A Child Living with a Pacemaker or Implantable Cardioverter Defibrillator (ICD)
With advances in technology, implanted pacemakers and ICDs generally last five to seven years or more (depending on usage and the type of device) and, in most cases, allow a child to lead a normal life. In addition, advances in device circuitry and insulation have reduced the interference risk from machinery, such as microwaves, which in the past may have altered or otherwise affected these surgically implanted cardiac devices. Even so, certain precautions must be taken into consideration when a child has an implanted pacemaker or ICD.
What precautions should be taken with an implanted pacemaker or ICD?
Your child should wear a medical identification bracelet or necklace to let others know about the device in case of emergency. When he or she is old enough to have a wallet, it is a good idea to also carry an ID card.
According to The American Heart Association and pacemaker manufacturers, the following items have not been shown to alter the function of today's pacemakers or ICDs:
Kitchen appliances such as blenders, toaster ovens, and electric knives
Televisions (including the remote control), FM and AM radios, and stereos
TV and radio transmitters
Ham radios and CB radios
Electric blankets and heating pads
Electric shavers, hair dryers, curling irons, and other personal care appliances
Gardening machinery, such as electric trimmers
Garage door openers
Copying and fax machines
Properly grounded shop tools (except power generators or arc welding equipment)
Typically, cellular phones do not affect the functioning of pacemakers or ICDs. Most devices made today have a filter that allows the use of the majority of cellular phones used throughout the world, including analog and digital technologies. However, the Federal Communications Commission is making new frequencies available for cellular phones, which may make pacemakers or ICDs less reliable. Experts are conducting studies to investigate this further. General recommendations include keeping a cell phone at least 6 inches away from a pacemaker or ICD, and avoiding carrying a cell phone in a breast pocket over the device.
Make sure your child uses caution when going through security detectors at airports and government buildings, such as courthouses. Although it is generally safe to go through airport security detectors (they should not damage the pacemaker or ICD), inform airport security personnel that your child has a pacemaker or ICD before he or she goes through security. The device may set off the alarm. Also, if your child is selected for a more detailed search, politely remind security that the hand-held metal-detecting wand should NOT be held over the device for any prolonged period of time (more than a second or two), as the magnet inside the detecting wand may temporarily change the operating mode of the device. Be prepared to show an identification card or a medical identification bracelet in order to pass through security checkpoints.
The following situations may cause interference with ICDs. (Some of the activities mentioned are not appropriate until a child nears adulthood, but may affect older teenagers.) Discuss the following in detail with your child's doctor:
Avoid working with, holding, or carrying magnets near the pacemaker or ICD.
Avoid magnetic resonance imaging (MRI) machines or other large magnetic fields, as these may affect the programming or function of the device. Also, the rapidly changing magnetic field within the MRI scanner may, in theory, cause heating of the device leads. In general, there are alternatives to MRI for persons with pacemakers, but if your child's doctor determines that he or she absolutely needs an MRI scan, discuss this thoroughly with your child's cardiologist before proceeding. If the cardiologist and you decide to go ahead, your child should be closely monitored by a cardiologist, with a pacemaker programming device immediately available, during MRI scanning. Also, metal objects are not permitted near MRI machines.
Abstain from diathermy (the use of heat in physical therapy to treat muscles).
Turn off large motors, such as cars or boats, when working on them, as they may temporarily "confuse" the device. Do not use chain saws, because of the close contact with the motor components.
Avoid certain high-voltage or radar machinery, such as arc welders, high-tension wires, radar installations, smelting furnaces, electric steel furnaces, and other high-current industrial equipment.
Avoid working in restricted spaces near radio or television transmitting towers and antennas.
If your child is having a surgical procedure performed by a surgeon or dentist, tell the surgeon or dentist that your child has a pacemaker or ICD. Some surgical procedures will require that your child's device be temporarily turned off or set to a special mode; however, this will be determined by your child's cardiologist. Temporarily changing the mode on your child's device can be performed noninvasively (no additional surgery is required), but should only be performed by qualified medical personnel.
Certain medical procedures may occasionally affect the function of the device, but might be performed successfully with some adjustments to the pacemaker or ICD settings. These procedures include the following:
Extracorporeal shock-wave lithotripsy (ESWL). A procedure that dissolves kidney stones.
Radiofrequency ablation. A procedure that uses radio waves to control irregular heart rhythms.
Transcutaneous electrical nerve stimulation (TENS). A device used to relieve acute or chronic pain.
Therapeutic radiation treatments for cancer
Consult your child's doctor or device company before your child undergoes these procedures.
Always consult your child's doctor if you have any questions concerning the use of certain equipment near your child's pacemaker.
Can my child participate in regular, daily activities with a pacemaker or ICD?
Once the device has been implanted, your child should be able to do the same activities everyone else in their age group does. Your child's doctor will provide activity instructions specific to your child.
However, when involved in a physical, recreational, or sporting activity, a child with a pacemaker or ICD should avoid receiving a blow to the area over the pacemaker. A blow to the chest or abdomen near the pacemaker or ICD can affect its functioning. Contact sports are usually not recommended for children with pacemakers or ICDs for this reason. If your child does receive a blow to that area, contact your child's doctor. Consult your child's doctor for activity restrictions.
Always consult your child's doctor when he or she feels ill after an activity, or when you have questions about beginning a new activity.
How can I ensure that my child's pacemaker or ICD is working properly?
Although your child's device is built to last five to seven years, always have it checked regularly to ensure that it is working properly. Different doctors may have different schedules for checking devices. Most are checked in the home using a telephone and special equipment provided by your child's device manufacturer. Your child's 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 performing 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 child's doctor.
Your doctor may ask you to check your child's pulse rate periodically. Report any unusual symptoms, or symptoms similar to those your child had prior to the device insertion, to your child's doctor immediately.
Always consult your child's doctor for more information, if needed.
What is the pulse?
The pulse rate is a measurement of the heart rate, or the number of times the heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the blood. This can be felt in various points in the body as a pulse. Taking a pulse not only measures the heart rate, but also can indicate the following:
Heart rhythm (abnormal rhythm may indicate a heart disorder)
Strength of the pulse (a weak pulse may indicate a fast heartbeat in which some beats are too weak to feel, heart failure, or a low volume of blood in the circulatory system)
Many pacemakers provide varying rates, depending on your child's activity level and other factors. The pulse rate may fluctuate and increase with exercise, illness, injury, and emotions. Girls ages 12 and older and women, in general, tend to have faster heart rates than do boys and men. Athletes, such as runners, who do a lot of cardiovascular conditioning may have slow heart rates and experience no problems.
How to check your child's pulse
As the heart forces blood through the arteries, 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 a 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 the pulse for 60 seconds (or for 15 seconds and then multiply by four to calculate beats per minute).
When counting, do not watch the clock continuously, but concentrate on the beats of the pulse. If you have trouble with this method, try a digital kitchen timer and set it for one minute. Stop counting when the timer alarms.
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; this can cause some people to pass out.
If you are having difficulty finding your child's pulse, consult your child's doctor for additional instruction.