An automated external defibrillator (AED) delivers an electrical shock to restore a normal heart rhythm during sudden cardiac arrest. A common concern arises regarding the use of an AED on someone with a pacemaker. It is generally safe and often necessary to use an AED on an individual with a pacemaker, though specific precautions are important to consider.
Understanding Pacemakers and AEDs
A pacemaker is a small electronic device implanted under the skin, typically near the collarbone, that sends electrical impulses to regulate the heart’s rhythm. This device helps manage abnormal heart rhythms, such as those that are too slow or irregular. Pacemakers are designed to deliver precise, low-energy electrical signals to ensure the heart beats at a suitable rate.
An AED, in contrast, is designed to deliver a larger, therapeutic electrical shock to correct life-threatening arrhythmias like ventricular fibrillation. Its function is to restart the heart’s natural electrical activity when it has become chaotic or stopped. The perceived conflict between these devices stems from the idea that the AED’s strong shock might interfere with or damage the delicate electronics of a pacemaker. Modern pacemakers are generally designed to withstand external defibrillation, minimizing this risk.
Applying an AED Safely with a Pacemaker
When using an AED on someone with a pacemaker, the first step is to locate the pacemaker itself. It typically appears as a small bulge or scar under the skin on the upper chest, most commonly on the left side, though it can sometimes be on the right.
Once the pacemaker is located, place the AED pads at least one inch away from the device. Standard AED pad placement involves placing one pad on the upper right chest and the other on the lower left side of the rib cage, underneath the armpit. If the pacemaker is in the usual left upper chest position, the left pad might need to be shifted slightly more towards the side or even to the back to ensure it is not directly over the pacemaker. Similarly, if the pacemaker is on the right, the right pad should be adjusted.
The goal of this adjusted placement is to ensure the electrical current from the AED does not directly cross through the pacemaker. After placing the pads, follow the AED’s verbal commands, as the device will analyze the heart rhythm and instruct whether a shock is needed. Acting quickly is important, as delays in treatment for sudden cardiac arrest pose a greater risk than any minimal risk to the pacemaker.
Acting in an Emergency
In any cardiac emergency, immediately calling emergency services is the first and most important step. This ensures professional medical help is on the way. When someone is experiencing sudden cardiac arrest, the immediate threat to life outweighs concerns about the pacemaker.
The benefits of using an AED to restore a normal heart rhythm outweigh potential minor risks to a pacemaker. While a damaged pacemaker can be addressed by medical professionals, a life lost cannot be recovered. If a pacemaker’s presence is unknown or not visible, proceed with standard AED application. General guidelines for AED use are safe for most individuals, and hesitation can be harmful. After any shock, continue to follow the AED’s instructions, which may include performing CPR, until emergency medical services arrive.