Challenges of living with a pacemaker or ICD


Good things to know that you might not think to ask or discuss with your doctor about your pacemaker/ICD. Mostly tips and discussions I have had with those who live with them.

Cold

Many patients  complain of  cold sensation in the chest due to the metal. I know of patients who put packaged hand warmers over pacemaker to keep warm. Be careful though as if your pacemaker site has been opened several times, the scar tissue is no longer sensitive to potential for burn.

Exercise 

Some people’s pacemakers do not pace enough to meet the hearts needs for exercise or strenuous exertion of daily life. Their heart rate does not increase enough for the effort made because the pacemaker doesn’t pick up the movement to tell it to increase the rate.   The pacemaker does recognize the movement  either due to sensitivity or design and a very stable upper body. I had a patient who could bike super hard and his heart rate wouldn’t go above 70. Needless to say it didn’t take long for him to get short of breath.  This is called chronotropic incompetance. One method to overcome this problem is to have patients literally must stimulate their pacemaker by tapping on it or doing arm circles to get the pacemaker to recognize there is physical activity going on and to trigger the algorithm to increase the rate of pacemaker firing. These patients would have complaints of symptoms of shortness of breath and fatigue with activity if they didn’t stimulate the pacemaker to increase heart rate. When the pacemaker speeds up they have enough blood flow to meet the physical demands of the activity. For others the rate may not be set high enough to get through the activity they perform with daily life.

It is important for patients to know the settings of the pacemaker, what is the sleep rate, the resting rate, the thresholds for firing.

 Programmable features include the rate of acceleration of the heart rate with exercise, the increase in heart rate at different levels of exercise, and the rapidity of deceleration of the heart rate as the patient stops exercising are all programmable.  Thus, the peak pacing heart rate for patients who participate in vigorous sports can be  adjusted and often the range is set as high as 140/min.

Here is where technology and science can clash. Cardiac patients are now being encouraged to increase their heart rates with interval training. The heart rate high parameters may not be realistic. It isn’t uncommon to be able to exercise strenuously yet comfortably including conversing, while being symptom free at heart rate ranges well above the traditional parameters.  If the pacemaker limits physical activity this is often a cause of frustration and depression for cardiac patients.As they feel they are being held back or held down fearful of what could happen if they exceed heart rate ranges prescribed.

The rates of acceleration and deceleration of the heart rate with exercise can be adjusted also to the activity level of the patient. Track heart rates with symptoms so when you see the pacemaker nurse they can adjust the settings appropriately.

It is also very important if you have an ICD you understand what the rate to trigger the algorithm is set for. If the heart rate is high enough with activity  the ICD  begins it’s instructions of shocking or pacing the heart out of what it thinks is a serious heart problem.

Movement Repeatedly lifting heavy loads over head can be a problem. The lead wire runs between the clavicle (collar-bone) and the first rib. If it repeatedly pinched and bent thousands of times the lead can fracture.

Electrical Interference

What does and doesn’t interfere with the pacemaker?  Modern ones are safer, better protected against microwaves and other stray electromagnetic radiation, and smarter. You may not have a magnetic resonance imaging (MRI) procedure. You should also avoid large magnetic fields such as power generation sites and industrial sites such as automobile junkyards that use large magnets. Arc-welding can create a high energy field that will reprogram pacemakers. In addition, cellular telephones, particularly the digital variety can cause problems.  Cell phones in the U.S. with less than 3 watts of output do not seem to affect pacemakers or the pulse generator, but as a precaution, cell phones should be kept at least 6 inches away from your pacemaker. Avoid carrying a cell phone in your breast pocket over your pacemaker.  Even your physicians will disagree with what motors and electronics can cause this. The best way is to contact the manufactures web site and get a list of what type electrical interference has been studied with that particular make and model.

