From the Guidelines
Patients with pacemakers should avoid strong electromagnetic fields, such as those from powerful magnets, large electrical generators, and industrial equipment, to prevent interference with device function. When using cell phones, it is recommended to hold them on the opposite side of the pacemaker and avoid placing phones directly over the device 1. During airport security, patients should inform TSA agents about their pacemaker and request a hand inspection rather than walking through metal detectors if possible. MRI scans require special precautions, and many modern pacemakers are "MRI-conditional" but require specific protocols and medical supervision 2.
Restrictions and Precautions
- Avoid therapeutic diathermy (heat treatments using radio waves) as these can damage the pacemaker system
- Household appliances like microwaves, computers, and standard electrical tools are generally safe when used normally
- Always carry a pacemaker identification card and inform all healthcare providers about the device before any procedures
- Patients with pacemakers should be careful not to lean over an unshielded, running motor, and high-voltage lines above trains can be hazardous, but the patient is shielded when inside the train 1
- Pacemaker-dependent athletes should not participate in most competitive sports that potentially involve bodily trauma, and athletes with a pacemaker and no signs of heart disease can participate in competitive sports with only minor cardiovascular demand, provided that exercise testing and 24-hour Holter monitoring show an appropriate increase in the paced heart rate during exercise, and no occurrence of significant arrhythmias 3
Medical Procedures
- Patients with permanent pacemakers who are pacemaker-dependent should have their device evaluated within 3 to 6 months before significant surgical procedures, as well as after surgery 4
- Electrocautery, lithotripsy, radio frequency ablation, and magnetic resonance imaging (MRI) can interfere with pacemaker function, and special precautions, such as reprogramming and monitoring, may be necessary during these procedures 2
From the Research
Restrictions for Patients with a Pacemaker Implant
The following restrictions and precautions are recommended for patients with a pacemaker implant:
- Magnetic resonance imaging (MRI) is generally contraindicated due to the risk of life-threatening interference with the device 5, 6, 7, 8
- However, in some cases, MRI can be performed safely with special precautionary measures, such as deactivating the pacing and defibrillator functions, and using asynchronous pacing mode for pacemaker-dependent patients 5, 6, 8
- Newer pacemaker systems have been approved for MRI scanning under certain conditions, reducing the risk of complications 5, 6
- Patients with pacemakers should avoid exposure to strong low-frequency electromagnetic fields, which can cause interference with the device 9
- Pre- and post-MRI checks of the device are recommended, as well as extensive monitoring and the availability of necessary personnel to deal with an emergency 5, 6, 8
Specific Precautions
- Pacemaker-dependent patients should have their device set to asynchronous pacing mode during MRI 5
- The pacing and defibrillator functions should be deactivated during MRI, if possible 5, 6, 8
- Patients should be continuously monitored during MRI, and emergency personnel should be available 5, 6, 8
- The type of pacemaker and its location in the body should be taken into account when assessing the risk of interference from electromagnetic fields 9