FREQUENTLY ASKED QUESTIONS Electromagnetic Compatibility Guide
For Implantable Cardiac Devices
Activities Post-implant
The goal is for you to lead a normal life as soon as possible after receiving your implanted heart device. Here are suggested precautions to follow during your recovery period. Your physician will provide you with specific directions based on your current medical condition and history.
Q: What activities can I resume?
A:Generally your device will not keep you from getting back into most activities and hobbies (i.e. bowling, tennis, gardening, etc.).
Q: When can I return to exercise?
A: As a general rule you can return to gentle exercise as soon as you feel able, but it is important that you adhere to any exercise restrictions provided by your doctor. Certain activities can contribute to the dislodgement of your new pacemaker leads.
For the first six weeks:
- Avoid lifting more than 5kg
- Avoid activities requiring you to over-reach or over-stretch (accessing high cupboards, fishing, swimming, golfing, playing lawn bowls, hanging out washing, vacuuming, etc.).
- Avoid activities that involve stretching through the body, such as yoga or pilates. Children should also avoid activities such as jumping on trampolines and swinging on monkey bars.
These restrictions only apply for the first six weeks post-implant, but it is important to check with your doctor prior to engaging in, or returning to, any heavy exercise such as running or gym routines.
Q:What do I need to know about travelling with a cardiac device?
A:Medtronic operates in many countries worldwide, with follow-up services provided at various locations by clinics and doctors. You should consult with your doctor to ensure there are no immediate health concerns preventing you from travelling safely.
Here are some helpful tips for travelling with cardiac devices:
- Ensure you copy your Device Identification Card in case your original is lost or stolen.
- Airport security staff are used to seeing people with cardiac devices. If you have any concerns at checkpoints, present them with your Device Identification Card.
- In the event of any issues while travelling, we recommend you go to the nearest hospital as soon as possible. If necessary, the hospital will arrange to have your device checked.
Q: Can I drive?
A: Driving restrictions are imposed by the Roads and Maritime Services regulations, and will vary based on your underlying medical condition.
Under certain circumstances, you may be excluded from driving for a period of time. You should consult with your doctor prior to driving.
Q: Will I be able to return to work?
A: Most patients are able to return to work after their device implant. You and your doctor will make this decision. The timing will depend on many things, including the type of work you do.
Q: Will I be able to resume sexual activity?
A: Intimacy is a normal part of life. We understand patients resume sexual activity when they feel comfortable. However if you have a question, it may be helpful to have a conversation with your doctor.
Q: Will my ICD deliver a shock during intimacy or daily activities?
A:It is rare. Your ICD is programmed to allow your heart rate to normally rise without treatment shocks being delivered. Your device should only deliver a shock when your heart rate meets the specific criteria programmed by your doctor.
If in doubt about an activity, always discuss with your doctor.
MRIs
Q: Are heart devices MR-compatible?
A: Currently, most heart devices are not considered safe in an MRI environment because the MRI could change the settings and/or temporarily affect the normal operation of the heart device. Medtronic has CRT-D, ICD and pacing systems which are approved for use in the MRI environment. These systems have an innovative design, developed so that under specific conditions, patients may safely undergo MRI scans. Talk to your doctor about the pacemaker, ICD and CRT options available to you and determine if your current or future cardiac system allows you safe access to an MRI scan.
Q: Can I have an MRI scan with my device?
A: An MRI scan uses magnetic fields to create an internal view of the body. You can undergo an MRI scan as long as you meet the patient eligibility requirements that Medtronic provides to your doctor. Discuss your eligibility for an MRI with your heart doctor.
Q: What if my doctor recommends an MRI scan and I don't have an MRI conditional device or leads?
A: Your doctor should discuss all potential benefits and risks of an MRI scan with you. Present your ID card to the doctor recommending the scan. This card will advise them to contact your attending heart doctor. If needed, your doctor can seek more information from a Medtronic representative.
Q: If I had an MRI scan, has this affected my heart device?
A: Your doctor can determine if there is an effect on your heart device. If you did not see your doctor after an MRI, contact your doctor.
