Living with a Pacemaker or Implantable Cardioverter Defibrillator (ICD)
Pacemakers and ICDs generally last 5 to 7 years or longer, depending on usage and the type of device. In most cases, you can lead a normal life with an ICD.
Advances in technology have reduced the chances that machines, such as microwaves, could interfere with your device. Even so, you must take certain precautions when you have a pacemaker or ICD.
What precautions should I take with my pacemaker or ICD?
The following precautions should always be considered. Discuss the following in detail with your doctor:
It is generally safe to go through airport or other security detectors. They will not damage the pacemaker or ICD. But, tell airport security that you have a pacemaker before you go through security. The device may set off the alarm. Also, if you are selected for a more detailed search, politely remind security not to hold the hand-held metal-detecting wand over the pacemaker for a prolonged period of time (more than a second or two). This is because the magnet inside the wand may temporarily change the operating mode of your device. Do not lean against or stay near the system longer than needed.
Avoid magnetic resonance imaging (MRI) machines or other large magnetic fields. These may affect the programming or function of the pacemaker. Also, the rapidly changing magnetic field within the MRI scanner can may cause heating of the pacemaker leads. There are usually other options to MRI for people with pacemakers, but if your doctor determines that you must get an MRI scan, discuss it with your cardiologist first. If he or she and you agree to go ahead, you should be closely monitored by a cardiologist, with a pacemaker programming device immediately available, during MRI scanning. Newer pacemaker and ICD technology may be a safe option for MRI as long as monitoring and certain safety precautions are used.
Avoid diathermy. This is the use of heat in physical therapy to treat muscles.
Turn off large motors, such as cars or boats, when working on them. They may temporarily "confuse" your device with the magnetic fields created by these large motors.
Avoid certain high-voltage or radar machines, such as radio or T.V. transmitters, arc welders, high-tension wires, radar installations, or smelting furnaces.
Cell phones available in the U.S. (less than 3 watts) are generally safe to use. A general guideline is to keep cell phones at least 6 inches away from your device. Avoid carrying a cell phone in your breast pocket over your pacemaker or ICD.
MP3 player headphones may contain a magnetic substance that could interfere with your device function when in very close contact. Keep the headphones at least 1.2 inches or 3 centimeters (cm) away from the device. They can be worn properly in the ears and not pose this risk. Do not drape your headphones around your neck, put your headphones in your breast pocket, or allow a person with headphones in to press against your device.
If you are having a surgical procedure done by a surgeon or dentist, tell your surgeon or dentist that you have a pacemaker or ICD. Some procedures require that your ICD be temporarily turned off or set to a special mode. This will be determined by your cardiologist. Temporarily changing the mode on your pacemaker can be done noninvasively (no additional surgery is required), but should only be done by qualified medical personnel.
Shock wave lithotripsy, used to get rid of kidney stones, may disrupt the function of your device without appropriate preparation. Ensure that your doctor is aware you have a pacemaker or ICD before scheduling this procedure.
Transcutaneous electrical nerve stimulation (TENs) to treat certain pain conditions may interfere with your pacemaker of ICD. Inform your doctor if you are considering this therapy.
Therapeutic radiation, such as that used for cancer treatments, can damage the circuits in your device. The risk increases with increased radiation doses. Appropriate precautions should be taken. Inform your doctor that you have a pacemaker or ICD before undergoing radiation treatments.
Always carry an ID card that states you have a pacemaker or ICD. It is recommended that you wear a medic alert bracelet or necklace if you have a device.
Always consult your doctor or device company if you have any questions about the use of equipment near your pacemaker or ICD.
Can I participate in regular, daily activities with a pacemaker or ICD?
Once the device has been implanted, you should be able to do the same activities everyone else in your age group is doing. Your activity is usually only limited while the incision is healing. These limits will only be for about 2 to 3 weeks, depending on your doctor's instructions. When you have a pacemaker or ICD, you may still be able do the following:
Exercise on advice from your doctor
Drive your car or travel if cleared by your doctor. There are legal restrictions that may prevent you from driving for 6 months after an ICD has been implanted or if the device fires. The heart rhythms that provoke the therapy can be cause loss of consciousness, which is dangerous if you are driving. Commercial driver's license are restricted in people who have ICDs.
Return to work
Work in the yard or house
Participate in sports and other recreational activities
Take showers and baths
Continue sexual relationships
When involved in a physical, recreational, or sporting activity, try not to get a blow to the area over the device. A blow to the chest near the pacemaker or ICD can affect its functioning. If you do get a blow to that area, see your doctor.
Always consult your doctor if you feel ill after an activity, or when you have questions about beginning a new activity.
How can I ensure that my pacemaker or ICD is working properly?
Although your device is built to last 5 to 7 years, you should have it checked regularly to ensure that it is working properly. Different doctors may have different schedules for checking devices. Many can be checked in the home using a remote monitoring system over a telephone or internet connection. The device manufacturer supplies the necessary equipment. Your doctor will recommend in-person device checks at specific intervals as well. Any device setting changes must be made in person, by a trained medical professional, using a device programmer.
Battery life, lead wire condition, and various functions are checked by doing a device interrogation. During an interrogation, the device is noninvasively connected to a device programmer using a special wand placed on the skin over the pacemaker or ICD. The data is transmitted from the device to the programmer and evaluated. Most in-home device interrogation systems use wireless technology to connect the device to special equipment that records the data and sends it to your doctor.
Your doctor may ask you to check your pulse rate periodically. Report any unusual symptoms or symptoms similar to those you had before the device insertion to your healthcare provider right away.
Always consult your doctor for more information, if needed.
How to check your pulse
As the heart forces blood through the arteries, you feel the beats by firmly pressing on the arteries, which are located close to the surface of the skin at certain points of the body. The pulse can be found on the side of the lower neck, on the inside of the elbow, or at the wrist.
When taking your pulse:
Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse.
Begin counting the pulse when the clock's second hand is on the 12.
Count your pulse for 60 seconds (or for 15 seconds and then multiply by 4 to calculate beats per minute).
When counting, do not watch the clock continuously, but concentrate on the beats of the pulse.
If unsure about your results, ask another person to count for you.
It is probably better to check the wrist (radial artery) pulse than a neck (carotid artery) pulse. If you must check a neck pulse, do not press hard on the neck, and never press on both sides of the neck at the same time, as this can cause some people to pass out.
October 16, 2018
Cardiac implantable electronic device interactions with electromagnetic fields in the non-hospital environment, Up To Date, Driving restrictions in patients with an imploantable cardioverter defibrillator, Up To Date, Implantable cardioverter defibrillators, Up To Date, Nordbeck, P., Magnetic resonance imaging safety in pacemaker an dimplantable cardioverter defibrillator patients: How far have we come? , European Heart Journal (2015); 36(24); 1505-1511, Part 6: Electrical Therapies: Automated External Defibrillators, Defibrillation Cardioversion, and Pacing. Link, M. Circulation. 2010, is. 122, ed. 3, s706-719.
Kang, Steven, MD,Snyder, Mandy, APRN