Leads breaking/Battery Change/Technology innovation

Just like your car needs tune ups and maintenance. Certain parts are not currently made to be lifelong and will require replacement. The risks and benefits of pacing should be discussed with the patient and family, including the need for regular pacemaker surveillance for the remainder of the patients life and the need for pacemaker replacements for battery depletion in the future.

Tattoos

Can you get a tattoo over your Pacemaker/ICD site?  Had a big issue with that one once. Patient fighting  with Pacemaker nurse who said no, pacemaker company reps get involved no one can agree. Mean time patient gets tattoo. Turned out was OK. But to get a few experts together and agree in an area where could produce potential litigation ….anyway don’t get me started.

Body Image/Women

Common after effects reported included depression, loss of libido, sleeplessness, and uncertainty. A big lump on the chest, right where the bra strap hits, no more bikini’s, how ugly, etc. etc…all complaints of women with pacemakers. There are some hospitals who place the pacemaker down below the breast in women. There is discussion of making them with more rounded edges to contour to a woman’s chest. If you hate it, talk with your doctor and pacemaker reps…what are the alternatives at the next upgrade. Kind of like upgrading your phone, make sure it has the bells and whistles you want.

Clock

Each time a pacemaker is interrogated with a programmer (the computer they use to do the tests, etc.) the pacemaker syncs its internal clock with the programmer’s clock. So, if you are on vacation and checked in a different time zone from where you live, it will be off that many hours once you are back home. Also, pacemakers do not adjust for daylight savings time, so that frequently accounts for event times being an hour off.

Finally, it is always possible that the programmer time is off. They are normally checked fairly regularly, but these things happen. When the programmer’s clock is wrong, your pacemaker’s time stamps will be wrong until it is interrogated by a programmer with the correct time. Day light savings time again, another common scenario discussed or reported by patients when they attend their cardiac rehabilitation program:

 If someone had an event at 8:00 pm the ICD would read  7 pm at an interrogation after the time change. That is something to remember for sure when asked what you were doing at a certain time the day of an event… And really, how would an ICD know about the time change, it’s not like it plugs into the internet on a regular basis… unless you have a care link.

 I got my pm about a month ago and  I had a problem w/ a shock at 1 a.m. every night. It was determined that it was the check mode going on and I was affected by it .There was no safety issue but it was very uncomfortable. I believe that is what the “problem” would be if any were to occur. The check mode would wake you up at an odd time. It is not something you need to correct until you get back unless you are noticing a great difference in the “feeling” of the pm.

Sleep modes
Modern pacemakers feature other specialized pacing modes which can benefit patients.  Most pacemakers available today have a sleep mode feature.  When programmed on, the sleep mode provides patients with a slower heart rate at night.  At a pre-set time in the evening, the pacing rate falls 10 to 15 beats per minute to provide the heart with a slower rate at night to permit the heart to rest better.  At a pre-set time in the morning, the pacemaker increases the pacing rate to the higher baseline rate used throughout the day. Again keep in mind Day light saving time.  Other pacemakers are programmed to switch to the slower rate when the patient becomes motionless after falling asleep and revert back to the faster daytime rate in the morning when the patient becomes more active.What type of person are you, regular as clock work, in which case the preset times work best, or a young person with a variable schedule and in that case the motion sensor would be best.

chest with pacemaker

http://www.icdsupportgroup.org/board/viewtopic.php?f=1&t=3943

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8 thoughts on “Challenges of living with a pacemaker or ICD

  1. Pingback: Don’t Ignore Your Nutrition Needs. Read On For Tips To Improve | Healthy Weight Loss System

  2. Is there a bra I can wear with a pace maker as I am very big busted and all my bra s cause me discomfort.

    • Angela,
      I don’t have a great answer for that one. I know some women add extra padding over their pacemakers, others have asked their physician to place the pacemaker generator lower – and to left of breast – some cardiologist routinely do this for their female patients, others don’t like this configuration. Generators are replaced every 5-10 years so can discuss options before the next upgrade. “Women Heart” programs have recommended to pacemaker manufacturers to make the generator more rounded to naturally fit a woman’s body. I hope other women patients can help out with recommendations as to how they cope with this issue. Thanks for reading.
      Beth

