Pacemakers

What powers these devices

The first implanted cardiac pacemaker used nickel-cadmium rechargeable battery, later on zinc-mercury battery was developed and used which lasted for over 2 years. Lithium iodine battery invented and used by Wilson Greatbatch and his team in 1972 made the real impact to implantable cardiac pacemakers. This battery lasts for about 10 years and even today is the power source for many manufacturers of cardiac pacemakers. With lithium iodine batteries we can measure and determine when the battery is about to get to its end of life. There is a point before the battery fails when we have several months to decide what to do.  The battery”s energy supply slowly wear out, and depending on the kind of device–some devices will last five to ten years. Some people get more life out of a device and some get less, depending on the situation and how much they use it. When the battery reaches its end of life  we open up the pocket where the device is located, and unscrew the leads. Then we plug in a new device and close up the skin. We will put in a brand new device, often of a higher quality and more technologically advanced.

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Will I ever outgrow the need for these devices?

For most people, the device will be needed for the rest of their life. There are specific individuals who may get a device for prophylactic purposes, or for some reason the condition resolves. That does not happen very often. If it can be determined for a fact that the problem has resolved, then occasionally it is possible to remove devices. Sometimes, patients would prefer not to live with the device, after a period of time, and the device is either pulled out or turned off, depending on the wishes of the patient.

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Can I use ham radio or a CB radio if I have a pacemaker?

Yes. The use of ham radio or CB radio should not damage or reprogram most modern pacemakers. There is a remote possibility that the microphone or transmitter may cause a single-beat inhibition. We don’t anticipate any interaction, but your physician or health care professional may elect to program the pacemaker to a less sensitive setting. If you notice interference, verify that the antenna is at least 3 feet away for portable units and 10 feet away for base stations.

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Will a house arrest monitor interfere with my pacemaker?

The house arrest monitor (Digital Products Corp.) has a radio frequency power of 150 mW at a frequency of 314 MHz. Based on this information, we do not anticipate any damage or reprogramming of your pacemaker. However, since the house arrest monitor is worn on the wrist or ankle, the wrist transmitter may come within an inch of the pacemaker. The potential for pacemaker inhibition exists. We recommend placing the monitor around your ankle. Most manufacturers have not completed testing on possible interactions between pacemakers and the house arrest monitoring system. You physician can determine if there is any interaction.

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Will airport security systems damage or reprogram my pacemaker?

There is a slight possibility that a pacemaker may mistake the energy from a security gate as your heart’s natural rhythm and withhold its pacing output for a single beat. Airport security gates emit radio frequency energy that is reflected back to the gates by metal objects. The energy emitted by the gates is localized to the area between and around the gates, so the single-beat inhibition would occur only for the duration that you remain in the energy field. Your pacemaker won’t be damaged or reprogrammed and we don’t expect you to experience any problems.

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Will an electrical current applied to my body interfere with my pacemaker?

Application of an additional current source can potentially cause a rate increase in impedance-based pacemakers. Generally, this rate increase is temporary and pacing returns to a normal rate once the interference signal is removed. Any rate increase will occur within the programmed minimum and maximum sensor rate range set by the clinician. Turning the ECG impedance monitoring to off can prevent interference. Most pacemaker manufacturers (for their newer physiologic pacemakers) use an injected current to determine the impedance for rate responsive pacing or for stroke volume determination. Any additional electrical current applied to the body can interfere with these pacing algorithms. Common electrical current therapies or diagnostic sources include:

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Will iontophoresis stimulators damage or reprogram my pacemaker?

Treatment should not damage most pacemakers. However, there is the potential for your pacemaker to sense the output from an iontophoresis stimulator and temporarily inhibit the pacemaker or cause asynchronous pacing. Whenever a current is passed through the body, there is a possibility that the pacemaker can sense this signal. Iontophoresis stimulators produce approximately 1-4 mA of current, which may interact with cardiac pacemakers. If you decide to proceed with the iontophoresis procedure, be alert for symptoms like those you may have experienced before the pacemaker was implanted (dizziness, light-headedness, and such). If these symptoms occur, discontinue treatment. The symptoms should disappear. For Physicians & Health Care Professionals Program pacemakers with impedance based sensors (like minute ventilation or stroke volume for rate responsive pacing) to a non-rate responsive mode to prevent increased pacing rates during iontophoresis treatment.

