Can blood pressure (BP) be checked on the same side as a pacemaker implant?

Blood Pressure Measurement in Patients with Pacemakers

Blood pressure can be safely measured on the same side as a pacemaker implant, but it is generally recommended to use the contralateral arm when possible to avoid potential interference with the device.

General Considerations for Blood Pressure Measurement in Pacemaker Patients

Preferred Arm for Measurement

• Blood pressure should typically be measured in the arm opposite to the pacemaker implantation site when feasible 1
• The contralateral arm is preferred to avoid potential interference with the pacemaker device and to prevent discomfort at the implantation site 1
• If the contralateral arm has arterial surgery (such as repair of coarctation of the aorta or creation of an arteriovenous fistula), then using the arm with the pacemaker may be necessary 1

When Measurement on the Pacemaker Side is Necessary

• If blood pressure must be measured on the same side as the pacemaker, it can be done safely with proper technique 1
• Ensure the blood pressure cuff is not placed directly over the pacemaker generator pocket 1
• Position the cuff at an appropriate distance from the device to avoid direct pressure on the implantation site 1

Proper Blood Pressure Measurement Technique

Cuff Selection and Positioning

• Use an appropriately sized cuff based on arm circumference (bladder length should be 75%-100% and width 35%-50% of arm circumference) 1
• Position the cuff on the upper arm at heart level with the lower edge a few centimeters above the antecubital fossa 1
• Ensure the patient is seated comfortably with back and arm supported 1

Measurement Protocol

• Allow the patient to rest for 5 minutes in a quiet environment before measurement 1
• Take three measurements 1-2 minutes apart and average the last two readings 1
• Record heart rate and check for arrhythmias by pulse palpation 1
• Compare initial readings between both arms; if systolic BP differs by >10 mmHg, use the arm with higher readings for subsequent measurements 1

Special Considerations for Pacemaker Patients

Timing of Measurements After Implantation

• Avoid blood pressure measurement on the implant side during the immediate post-implantation period until wound healing is complete 2
• Early manipulation of the arm on the implant side may increase risk of wound infection and lead dislocation 2

Potential Concerns with Pacemaker Interference

• Modern pacemakers are designed with protective circuits against external electrical discharges, making interference from blood pressure measurement devices unlikely 1
• Oscillometric devices (automated BP monitors) are generally safe to use in pacemaker patients but may be less accurate in patients with arrhythmias 1
• Manual auscultatory method is preferred for patients with atrial fibrillation 1

Arm Position Effects on Readings

• Ensure proper arm positioning during measurement, as incorrect positioning can significantly affect readings 3
• Arm supported on a desk at heart level is the standard position; measurements with the arm on the lap or unsupported at the side can lead to falsely elevated readings (3.9-6.5 mmHg systolic and 4.0-4.4 mmHg diastolic) 3

Common Pitfalls to Avoid

• Placing the blood pressure cuff directly over the pacemaker generator pocket 1
• Using an inappropriately sized cuff, which can artificially elevate or reduce BP readings 1
• Failing to compare readings between arms at the initial visit 1
• Not accounting for the effects of arm position on blood pressure readings 3, 4
• Ignoring the potential for orthostatic hypotension, which should be assessed at the initial visit 1

By following these guidelines, blood pressure can be safely and accurately measured in patients with pacemakers, preferably using the contralateral arm when possible, but the ipsilateral arm can be used when necessary with appropriate technique.