Which of the following is an absolute contraindication to NMES?

• A. History of knee osteoarthritis.
• B. Presence of a cardiac pacemaker or implanted cardiac device.
• C. Mild sunburn on the treatment area.
• D. Recent dental infection.

Answer: (B)

The key idea is safety around implanted cardiac devices. NMES works by delivering electrical currents to provoke muscle contractions, and these currents can interfere with pacemakers or implanted cardiac devices. Such interference can disrupt sensing or pacing, potentially causing inappropriate pacing, inhibition, or other dangerous device malfunction. Because of this risk, having a cardiac pacemaker or implanted cardiac device is an absolute contraindication to NMES. When a patient has an implanted device, clinicians consult device guidelines and the patient’s cardiologist before considering any electrical stimulation.

Other options don’t present the same level of risk. A history of knee osteoarthritis is not an absolute barrier to NMES and may simply shape the treatment plan. A mild sunburn on the treatment area isn’t an inherent contraindication; it might necessitate avoiding or adjusting treatment over that skin, but not categorically ruling it out. A recent dental infection is unrelated to NMES safety.