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Will the LASIK procedure damage my pacemaker?

The LASIK procedure uses light energy, so we do not anticipate any damage to the pacemaker due to this procedure. We have received verbal reports that the LASIK procedure has been performed on pacemaker patients uneventfully.

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Will shockwave lithotripsy (for the treatment of kidney stones) impact my pacemaker’s function?

Shock wave lithotripsy uses a spark gap or electromagnetic transducer to produce a shock wave for patients with renal calculi (kidney stones). The pacemaker may sense the electrical signal from a lithotripter as intrinsic heart activity and cause a single beat inhibition of the ventricular output pulse. Single beat inhibition won’t be noticed by the patient. For Physicians & Health Care Professionals To minimize potential inhibition, time shock wave delivery synchronously with the patient’s R-wave. Extracorporeal Shock Wave Lithotripsy (ESWL) should be performed in the R-wave triggered mode. ESWL can trigger the atrial output pulse and the subsequent inhibition of the following ventricular pulse. Program dual pacemakers to the VVI or VOO mode prior to ESWL to prevent this occurrence. ESWL can permanently damage the piezoelectric crystal in an activity sensor based pacemaker if the ESWL focal point is directed towards the pacemaker. Focus the beam at least six inches away from the implanted pacemaker. Program activity sensor based pacemakers to a non-rate responsive pacing mode prior to ESWL therapy. Perform a thorough assessment of the pulse generator immediately prior to and after exposure to ESWL. This will rule out any device damage. For activity sensor based pacemakers, make sure to assess sensor function after an ESWL procedure. We recommend including a copy of the programmer printouts in the patient’s records.

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Will microwave prostate therapy damage or reprogram my pacemaker?

Based on information from two manufacturers (Targis™ and Prostratron®), we do not anticipate any damage or reprogramming of our pacemakers due to microwave prostate therapy. Physicians and health care professionals may elect to program the pacemaker to a less sensitive setting. Program all sensing configurations to bipolar and decrease the ventricular sensitivity. Select a maximum tracking rate (MTR) that the patient can tolerate with ease.

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Do pacemaker recipients need to avoid microwave ovens?

Cardiac pacemakers are prone to possible interference from other sources of electrical equipment, including microwave ovens. Both the microwave and pacemaker industries have made technological advances in the area of shielding. Electrical leakage from newer microwave ovens is minimal and should not affect an implanted pacemaker. The use of a microwave oven that meets U.S. federal safety standards by a person with a pacemaker has not been found to subject the person to any potential harmful problems. If the microwave oven is in proper working order, we do not anticipate any pacemaker interference problems.

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Can pacemaker recipients undergo magnetic resonance imaging (MRI)?

pacemaker recipients should not undergo MRI because of the extremely strong magnetic fields generated during the procedure. MRI may impair the normal operation of an implanted pacemaker. A review of literature shows isolated cases in which damage occurred, but this is considered rare. If an MRI is necessary, the following effects may occur:     * Asynchronous pacing resulting from the extremely strong magnetic field generated by the MRI     * Single beat inhibition of pacing output due to over sensing of the radio frequency field created by the MRI     * High rate pacing due to synchronization with the radio frequency field created by the MRI     * Potential pacemaker component damage due to the magnetic field generated by the MRI     * Lead dislodgment and pacemaker movement within the pocket Normal function should resume once the pacemaker is out of the MRI field. Assess the pulse generator function before and following exposure to MRI to rule out the possibility of pacemaker damage. Review the following guidelines:

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Will a nerve conduction procedure impact my pacemaker?

Nerve conduction testing shouldn’t damage or reprogram pacemakers. There is potential for a pacemaker to sense the output from test equipment. This may temporarily inhibit the pacemaker. If inhibition occurs, shut off the test equipment to stop the interference. The pacemaker will automatically pace as usual. If you are undergoing a nerve conduction procedure, be alert for symptoms like those when the pacemaker was implanted (dizziness, light-headedness, and such). If these symptoms occur, stop the procedure. Physicians and health care professionals may elect to program the pacemaker to a less sensitive setting. Program all sensing configurations to bipolar and decrease the ventricular sensitivity. Select a maximum tracking rate (MTR) that the patient can tolerate with ease.