*The Medtronic SureScan® pacing system is MR Conditional designed to allow patients to undergo MRI under the specified conditions for use. A complete system, consisting of a Medtronic SureScan® device and one or more SureScan® compatible leads, is required for use in the MRI
Anti-Theft Detectors and Airport Security Systems
Q: Can I go through anti-theft detectors?
A: Yes. Anti-theft detectors in stores and libraries generate electromagnetic fields that can “sense” embedded tags on merchandise. It may be possible, under unique circumstances, for these fields to temporarily affect the operation of your heart device. Significant effects from interference are unlikely if you pass normally through the detectors.
It is recommended that you:
- Be aware of anti-theft detectors
- Walk through at a normal walking speed
- Don’t linger close to the detection system equipment. If you are near an anti-theft system and feel symptoms, promptly move away from the equipment. Your heart device will resume its previous state of operation when you move away from the equipment.
Q: Can I go through security systems such as those found in airports and courthouses?
A: Given the short duration of security screening, it is unlikely that your Medtronic device will be affected by metal detectors (walk through archways and hand-held wands) or full body imaging scanners (also called millimetre wave scanners or 3D imaging scanners) such as those found in airports, courthouses and jails. However the metal case of your heart device could set off a metal detector.
To minimise the risk of temporary interference with your heart device while going through the security screening process, avoid touching metal surfaces around any screening equipment. Do not stop or linger in a walk-through archway; simply walk through the archway at a normal pace. If a hand-held wand is used, ask the security operator not to hold it over your device and not to wave it back and forth over your device.
You may also request a hand search as an alternative. If you have concerns about these security screening methods, show your device identification card, request alternative screening, and then follow the instructions of the security personnel.
Household Magnets
Q: Do magnets affect pacemakers and implantable defibrillators?
A: Even though most electromagnetic fields in the home environment will rarely affect the function of a pacemaker or implantable defibrillator, it is recommended you keep any item containing magnets at least 15cm away from your pacemaker or implantable defibrillator. The reason for this is because there is a small magnetically activated switch built into the electronics of pacemakers and implantable defibrillators.
This internal switch is designed to close when a magnet of enough strength is placed over it. When the internal switch is closed in the pacemaker, the device paces the heart at a continuous pre-set rate (which could be different than the rate your doctor programmed). When the internal switch is closed in an implantable defibrillator, it prevents it from delivering different therapies.
You may not always know if an item has a magnet in it. However, if you use household items as they are intended, and they are properly maintained, they should have no effect on your heart device. This includes microwaves, kitchen appliances, cordless phones, radios, televisions, video games, CD players, hair dryers, electric shavers, electric toothbrushes, electric blankets, leaf blowers, lawn mowers, garage door openers, computers and small shop tools. Note: some items of clothing, such as maternity / nursing bras, may contain concealed magnets within the garment.
If you mistakenly place a magnet too close to your heart device, simply move the item away. Removing the magnet returns the pacemaker or implantable defibrillator back to its previous, normal programming.
The use of magnetic mattress pads and pillows is not recommended since it would be difficult to keep a 15cm separation from your heart device.
Welding and Chainsaws
Q: I read in my patient manual that I should avoid welding and the us eof chainsaws. Why?
A: Unlike most other household power tools, welders and chainsaws are two power tools that may have a higher tendency to temporarily affect the normal function of your pacemaker or implantable cardioverter defibrillator.
Q: What if I need to use a welder or chainsaw?
A: It is recommended you avoid welding and the use of chainsaws. We understand some individuals may need to still use a welder or chainsaw; any decision you make to use these tools should be made in consultation with your heart doctor. Your doctor can advise you as to the degree of risk these responses pose for your medical condition. Aprons or vests will not effectively shield your pacemaker or implantable defibrillator from the EM energy generated by these tools. It is recommended you follow the guidelines of use in this brochure.
Chainsaw Considerations:
- The motor of an electric chainsaw held 15cm away from a heart device poses less risk of affecting your pacemaker or implantable defibrillator than the ignition system of a fuel-powered chainsaw.
- If using a fuel-powered chainsaw, maintain
- a 30cm distance between the components of the ignition system and your heart device. Also, it is better to use one that is built with the spark plug located away from the hand grips.
