Editing Pacemaker (section)

=== Magnetic fields, MRIs, and other lifestyle issues ===
A patient's lifestyle is usually not modified to any great degree after the insertion of a pacemaker. There are a few activities that are unwise, such as full-contact sports and exposure of the pacemaker to intense magnetic fields.

The pacemaker patient may find that some types of everyday actions need to be modified. For instance, the shoulder harness of a vehicle [[seatbelt]] may be uncomfortable if it falls across the pacemaker insertion site. Women will not be able to wear bras for a while after the operation, and later might have to wear bras with wide shoulder straps.

For some sports and physical activities, special pacemaker protection can be worn to prevent possible injuries, or damage to the pacemaker leads.

Pacemakers may be affected by [[Magnetic field|magnetic]] or [[electromagnetic field]]s, and [[Ionising radiation|ionising]] and [[acoustic radiation]]. However, a 2013 study found that "The overall risk of clinically significant adverse events related to EMI (electromagnetic interference) in recipients of CIEDs (cardiovascular implantable electronic devices) is very low. Therefore, no special precautions are needed when household appliances are used. Environmental and industrial sources of EMI are relatively safe when the exposure time is limited and distance from the CIEDs is maximized. The risk of EMI-induced events is highest within the hospital environment."<ref name=beinart>{{cite journal| last1=Beinart|first1=R|last2=Nazarian|first2=S| title=Effects of external electrical and magnetic fields on pacemakers and defibrillators: from engineering principles to clinical practice| journal=Circulation |date=24 December 2013 | volume= 128 | issue= 25 | pages= 2799–809 | pmid=24366589 | doi=10.1161/CIRCULATIONAHA.113.005697|doi-access=free| pmc=3908865}}</ref> The study lists and tabulates many sources of interference, and many different potential effects: damage to circuitry, asynchronous pacing, etc. Some sources of hazard in older devices have been eliminated in newer ones.

Activities involving strong [[magnetic field]]s should be avoided. This includes activities such as [[arc welding]] with certain types of equipment,<ref>{{cite journal |vauthors=Marco D, Eisinger G, Hayes DL | title = Testing of work environments for electromagnetic interference| journal = Pacing Clin Electrophysiol | volume = 15 | issue = 11 Pt 2 | pages = 2016–22 | date = November 1992 | pmid = 1279591 | doi = 10.1111/j.1540-8159.1992.tb03013.x | s2cid = 24234010}}</ref> and maintaining heavy equipment that may generate strong magnetic fields. Some medical procedures, particularly [[magnetic resonance imaging]] (MRI), involve very strong magnetic fields or other conditions that may damage pacemakers.

However, many modern pacemakers are specified to be [[Safety_of_magnetic_resonance_imaging#Implants|MR conditional or MRI conditional]], safe to use during MRI subject to certain conditions.<ref name=maass>{{cite journal |last1=Maass |first1=A. H. |last2=Hemels |first2=M. E. W. |last3=Allaart |first3=C. P. |title=Magnetic resonance imaging in patients with cardiac implantable electronic devices |journal=Netherlands Heart Journal |date=December 2018 |volume=26 |issue=12 |pages=584–90 |doi=10.1007/s12471-018-1192-3 |pmid=30406601 |pmc=6288036 }}</ref> The first to be so specified was the [[Medtronic]] Revo MRI SureScan, approved by the US FDA in February 2011,<ref>{{cite web | title=Revo MRI SureScan Pacing System – P090013|publisher=U.S. Food and Drug Administration - Medical Device Approvals and Clearances | date=24 February 2011 | url=http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm244469.htm | archive-url=https://web.archive.org/web/20121020065907/http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm244469.htm | archive-date=20 October 2012 | url-status=dead}}</ref> which was the first to be specified as MR conditional.<ref>{{cite web| title=Terminology |publisher=Magnetic Resonance Safety Testing Services | url=http://www.magneticresonancesafetytesting.com/Terminology.php|url-status=live| access-date=13 February 2023|archive-url=https://web.archive.org/web/20131011031738/http://magneticresonancesafetytesting.com/genpg.asp?pgname=Terminology|archive-date=11 October 2013}}</ref><ref>Husten, Larry. [https://www.forbes.com/sites/larryhusten/2013/02/13/fda-approves-second-generation-mri-friendly-pacemaker-system-from-medtronic/ "FDA Approves Second Generation MRI-Friendly Pacemaker System From Medtronic"]. ''Forbes'', 2013-02-13.</ref> There are several conditions to use of MR Conditional pacemakers, including certain patients' qualifications and scan settings. An MRI conditional device has to have MRI settings enabled before a scan, and disabled afterwards.<ref>{{Cite report|chapter-url=https://www.cardiovascular.abbott/content/dam/bss/divisionalsites/cv/pdf/guides/2b323673-151a-480a-9f93-06c2433ca230.pdf|title=MRI-Ready Systems Manual - MRI Procedure Information for the MR Conditional System|publisher=St. Jude Medical|year=2016|chapter=For physicians: V: Select and save MRI settings; VII: Disable MRI settings}}</ref>

