 2:1 or 3:1 ventricular capture ratios at all of the positions. No significant changes in creatine kinase-MB and troponin-I were seen. Cocaine increased the VFT of NMI discharges at all dart locations tested and reduced cardiac vulnerability to VF. The application of cocaine increased the safety margin by 50% to 100% above the baseline safety margin.
Article
The purpose of this study was to evaluate the cardiac consequences of neuromuscular incapacitating device (NID)/stun gun discharge in an experimental model. The large-voltage electrical discharges from NIDs have been suggested to pose a risk for triggering cardiac arrhythmias. Intracardiac catheters and blood pressure transducers were inserted before the application of NID discharges in six anesthetized pigs. Two different commercially available models (NID-1 and NID-2), two different vectors of discharges (thoracic: parallel to the long axis of the heart on the chest wall, and nonthoracic: away from the chest, across the abdomen), and two different durations of discharge (5 and 15 s) were tested. The effect of simulated adrenergic stress using epinephrine was also evaluated. We studied a total of 150 discharges to 6 pigs; 74 of these discharges resulted in stimulation of the myocardium, as documented by electrical capture (mean ventricular rate during stimulation and capture, 324 +/- 66 beats/min). Of the 94 thoracic discharges, 74 stimulated the myocardium, compared with none from 56 nonthoracic discharges (p < 0.0001). During 16 discharges with epinephrine, there were 13 episodes of stimulation of the myocardium, of which 1 induced ventricular fibrillation and 1 caused ventricular tachycardia. Thoracic discharges from NID-1 were more likely to stimulate the myocardium than those from NID-2 (98% vs. 54%, p = 0.0007). In an experimental model, NID discharges across the chest can produce cardiac stimulation at high rates. This study suggests that NIDs may have cardiac risks that require further investigation in humans.
Article
Electromuscular incapacitating devices (EMDs), such as Tasers, deliver high current, short duration pulses that cause muscular contractions and temporarily incapacitate the human subject. Some reports suggest that EMDs can kill. To help answer the question, "Can the EMD directly cause ventricular fibrillation (VF)?", ten tests were conducted to measure the dart-to-heart distance that causes VF in anesthetized pigs [mass = 64 kg +/- 6.67 standard deviation (SD)] for the most common X26 Taser. The dart-to-heart distance that caused VF was 17 mm +/- 6.48 (SD) for the first VF event and 13.7 mm +/- 6.79 (SD) for the average of the successive VF events. The result shows that when the stimulation dart is close enough to the heart, X26 Taser current will directly trigger VF in pigs. Echocardiography of erect humans shows skin-to-heart distances from 10 to 57 mm (dart-to-heart distances of 1-48 mm). These results suggest that the probability of a dart on the body landing in 1 cm2 over the ventricle and causing VF is 0.000172.
Article
Little objective laboratory data are available describing the physiologic effects of stun guns or electromuscular incapacitation (EMI) devices, but increasing morbidity and even deaths are associated with their use. We hypothesized that exposure to EMI discharges in a model animal system would induce clinically significant acidosis and cardiac arrhythmia. Ten Yucatan mini-pigs, six experimental and four sham controls, were anesthetized with ketamine, xylazine, and glycopyrrolate. Experimental pigs were exposed to two 40-second discharges from an EMI device over the left thorax. Electrocardiograms, troponin I, blood gases, and lactate levels were obtained pre-exposure, at 5, 15, 30, 60 minutes, and at 24, 48, and 72 hours postdischarge. No acute or delayed cardiac arrhythmias were seen. Heart rate was not affected significantly (p>0.05). A subclinical increase in troponin I was seen at 24 hours postdischarge (0.040+/-0.030 ng/mL, p>0.05). Central venous blood pH (7.432+/-0.014) and pCO2 (36.1+/-0.9 mm Hg) were not changed significantly (p>0.05) during the 60-minute postdischarge period. A moderate significant increase in lactate occurred in the 5-minute postdischarge group (4.9+/-0.3 mmol/L, p=0.0179). All blood chemistry and vital signs were normal at 24, 48, and 72 hours postdischarge. Although significant changes in some parameters were seen, these changes were small and of little clinical significance. Lengthy EMI exposures did not cause extreme acidosis or cardiac arrhythmias. These findings may differ from those seen with other EMI devices because of the unique MK63 waveform characteristics or to specific characteristics of the model systems.