Living with a pacemaker or ICD: phones, magnets, airports, MRI and sports

EHRA advises keeping your phone 15–30 cm away from the device. The FDA and NHLBI give a distance of at least 15 cm for phones and smartwatches. In practice, this means:

• Do not carry your phone in a pocket over the device.
• When talking, use the ear on the opposite side or the speaker mode.
• Keep headphones as far from the device as possible and do not put them in a breast pocket (NHLBI).

Some new smartphones have a strong magnet. According to EHRA, if such a phone is held directly over the device, it may turn off some ICD functions.

Sources differ on smartwatches: EHRA says there is no restriction, while the FDA says 15 cm. Follow the stricter advice, that is, 15 cm, and ask your own doctor for a definite answer.

According to EHRA and NHLBI, most household appliances cause no problems, but there are some exceptions:

• Induction cooktop: stay 50 cm away while it is on.
• Microwave oven and ordinary household appliances: no restriction, or usually safe.
• Garden tools: no restriction if they are properly grounded.
• Power tools: keep a safe distance, and do not lean over a running car engine (NHLBI).
• Welding equipment and electric fences for animals: may interfere with the device (NHLBI).

If you feel unwell near something, move away from it.

Tell the security staff that you have a device and show your card. You will probably be checked by hand. The sources make two specific points:

• NHS: a handheld metal detector must not be used over the device.
• NHLBI: walk-through gates carry little risk.

Always carry the card with you and show it to any doctor, dentist or security officer. According to NHLBI, the card lists the device type, the leads, the implantation date and your doctor's contact details.

Tell every doctor about your device. According to EHRA:

• MRI: the strong magnetic field may affect the device. Many manufacturers make pacemakers and ICDs that are MRI-compatible under certain conditions (MR-conditional), but caution is still needed: ask a radiologist or a cardiologist.
• X-ray and CT: no special precautions are needed.
• Dentist: usually no special precautions.
• Surgery: the team must know about the device, because electrocautery (stopping bleeding with electricity) may be used.
• Radiation therapy: affects how the device works only very rarely; this depends on the dose and the area treated; checks become more frequent.
• Lithotripsy (breaking up kidney stones): possible; ask your doctor.
• TENS (electrical nerve stimulation through the skin): not recommended.
• Cardioversion (restoring the rhythm with electricity): possible, with checks before and after.

Sources differ on returning to sports. EHRA: usually within one or two weeks, once the incision has been checked. NHS (pacemaker): no strenuous exercise for 4–6 weeks. Follow your own doctor's instructions. If you have an ICD, be sure to talk to your doctor before sports and driving.

EHRA advises avoiding sports with a risk of chest injury (rugby, boxing, martial arts). Sports with vigorous arm movements (volleyball, tennis, golf, rock climbing, basketball) may increase the risk of late damage to the lead.

On driving, EHRA says not to drive in the first weeks after implantation. Recommendations differ greatly between countries, and also between private and professional drivers. The restriction comes from the heart disease, not from the device, so driving rules should not be a reason to refuse a recommended device. Do not drive if you feel unwell, have chest pain or feel dizzy.

According to NHLBI, shortness of breath, dizziness or feeling as if you are about to faint may be a sign that the device is not working properly: call your doctor right away.

If an ICD delivers a single shock, EHRA advises checking whether you are injured, resting for a few hours and informing your treatment center. If there is more than one shock within 24 hours, contact your doctor or the center where the device was implanted very quickly. If a second shock comes a few hours after the first, go to a facility that can help ICD patients. If there is chest pain, shortness of breath, fainting, or a head injury while taking a blood thinner, call 103.