Follow-up after Pacemaker Implantation
Pacemakers must be checked periodically to make sure that they are functioning correctly. Some general testing can actually be done over the phone, using a process called transtelephonic monitoring. This testing of the pacemaker may be done every 2 weeks for the first month after pacemaker implantation, then every month or 2 thereafter.
More detailed testing of the pacemaker must be done in person. These tests may be performed twice in the first 6 months after pacemaker insertion and then every 6 months thereafter. Checking the pacemaker at periodic intervals is important because the battery wears down over time and there is a small risk that one of the electrical leads implanted in the heart can "fracture" or malfunction.
In 2009, the U.S. Food and Drug Administration (FDA) approved the first wireless pacemaker. This device uses cellular technology to monitor the patient's condition, evaluate pacemaker function, and transmit this information to the patient's physician within minutes.
Special Considerations for Patients with Pacemakers
Patients who have a pacemaker should be aware of special considerations, including the following:
- Certain medications used to control and treat abnormal heart rhythm (called an antiarrhythmic agent) can affect the ability of the pacemaker to successfully stimulate the heart to contract. Therefore, pacemaker function must be rechecked when a patient begins taking these medications.
- Electromagnetic noise or interference (such as that generated by certain heavy industrial equipment) may impede pacemaker function or may even change the way a pacemaker is programmed to operate.
- An electric cautery device used during surgery can "confuse" the pacemaker, and the pacemaker may mistake the electric impulse generated by the cautery device for the electric impulses generated by the heart. Therefore, patients with pacemakers should be sure the surgeon is aware that they have a pacemaker. The surgeon may then consult with a cardiologist about any special steps to take during the surgical procedure.
- Patients with pacemakers should not undergo magnetic resonance imaging or MRI scan. The strong magnetic fields generated during this imaging procedure can affect the pacemaker and the presense of any implanted metal object in patients undergoing MRI scan is not advised and potentially dangerous. In February 2011, the FDA approved the first pacemaker designed to be used safely during MRI scan in certain patients.
- Cellular phones and other cellular devices can interfere with pacemaker functioning. Digital phones are more likely to cause problems than analog phones. Keeping cell phones at least 6 inches away from the pacemaker may reduce the risk for problems. Issues regarding cellular phones should be discussed with the patient's heart doctor.
- Walk-though metal detectors (e.g., used at airports) are not generally regarded as a significant problem for pacemaker functioning. In some older pacemakers, these metal detectors may inhibit the pacemaker for one or two heart beats, but this usually does not cause any symptoms. Because pacemakers are made of metal, patients should be aware that they are likely to set off the metal detector alarm. Patients should be sure to carry their wallet-sized pacemaker identification card while travelling. Handheld wand metal detectors can cause problems for pacemakers and should not be used near patients with a pacemaker.