What precautions should I take with my pacemaker or ICD?

Discuss the following with your healthcare provider:

• It's generally safe to go through airport or other security detectors. They won't 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 undergo a more detailed search, politely remind security not to hold the handheld metal-detecting wand over the pacemaker for more than a second or two. This is because the magnet inside the wand may temporarily change the operating mode of your device. Don't lean against or stay near the system longer than needed. 

• Most current pacemakers and ICD companies now make devices that can go through an MRI after waiting at least 6 weeks after implant. But some older devices may not be safe in an MRI. Check if it's OK to get an MRI with your type of device. Large magnets or an MRI scanner may affect the programming or function of the pacemaker. Also, the rapidly changing magnetic field within the MRI scanner can heat the pacemaker leads. There are usually other options for people with pacemakers that aren't compatible. But if your healthcare provider decides that you must get an MRI scan, talk with your cardiologist first. If they and you agree to go ahead, you should be closely monitored by a cardiologist. A pacemaker programming device needs to be available right away during MRI scanning. Your device will likely need to be reprogrammed before and after the MRI scan to ensure safety during the scan. Newer pacemaker and ICD technology may be a safe option for MRI as long as they are compatible and monitoring and certain safety precautions are used.

• Don't use heat in physical therapy to treat muscles (diathermy).

• Turn off large motors, such as cars or boats, when working on them. They may temporarily "confuse" your device with the electromagnetic interference created by these large motors.

• Stay away from certain high-voltage or radar machines, such as radio or TV transmitters, arc welders, high-tension wires, radar installations, or smelting furnaces.

• Be careful when using cell phones and other electronic devices. Keep them at least 6 inches away from your pacemaker or ICD. It's safest to hold all cell phones to the ear farthest from your pacemaker or ICD or use the speaker mode setting. Don’t carry your phone or electronic device in your chest pocket, over the pacemaker or ICD. Experts advise carrying your cell phone and other electronics in a pocket or bag below your waist. Most cell phones and electronic devices don't interfere with pacemakers or ICDs. But some cell phones and electronic devices, such as smart watches, use powerful magnets for wireless charging. These may interfere with how your pacemaker or ICD works. The magnet used for charging or other magnet accessories can also interfere with how your pacemaker or ICD works. These devices should be kept at least 12 inches away from your pacemaker when charging wirelessly or being stored. Follow any other instructions given to you by your healthcare provider or from the maker of your pacemaker or ICD.

• MP3 player headphones may contain a magnetic substance that could interfere with your device's function when in very close contact. Keep the headphones at least 1.2 inches (3 cm) away from the device. They can be worn properly in the ears and not pose this risk. Don't drape your headphones around your neck, put your headphones in your breast pocket, or let a person wearing headphones press against your device.

• If you are having an operation 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 without surgery but should be done only by qualified medical personnel.

• Shock wave lithotripsy is used to get rid of kidney stones. It may disrupt the function of your device if the correct preparation isn't made. Tell your healthcare provider that 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 or ICD. Tell your healthcare provider if you are considering this therapy.

• Therapeutic radiation used for cancer treatments can damage the circuits in your device. The risk increases with increased radiation doses. Take precautions. Tell your healthcare provider that you have a pacemaker or ICD before having radiation treatments.

• Always carry an ID card that states you have a pacemaker or ICD. It's recommended that you wear a medic alert bracelet or necklace if you have a device.

Always talk with your healthcare provider or device company if you have any questions about the use of equipment near your pacemaker or ICD.

Can I do regular daily activities with a pacemaker or ICD?

Once the device has been implanted, you should be able to do most of the same activities everyone else in your age group is doing. Your activity is often only limited while the incision is healing. These limits will be for only 3 to 4 weeks, depending on your healthcare provider's instructions. When you have a pacemaker or ICD, you may still be able do the following:

• Exercise on advice from your healthcare provider

• Drive your car or travel if cleared by your healthcare provider. There are legal restrictions that may prevent you from driving for up to 6 months after an ICD has been implanted or if the device fires. The heart rhythms that provoke the therapy can cause loss of consciousness, which is dangerous if you are driving. Commercial driver's licenses 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, avoid getting 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 healthcare provider.

Always talk with your healthcare provider if you feel ill after an activity, or when you have questions about starting a new activity.

How can I ensure that my pacemaker or ICD is working correctly?

Although your device is built to last 10 years, have it checked regularly to ensure that it's working correctly. Different healthcare providers 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 needed equipment. Your healthcare provider will also recommend in-person device checks at specific intervals. 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 connected to a device programmer using a special wand placed on the skin over the pacemaker or ICD. The data is sent from the device to the programmer and assessed. Most in-home device interrogation systems use wireless technology to connect the device to special equipment. The equipment records the data and sends the information to your healthcare provider.

Your healthcare provider 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 talk with your healthcare provider 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.

• Start counting the pulse when the clock's second hand is on the 12.

• Count your pulse for 60 seconds.

• When counting, don't 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's probably better to check the wrist (radial artery) pulse than a neck (carotid artery) pulse. If you must check a neck pulse, don't 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.