Living With a Pacemaker

Living with a pacemaker:

With advances in technology, implanted pacemakers today generally last eight to 10 years (depending upon the type of heart condition) and, in most cases, allow a child to lead a normal life. In addition, advances in pacemaker circuitry have reduced the interference risk from certain machinery, such as microwaves, which in the past may have altered or otherwise affected the pacemaker. Even so, certain precautions must be taken into consideration when a child has an implanted pacemaker.

What precautions should be taken with an implanted pacemaker?

Your child should wear a medical identification bracelet or necklace to let others know about the pacemaker in case of emergency. When he/she is old enough to have a wallet, it is a good idea to also carry an ID card that states he/she has a pacemaker.

In the past, people with pacemakers risked interference with the proper functioning of their pacemakers if they were too close to many items common in the everyday environment. However, with improvements in pacemaker technology, this type of interference is less common.

According to The American Heart Association and pacemaker manufacturers, the following items have not been shown to alter the function of today's pacemakers:

• microwave ovens
• 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
• metal detectors
• computers
• copying and fax machines
• properly grounded shop tools (except power generators or arc welding equipment)

Currently, cellular phones do not affect the functioning of pacemakers. Most pacemakers 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, new frequencies are being made available for cellular phones by the Federal Communications Commission, and these new frequencies may make pacemakers less reliable. Studies are being done to investigate this further.

Make sure your child uses caution when going through security detectors at airports and government buildings such as courthouses. Pacemakers currently being manufactured should not be affected by these security devices, as long as its wearer moves through and away from the detector at a normal speed. Check with your child's physician about the safety of going through such detectors with your child's particular pacemaker. The metal in the pacemaker may activate a security alarm, however. Be prepared to show an identification card for the pacemaker or a medical identification bracelet in order to pass through security checkpoints.

The following situations may cause interference with pacemakers. (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 physician:

• Avoid working with, holding, or carrying magnets near the pacemaker.
• Avoid magnetic resonance imaging (MRI) machines or other large magnetic fields, since the pacemaker's performance can be affected. 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 pacemaker's rate. Do not use chain saws, because of the close contact with the motor components.
• Avoid certain high-voltage or radar machinery, such as electric 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, so that electrocautery will not be used to control bleeding (the electrocautery device can change the pacemaker settings).

Certain medical procedures may occasionally affect the function of the pacemaker, but might be performed successfully with some adjustments to the pacemaker 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 physician before your child undergoes these procedures.

Your child may also have to take antibiotic medication before any medically-invasive procedure to prevent infections that may affect the pacemaker.

Always consult your child's physician 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?

Once the pacemaker has been implanted, children with pacemakers should be able to do the same activities everyone else in their age group is doing: living normally.

However, when involved in a physical, recreational, or sporting activity, a child with a pacemaker should avoid receiving a blow to the skin over the pacemaker. A blow to the chest or abdomen near the pacemaker can affect its functioning. Contact sports are usually not recommended for children with pacemakers for this reason. If your child does receive a blow to that area, contact your child's physician. Consult your child's physician for activity restrictions.

Always consult your child's physician when he/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 is working properly?

Although your child's pacemaker is built to last several years, always check the pacemaker regularly to ensure that it is working properly. The proper method for checking the accuracy of your pacemaker includes the following:

• Take your child's pulse regularly to make sure the pacemaker is keeping your child's pulse at the targeted rate.
• Participate in a telephonic check-up for your child's pacemaker on a periodic basis. Your child's physician will provide special instructions.
• See your child's physician regularly for check-ups.
• Report any unusual symptoms or symptoms similar to those your child had prior to the pacemaker insertion to your child's physician immediately.

Always consult your child's physician 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, and 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:

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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.

If you are having difficulty in finding your child's pulse, consult your child's physician for additional instruction.

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