- Immediately stop cutting and turn off your chainsaw if you start feeling light-headed
- or dizzy, or you believe your implantable defibrillator has delivered a shock.
- Do not work on the engine while it is running.
- Do not touch the coil, distributor, or spark plug cables of a running engine.
Note: The use of a fuel-powered chain saw is not recommended because your hands and body come in close contact with the electric spark-generating components.
Welding Considerations:
- Limit welding current to less than 160 ampere range.
- Work in a dry area with dry gloves and shoes.
- Maintain a 60cm distance between the welding arc and your heart device.
- Keep the welding cables close together and as far away as possible from your heart device. Place the welding unit approximately 1.5m from the work area.
- Connect the ground clamp to the metal as close to the point of welding as possible. Arrange the work so the handle and rod will not contact the metal being welded if they are accidentally dropped.
- Wait several seconds between attempts if having difficulty starting to weld.
- Work in an area that offers firm footing and plenty of room for movement.
- Immediately stop welding and step away from the area if you start feeling light-headed
- or dizzy, or you believe your pacemaker or implantable defibrillator has delivered a shock.
- Maintain a 30cm distance between the components of the ignition system and your device implant site when operating the welder.
- Work with an informed person who understands these considerations.
Follow-Up Care and Monitoring
Q: Is follow up required for my cardiac device?
A: Yes, now that you have received your cardiac device, follow-up is required to ensure that therapy is optimal. Timing for follow-up varies from place to place and from doctor to doctor, but your first appointment will usually occur within six weeks after surgery, and the second appointment usually three to four months later. After the second appointment, follow-up will depend on your doctor’s preference and his/her assessment of your condition; but these visits will usually occur every six to twelve months.
You should receive an appointment for your first follow-up visit before you leave the hospital. As a general rule, you should see your heart doctor at least every twelve months.
In addition to these check-ups with your doctor, your clinic or practice may choose to have your heart device checked through remote monitoring. This remote monitoring can replace some visits, but not all. Your doctor may still need to see you in their clinic or practice to perform a physical examination, or to adjust your heart device settings or medications.
During these check-ups your doctor may:
- Monitor the battery status of heart device.
- Check the leads to determine how they are working with the heart device and your heart.
- Review your heart device settings to ensure they are programmed appropriately to your medical needs.
- Make programming adjustments to your heart device.
Q: What should i do with the device identification card?
A: You will be provided with a temporary (paper) device identification card prior to leaving the hospital. Carry this card with you at all times so that it is available in the event that you require medical attention.
A permanent card will be sent to your home address within eight weeks. If you do not receive your card, or your details change, please contact Medtronic and enquire about Device Identification Cards. On receipt of your permanent card, store the temporary one as a backup.
Your ICD is designed to protect you from dangerous heart rhythms. Because of this, you may experience unexpected shocks.1-2
Shocks can happen, but are not necessarily a sign of trouble. Shocks may be uncomfortable, but your ICD is your best protection against sudden cardiac arrest.3
Be prepared and have a shock plan in place.
- Discuss and confirm your shock plan with your clinic or doctor.
- Always carry your device identification card and an updated medication list in your wallet or purse.
- Remember to dial 000, or the emergency number in your area, in an emergency.
- Make sure family members and co-workers are aware of your shock plan.
- Never drive yourself to the hospital.
- Your remote monitor should never be used as a substitute for emergency care. Only transmit when you have been instructed to do so.
*This does not apply to patients with a pacemaker.
1
Sears SF, Shea JB, Conti JB. How to respond to an implantable cardioverter-defibrillator shock. Circulation. June 14, 2005;111(23):e380-382.
2
Mishkin JD, Saxonhouse SJ, Woo GW, et al. Appropriate evaluation and treatment of heart failure patients after implantable cardioverter-defibrillator discharge: time to go beyond the initial shock. J Am Coll Cardiol. November 24, 2009;54(22):1993-2000.
3
Zipes DP, Roberts D. Results of the international study of the implantable pace-maker cardioverter-defibrillator. A comparison of epicardial and endocardial lead systems. The Pacemaker-Cardioverter-Defibrillator Investigators. Circulation. July 1, 1995;92(1):59-65.