  3. Help! I’m a deconditioned 61 yr. old male who received a 2 lead pacemaker in 9-14. Fear of breaking my leads or crushing anything in between the collarbone and the first rib is paralyzing me from using my much-missed basement weight training gym. I don’t want to stop using any of my favorite upper body exercises. I’ve been working out long enough to know that this body needs serious muscle building as well as aerobics in order to lose weight. Would 1-2 super-slow sets of 7-10 reps followed by short range pulse reps near the concentric end of the strokes 2-3 times a week effectively preserve the integrity of the pacemaker’s leads? Also, would limiting the upper end of the movement range of overhead presses, both ends of cable crossovers, and the stretch end of dips, pull-downs, and overhead extensions while executing them with the same super-slow method help things out?

    • Most likely your workout plan will not hurt the pacemaker leads if you keep the weights moderate and not super heavy focusing on reps vs. increased resistance. Discuss this with your cardiologist, not all are placed in a position to be concerned about and sometimes the physician feels the benefit of the exercise outweighs the risk. Yes limiting the upper end of the movement range in the exercises you mentioned would be more protective to the wires as well. Until you talk with your physician though there are lots of exercises you can do with the weights or dumbbells that are plenty safe, biceps, triceps, upright rows, bent rows, shoulder flexion, extension and abduction to 90 degrees, push ups, and planks plenty to get you started.

    •    Thank you so much for your prompt and excellent response. Re: “focusing on reps vs. increased resistance” in your reply, is there a middle ground available here, instead of mutual exclusion? I’m asking this because the body needs to be constantly challenged in order to make progress. Assuming by “focusing on reps”, you mean increasing reps and not focusing on workout form; if a combined strategy of increasing resistance by tiny increments while moderately increasing reps is employed instead of steadily increasing reps alone, wouldn’t that minimize the amount of flexing near the leads within each session and over the long run? Of course, smooth, consistent, super-slow movements with no jerking is key. This “tricks” the body into dealing with a moderate weight as though it was a heavier weight in terms of hormone release, perceived resistance, etc., and it should be easier on the leads.  Thanks.   Dave             

    • Thank you so much for your prompt and excellent response. Re: “focusing on reps vs. increased resistance” in your reply, is there a middle ground available here, instead of mutual exclusion? I’m asking this because the body needs to be constantly challenged in order to make progress. Assuming by “focusing on reps”, you mean increasing reps and not focusing on workout form; if a combined strategy of increasing resistance by tiny increments while moderately increasing reps is employed instead of steadily increasing reps alone, wouldn’t that minimize the amount of flexing near the leads within each session and over the long run? Of course, smooth, consistent, super-slow movements with no jerking is key. This “tricks” the body into dealing with a moderate weight as though it was a heavier weight in terms of hormone release, perceived resistance, etc., and it should be easier on the leads.

      Thanks.

      Dave

  4. Watch out for overhead high resistance which forces a more compressive force on the leads. If only doing a couple of sets no problem, if doing extreme amount of setsthis is an issue.

    There are lots of muscles in the body to get the metabolism going, put your emphasis into these. Glutes, hamstrings, quads, abs. You also don’t have to lift weights to get a resistance workout, you can use your body as resistance. Am thinking of activities such as yoga,martial arts, tai chi, pilates, TRX, lunges, squats, as I mentionioned planks.

    I would love to tell you there is a middle ground however there are issues with pacemaker leads, it is the challenging part of medicine. They need to be soft, flexible and pliable however the covering wears down or can develop breakdown regardless of the weight lifting thing. Make sure you follow the recalls on leads, see your physician regularly and get their input. Unfortunately from an outsider perspective that is the best advice I can offer at this time.

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