Living With a Pacemaker or ICD

Both pacemakers and implantable cardioverter defibrillators (ICDs) are small devices that monitor your heartbeat and deliver energy to the heart when needed. Pacemakers regulate heart rates that are too slow, while ICDs regulate heart rates that are very fast and life-threatening, resulting in conditions such as ventricular tachycardia or ventricular fibrillation.

Depending on the heart problem, a specific type of pacemaker — which might be wireless or have up to three wires (called leads) — may be used. Types of pacemakers include:

• Single-chamber pacemaker: Uses a single lead attached to one chamber of your heart
• Dual-chamber pacemaker: Uses two leads attached to two chambers of your heart
• Biventricular pacemaker: Uses three leads that attach to the two lower chambers of your heart and the upper right chamber of your heart
• Leadless pacemakers: A very small pacemaker inserted with a catheter-based procedure. This pacemaker is attached to an inner wall of your heart, which means it doesn’t need to use any leads at all.

All these pacemakers are implanted using minimally invasive techniques that do not require patients to stay overnight in the hospital.

"Most new implantable cardioverter defibrillators (ICDs) can do the same job as a pacemaker, as well as detect dangerous heart rhythms," explains Ulrika Birgersdotter-Green, MD, a cardiologist and director of pacemaker and ICD services at UC San Diego Health. "Once these are detected, the ICD can pace the heart or deliver a shock to restore your heart to its normal rhythm. These ICDs are implanted using one or two leads to the heart."

Pacemakers and ICDs generally last 10 years or longer, depending on usage and the type of device. In most cases, people can lead normal lives with a pacemaker or ICD. Patients are enrolled in a remote monitoring program that allows a full check of the device from home.

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 activities that everyone in your age group is doing, after activity restrictions of about three to four weeks (depending on your care plan). If you have a pacemaker or ICD, you can:

• Exercise as advised by your health care provider.
• Drive or travel if cleared by your health care provider. There are legal restrictions that may prevent you from driving for up to six months after an ICD has been implanted or if the device activates. The heart rhythms that affect the therapy can cause loss of consciousness, which is dangerous if you are driving.
• Return to work (if it’s not too strenuous).
• Work in your house or yard.
• Participate in sports and other recreational activities.
• Take showers and baths.
• Continue sexual relations.

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. See your health care provider if you get a blow to that area.

Always talk with your doctor if you feel ill after an activity or have questions about starting a new activity.

What Precautions Should I Take With My Pacemaker or ICD?

Be aware of the following and discuss it with your health care provider as needed:

• Airport security: It's generally safe to go through airport or other security detectors. They won't damage the pacemaker or ICD, but tell airport security you have a pacemaker before you go through security. The device may set off the alarm. Also, if you undergo a more detailed search, ask 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.
• MRI scans: All current pacemakers and ICDs are now MRI-compatible. Some older devices have not been approved for an MRI. If your health care provider recommends an MRI scan, consult your cardiologist.
• Large motors: Turn off large motors, such as cars or boats, when working on them. Their electromagnetic signals may temporarily "confuse" your device.
• High-voltage equipment: 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.
• Cellphones and smartwatches: Some cellphones and electronic devices, such as smartwatches, use powerful magnets for wireless charging. Keep them at least 6 inches away from your pacemaker or ICD. It's safest to hold all cellphones 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 phone and other electronics in a pocket or bag below your waist.
• Headphones: Some headphones may contain a magnetic substance that could interfere with your device's function when in very close contact. Keep them at least 1.2 inches away from the device. If worn properly in the ears, they do not pose this risk. Don't drape your headphones around your neck or place them in your breast pocket, and don’t let a person wearing headphones press against your device.
• Surgery or dental work: If you are having surgery or dental work, tell your surgeon or dentist that you have a pacemaker or ICD. Some procedures may require your device to be temporarily turned off or set to a special mode.
• Shock wave lithotripsy: Shock wave lithotripsy, used to remove kidney stones, may disrupt your device if the correct preparation isn't made. Tell your health care provider that you have a pacemaker or ICD before scheduling this procedure.
• TENS therapy: Transcutaneous electrical nerve stimulation (TENS) to treat certain pain conditions may interfere with your pacemaker or ICD. Tell your health care provider if you are considering this therapy.
• Radiation therapy: Therapeutic radiation for cancer treatments can damage the circuits in your device. The risk increases with higher radiation doses. Inform your health care 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," advised Dr. Birgersdotter-Green. "It's recommended that you wear a medic alert bracelet or necklace if you have a device."