{{As of|2014}} the five most commonly used cardiac pacing device manufacturers (covering more than 99% of the US market) made FDA-approved MR-conditional pacemakers.<ref>{{cite journal |last1=Ferreira |first1=António M |last2=Costa |first2=Francisco |last3=Tralhão |first3=António |last4=Marques |first4=Hugo |last5=Cardim |first5=Nuno |last6=Adragão |first6=Pedro |title=MRI-conditional pacemakers: current perspectives |journal= Medical Devices: Evidence and Research|date=7 May 2014 |volume=7 |pages=115–24 |doi=10.2147/MDER.S44063 |pmid=24851058 |pmc=4019608 |doi-access=free }}</ref> The use of MRI may be ruled out by the patient having an older, non-MRI Conditional pacemaker, or by having old pacing wires inside the heart, no longer connected to a pacemaker.

A 2008 US study found<ref>{{cite web
|url=http://www.bidmc.org/News/InResearch/2008/November/MP3PlayerStudy.aspx
|title=MP3 Headphones Interfere With Implantable Defibrillators, Pacemakers – Beth Israel Deaconess Medical Center
|publisher=www.bidmc.org
|access-date=2008-11-10
|archive-date=2010-09-27
|archive-url=https://web.archive.org/web/20100927014850/http://www.bidmc.org/News/InResearch/2008/November/MP3PlayerStudy.aspx
|url-status=dead
}}</ref> that the magnetic field created by some headphones used with portable music players or cellphones may cause interference if placed very close to some pacemakers.

In addition, according to the [[American Heart Association]], some home devices have the potential to occasionally inhibit a single beat. Cellphones do not seem to damage pulse generators or affect how the pacemaker works.<ref>{{cite web|title=What is a pacemaker?|url=http://hrmreview.net/what-is-pacemaker/|publisher=HRMReview|access-date=22 May 2014|url-status=dead|archive-url=https://web.archive.org/web/20140522160829/http://hrmreview.net/what-is-pacemaker/|archive-date=22 May 2014}}</ref> It is recommended that objects containing magnets, or generating a significant magnetic field, should not be in close proximity to a pacemaker. Induction cooktops, in particular, can pose a risk.<ref>{{cite journal |last1=Irnich |first1=Werner |last2=Bernstein |first2=Alan D. |title=Do induction cooktops interfere with cardiac pacemakers? |journal=EP Europace |date=May 2006 |volume=8 |issue=5 |pages=377–84 |doi=10.1093/europace/eul014 |pmid=16635999 }}</ref>

Before medical procedures, the patient should inform all medical personnel that they have a pacemaker. Having a pacemaker does not imply that a patient requires the use of [[antibiotic]]s to be administered before procedures such as dental work.<ref>{{cite journal |last1=Baddour |first1=Larry M. |last2=Epstein |first2=Andrew E. |last3=Erickson |first3=Christopher C. |last4=Knight |first4=Bradley P. |last5=Levison |first5=Matthew E. |last6=Lockhart |first6=Peter B. |last7=Masoudi |first7=Frederick A. |last8=Okum |first8=Eric J. |last9=Wilson |first9=Walter R. |last10=Beerman |first10=Lee B. |last11=Bolger |first11=Ann F. |last12=Estes |first12=N.A. Mark |last13=Gewitz |first13=Michael |last14=Newburger |first14=Jane W. |last15=Schron |first15=Eleanor B. |last16=Taubert |first16=Kathryn A. |title=Update on Cardiovascular Implantable Electronic Device Infections and Their Management |journal=Circulation |date=26 January 2010 |volume=121 |issue=3 |pages=458–77 |doi=10.1161/circulationaha.109.192665 |pmid=20048212 |doi-access=free }}</ref>