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Does the radar used in speed guns cause an interaction with pacemakers?

Radar used in speed guns has not been reported to cause any interaction with cardiac pacemakers. Recipients of our pacemakers work at airports and on ships where radar is used. To date we have no clinical reports of electromagnetic interference (EMI) with radar. Ground based radar is directed above the horizon to avoid any direct radiation exposure to humans.

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Will radiation therapy (used to treat cancer) cause problems with my pacemaker?

Today’s technology uses complementary metal oxide semiconductors (CMOS) for their integrated circuits. pacemakers built prior to the early 1970s used transistors that were highly resistant to therapeutic radiation. Low current consumption CMOS circuits are more susceptible to therapeutic doses of radiation. The damage occurs to the silicone and silicone oxide insulators within the transistors. Leads may be irradiated without risk. Therapeutic radiation therapy is administered in one of the following ways:     * Radioactive cobalt     * Linear accelerators     * Betatrons The linear accelerators and betatrons produce radiation and a strong electromagnetic field.

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Can a person with a pacemaker use therapeutic ultrasound?

The use of therapeutic ultrasound should be okay and is not contraindicated for pacemaker recipients. There is a remote possibility of single beat inhibition of the pacemaker, which may result due to the pacemaker’s inappropriate sensing of the ultrasonic waves. This possibility decreases with the therapy distance from the pacemaker. Do not use therapeutic ultrasound within six inches of the pacemaker. Inhibition is less likely if the pacemaker is programmed to the bipolar mode. If you feel dizzy, light-headed, or short of breath during your treatment, notify your physical therapist and immediately discontinue the therapy.

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Do Transcutaneous Nerve Stimulation (TENS) devices interact with pacemakers?

TENS devices can interact with pacemakers. Most likely, a temporary inhibition will occur. To minimize the potential for interaction with a TENS device, program the pacer to the bipolar mode and decrease the sensitivity level. For Physicians & Health Care Professionals Warnings    1. Burst mode is contraindicated and can result in the pacemaker’s total inhibition.    2. Temporary single beat inhibition due to over sensing of the electrical stimuli may occur. Take the following steps to minimize complications:    1. Monitor the patient’s heart rate during the procedure.    2. Place the electrode left to right (lateral not anterior-posterior).    3. Place electrode pads close to each other.    4. Always maintain a high frequency (>30 Hz).    5. Program pacemakers that use impedance based sensors (such as minute ventilation or stroke volume for rate responsive pacing) to a non-rate responsive mode to prevent increased pacing rates during TENS therapy.

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Can I use a magnetic mattress pad or magnetic necklace?

pacemakers have a magnetic coil inside. If you have an implanted pacemaker, do not use a magnetic mattress pad or magnetic necklace. If your pacemaker and a magnetic item are near each other, the magnetic field may activate the coil inside the pacemaker. Items such as magnet insoles, belts, knee braces, and join wraps (below the waist) do not affect the pacemaker.

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If I have a pacemaker, what precautions should I take around electrical arc welding?

Cardiac pacemakers are electronic devices with sensing circuits which detect small electrical signals from inside the heart. pacemakers may detect extraneous electrical signals from other sources. The pacemaker can incorrectly interpret these signals as heart activity, which may inhibit the pacemaker. The result could be no output pulse or asynchronous pacing. Asynchronous pacing means that there is no coordination between the heart and the pacemaker. If you are not in close proximity to an electric welder, you shouldn’t have any problems. However, this doesn’t mean that there is a total absence of the effects of welding interference on pacemakers. Any problems caused by radiated interference will end when the arcing ends.

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Will an ultrasonic toothbrush interfere with an implanted pacemaker?

Standard electric toothbrushes and ultrasonic toothbrushes should not interfere with an implanted pacemaker. There haven’t been any patient or clinical reports of an interaction between ultrasonic toothbrushes and pacemakers.

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