Can You Use a Defibrillator on a Person with a Pacemaker?

Automated External Defibrillators, or AEDs, can be crucial in saving lives outside of the hospital. It’s thought that, in addition to following CPR, using an AED can improve survival rates from cardiac arrest by up to 50%.

People who are at particular risk of cardiac arrest and other heart problems might also use pacemakers and ICD (Implantable Cardioverter-Defibrillators) devices, which can help them manage healthy heart rhythms.

But what if someone with a pacemaker needs extra help from an AED? Can you safely use a defibrillator on someone with an ICD or a pacemaker? The answer is yes - AEDs can be used on individuals with these devices, as long as proper precautions are taken. In this guide, we’ll answer these questions and look at a few common AED myths.

Understanding Pacemakers and ICDs

Pacemakers and implantable cardioverter-defibrillators (ICDs) are surgically implanted devices designed to help manage irregular heart rhythms. Pacemakers work by sending electrical impulses to prompt the heart to beat at a normal rate, typically used in cases of bradycardia (a slow heartbeat) or irregular rhythms. ICDs, on the other hand, monitor the heart for dangerous arrhythmias, such as ventricular tachycardia or ventricular fibrillation, and deliver shocks when necessary to restore a normal rhythm. These devices are vital for preventing complications associated with arrhythmias and significantly reduce the risk of sudden cardiac arrest​ 

A defibrillator, particularly an automated external defibrillator (AED), is needed in cases of sudden cardiac arrest (SCA) when the heart’s electrical system fails, leading to chaotic or absent heart rhythms such as ventricular fibrillation or pulseless ventricular tachycardia. In such scenarios, neither a pacemaker nor an ICD may be able to respond effectively. 

Can a Defibrillator Be Used on Someone with a Pacemaker?

Yes, a defibrillator can be used on a person with a pacemaker or an implantable cardioverter-defibrillator (ICD), but precautions should be observed. When using an automated external defibrillator (AED), ensure the pads are placed at least one inch away from the pacemaker or ICD to avoid interference. AEDs are designed to assess the heart's rhythm and deliver a shock only when necessary. This means even if the pacemaker or ICD is functioning, the AED will not deliver an inappropriate shock due to its built-in safety mechanisms. However, if the pacemaker or ICD fails to correct life-threatening arrhythmias, the AED is essential for restoring normal heart rhythm​. 

Myths and Misconceptions about Defibrillators

Are AEDs dangerous for untrained bystanders? AEDs are designed to be user-friendly, providing clear instructions and analyzing heart rhythms to ensure shocks are delivered only when necessary. Even untrained individuals can safely and effectively use them during emergencies.

AEDs damage pacemakers? When pads are correctly positioned, the electric shock bypasses the pacemaker, preventing any significant interference. Additionally, AEDs defibrillators have built-in safeguards to prevent incorrect usage, making them safe for a wide range of medical situations, including in patients with implanted cardiac devices​

AEDs don’t work on people who are overweight? There’s a myth that AEDs won’t be effective on individuals who are overweight or obese. However, AEDs are designed to work on people of all sizes. The shock delivered by the AED is based on the electrical rhythms of the heart, and the device adjusts to deliver the right level of energy for the situation. No matter a person’s body type, AEDs will still function as intended if the pads are placed correctly. 

Are AEDs only for heart attacks? AEDs are often associated with heart attacks, but they are specifically designed to treat sudden cardiac arrest (SCA), which is caused by an abnormal heart rhythm, not a heart attack. Sudden cardiac arrest can happen with or without a heart attack, and an AED is crucial in treating it. 

Statistics show that 90% of cardiac arrest patients survive when they receive AED shocks in the first minute. Every second counts – so don’t waste them wondering whether or not pacemakers are compatible with defibrillators!

Training and Skills for AED Use

Many modern AED devices are designed to offer in-use guidance, meaning members of the public can use them, if in a public area, in the event of an emergency. However, it is still important for professionals, such as first responders, and members of the public to learn how to use AEDs. 

For example, people fitted with pacemakers and ICDs, i.e., those with pre-existing heart conditions, are likely to be at higher risk than those without such fittings. Therefore, it’s wise to learn about AED pad placement, appropriate use, and what to look for in a quick visual inspection of your patient. 

As mentioned, you might typically see pacemaker scarring or slight chest lumps that suggest your patient has internal devices. In the event of having a cardiac arrest, it’s highly unlikely the victim will be able to tell you if they have a pacemaker or not – so, it’s better to be aware of what to look for. 

Just as it’s important to refresh first aid training and the basics of CPR, it’s just as important that building personnel know how to use AEDs effectively – don’t overlook the value of investing in training for your team! 

Do also take care to engage your team on how to use different types of defibrillators – such as manual devices – wherever possible. 

How to Perform CPR on People with Pacemakers

In the event of someone with a pacemaker suffering a cardiac arrest, it’s vital to follow standard CPR procedures, regardless of using AEDs. 

The basics of CPR still apply with people fitted with pacemakers. However, you should adjust your compressions slightly to avoid disrupting where the implant is fitted. Apply compressions quickly and firmly – between 100 and 120 per minute – close to the centre of the chest, and away from the pacemaker site. 

Simply being mindful of a pacemaker or ICD during CPR is enough – you can usually tell if someone has a fitting if they have a small bump under the skin, or if there is chest scarring. In which case, it is better to be safe rather than sorry, and to avoid damaging the device or causing harm to the patient.

Conclusion

It’s a myth that you can’t use AEDs on someone with a pacemaker or an ICD. In fact, in many cases, doing so will make the difference between life and death. 

Therefore, always make sure to account for potential pacemaker fittings before using an AED, consult any manuals provided, and top up your team’s training – even knowing the basics can help to save lives in the event of an emergency. 

FAQ on Using a Defibrillator on a Person with a Pacemaker

Let’s close our guide with some commonly asked questions about AEDs and pacemakers.

Can a defibrillator cause electrical interference when used on a metal surface?

Yes, using a defibrillator directly on a metal surface can cause interference and stop an AED from working correctly. However, it is usually safe to use an AED on a patient who is lying on a metal surface. Devices such as metal detectors, cellphones, and headphones are unlikely to cause interference or impede AEDs, either.

What if the pacemaker or ICD is delivering a shock when I use the defibrillator?

You can still use an AED alongside an ICD when attending to a patient. The AED pads should be placed at least one inch away from the implanted device to avoid interference. The AED will analyze the heart rhythm and determine if a shock is necessary. AED’s built-in safety mechanisms will guide appropriate action. Experts agree that it’s safe to use general CPR while ICDs are in effect, too. 

Sources

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