ACLS Protocol for Patients with Pacemaker or Defibrillator
An implanted pacemaker and/or defibrillator can be a life-saving device for patients with cardiac conditions. However, there may be situations where external defibrillation or cardioversion is required. The question then arises whether a patient with an implanted pacemaker or defibrillator can still receive these procedures.
External defibrillation and cardioversion are medical procedures used to restore the heart’s normal rhythm. Each involves delivering a controlled electrical shock to the heart through paddles placed on the chest. While they may sound similar, they differ in the type of shock used and the heart’s underlying rhythm.
It is important to understand the difference between elective cardioversion for rhythms such as atrial fibrillation/flutter and defibrillation to treat life-threatening ventricular fibrillation or pulseless ventricular tachycardia. In an emergency situation defibrillation should not be delayed! The device can be assessed after the life-threatening arrhythmia is treated.
Patients with Pacemakers
A pacemaker is a small device implanted under the skin near the clavicle to regulate the heartbeat. Pacemakers send electrical signals to the heart to help it beat regularly. The device can be programmed to adjust the heart rate to the patient’s needs.
Patients with pacemakers still require external defibrillation if they experience ventricular fibrillation (VF) or ventricular tachycardia (VT).
However, when delivering the electrical shock, the defibrillator pads should be placed at least one inch away from the pacemaker. The pacemaker should be interrogated after an external defibrillation to ensure it continues to function properly.
Patients with Defibrillators
An automatic internal cardiac defibrillator (AICD) is a device that can detect and treat dangerous arrhythmias. It can deliver a shock to the heart to restore a normal rhythm if needed. Most modern defibrillators also function as pacemakers.
When a patient with an AICD develops VF or sustained VT their device should provide a shock to restore a normal rhythm. When this fails an external defibrillation becomes necessary. When a patient with an AICD requires an elective external shock for cardioversion for atrial fibrillation or flutter, the defibrillator’s function may need to be temporarily turned off during the procedure. This is to prevent the defibrillator from interfering with the external shock and potentially delivering an unnecessary shock to the patient.
Anytime a patient with an AICD receives an external shock it is imperative the device be interrogated afterwards to ensure proper function.
In summary, patients with implanted pacemakers or defibrillators can still receive external defibrillation or cardioversion when needed. The approach to the procedure may vary depending on the patient’s specific situation, but with proper precautions, the procedure can be performed safely.
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