Can a patient with a pacemaker (pacemaker) receive a Nexplanon (etonogestrel implant) insertion in their arm?

Nexplanon Insertion in Patients with Pacemakers

Yes, Nexplanon can be safely inserted in the arm of a patient with a cardiac pacemaker, as there are no contraindications or interactions between the two devices. 1

Rationale for Safety

• Cardiac pacemakers are implanted in the chest area, while Nexplanon is inserted subcutaneously in the upper arm, creating adequate anatomical separation between the devices 1, 2
• The European Society of Cardiology/European Society of Anaesthesiology guidelines specifically address perioperative management of patients with pacemakers, with no contraindications for subcutaneous implants in other body areas 1
• Nexplanon exerts its contraceptive effects primarily through hormonal mechanisms (suppression of ovulation) and does not emit electromagnetic interference that could affect pacemaker function 3

Important Considerations for Insertion

• The healthcare provider should document the presence of the pacemaker in the patient's chart before Nexplanon insertion 1
• Standard Nexplanon insertion technique should be followed, with particular attention to:
  • Proper subdermal placement in the inner aspect of the non-dominant upper arm 3, 4
  • Avoiding deep insertion that might affect nearby neurovascular structures 4
  • Using the redesigned Nexplanon applicator that increases insertion accuracy 4

Potential Concerns and Mitigations

• Electromagnetic interference: The Nexplanon insertion procedure does not involve electrocautery or other equipment that could interfere with pacemaker function 1, 5
• Infection risk: While infection is a potential complication of any implant procedure, the risk is low (approximately 1.1-1.4%) and can be minimized with proper sterile technique 2
• Anatomical considerations: The standard Nexplanon insertion site in the upper arm is anatomically distant from the pacemaker implantation site in the chest, eliminating concerns about device interaction 5

Alternative Insertion Sites

• In rare cases where the standard insertion site might be problematic, alternative insertion sites such as the scapular region have been documented as safe and effective 6
• However, for most patients with pacemakers, the standard upper arm insertion site remains appropriate 3

Follow-up Recommendations

• Standard follow-up for both the pacemaker and Nexplanon should be maintained independently 5
• Patients should be advised that Nexplanon does not affect pacemaker function and vice versa 1
• Nexplanon should be removed or replaced after three years of use, as per standard recommendations 3

In conclusion, having a cardiac pacemaker does not contraindicate the use of Nexplanon, and the standard insertion technique in the upper arm remains appropriate for these patients 1, 3.