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AED with a Pacemaker: Can you use a defibrillator on someone with a pacemaker?

AED with a Pacemaker: Can you use a defibrillator on someone with a pacemaker?

November 08, 2021 | Last Updated: October 20, 2021
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People with pacemakers implanted in their chests can experience cardiac arrest, too. You can use an AED on someone with a pacemaker, but there are some important things to know first.

What is a pacemaker?

Our hearts each have their own internal pacemaker called the sinoatrial (SA) node or sinus node. The SA node is a collection of cells in the top of the right corner of the heart that makes electrical impulses. These pulses cause your heart to beat. 

An artificial pacemaker is a battery-powered electrical medical device that emits pulses to the heart to help it beat when the SA node, or some other part of the heart, is not working effectively and keeping the heart from beating correctly. Pacemakers stimulate the heart's muscles and regulate its contractions to keep blood pumping through the body. When set correctly, a pacemaker helps make sure the heart beats at a steady pace to meet an individual's needs, both at rest and when the person is active.

Pacemakers can be used to treat the following heart conditions:

  • When the heart beats too slow, too fast, or at random
  • An accelerated heart rate following a heart attack

How to identify when someone has a pacemaker

People with medical devices of any kind typically carry medical alert cards in their wallets, or wear medical alert jewelry. However, everyone is different and when someone has collapsed, time is of the essence. You can check for a pacemaker visibly fairly quickly. Pacemakers look like a small bulge under the person’s skin (under a scar) on the upper chest or abdomen (usually on the victim’s left side).

How to use an AED on someone with a pacemaker

To use an AED on a person with a pacemaker suffering SCA, you will need to make sure that you call for help, perform CPR, and initiate a lifesaving shock once an AED has been located. 

STEP 1 – CALL: Recognize Cardiac Arrest and Call 911

Scene Safety: perform a quick survey of the scene to make sure that it’s safe for you to help

Check for responsiveness: if the victim is not responsive and not breathing normally, they might be in cardiac arrest

Call 911

STEP 2 – PUSH: Perform CPR

Start CPR: push hard and fast on the center of the chest. If there are other people around, ask them to assist you in calling 911 and getting the AED.

STEP 3 – SHOCK: When the AED Arrives  

Here are the steps for using an AED on someone with a pacemaker:

    1. Turn on the AED and follow the audio instructions.
    2. Remove all clothing surrounding the patient’s chest (including bra).
    3. Locate the pacemaker.  Usually, these implants are placed on the upper left side of the chest below the collarbone. However, surgeons may place them on the right side of the chest if a pre-existing condition prevents the doctors from positioning it on the left. Scan both places visually.
    4. Apply the AED pads to the person’s chest’s bare skin. Make sure the person’s chest is dry. Position the pads at least 3 cm away from the pacemaker and around the upper right side of the chest. Even though companies design pacemakers to withstand shocks from AEDs, it is crucial to ensure the pads are placed far enough away from the device to mitigate any risks.
    5. Allow the AED to analyze the person’s heart rhythm.
    6. Deliver a shock (if needed): the AED will determine if the person is in cardiac arrest and if a shock is needed. Make sure no one touches the person as the AED delivers a defibrillation shock. 
    7. Perform CPR and Re-analyze. AEDs are programmed with the American Heart Association’s guidelines. The current AHA’s protocols call for two-minutes of CPR in between AED heart rhythm analysis periods. Follow the AED instructions. 
    8. Continue listening to the AED until EMS arrives and takes over the rescue.

FAQ

Take a look at some common questions we see about AEDs with a pacemaker

Can you do CPR on a person with a pacemaker?

Yes, you can perform CPR on a person who has a pacemaker. CPR chest compressions are done in the center of the chest. Since pacemakers are usually on the far left or right sides of the chest, CPR should not affect the device.

What about people with an implantable cardioverter-defibrillator?