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Living with Pacemakers, Defibrillators, Pumps & Ventilators

A practical safety guide for anyone who relies on a device that is implanted or worn — a pacemaker or defibrillator (ICD), an insulin pump or glucose monitor, an implanted drug pump, or a home ventilator, CPAP or BiPAP. It covers the warning signs that need 911, magnets and everyday electronics, electrical treatments, MRI and airport screening, and planning for a power cut.

Know these emergency signs before you need them:

  • Defibrillator (ICD) shocks. Go to a hospital emergency department (call 911) if you feel several strong shocks in a short time, or you have symptoms of a heart attack or warning signs of cardiac arrest. If you feel one or two strong shocks and the symptoms go away, call your healthcare provider for an appointment that day or the next. Always tell your provider about any shock (NHLBI). If you wear a defibrillator vest (WCD) and it gives a warning sound, get into a safe position because you may faint, and warn others to step back (NHLBI).
  • Pacemaker trouble. If a pacemaker isn’t working, you may feel short of breath, dizzy or faint, and you should call your doctor immediately (NHLBI). The NHS says to get emergency help (999 in the UK; 911 here) for severe difficulty breathing, a tight or heavy chest, pain that spreads to the arms, back, neck or jaw, very pale, blue or grey lips or skin, or sudden confusion, and not to drive yourself (NHS). Fever, chills, or pain or redness where the device sits can mean infection, even 6 months or more after surgery (NHLBI).
  • Insulin pump problems. Call 911 for extremely high blood sugar with nausea, vomiting, shortness of breath, confusion or loss of consciousness, or for extremely low blood sugar, low blood sugar that doesn’t respond to fast-acting carbohydrates, or low blood sugar with confusion or loss of consciousness (FDA). A clogged pump can lead to diabetic ketoacidosis (DKA); go to the emergency room or call 911 if your blood sugar stays at 300 mg/dL or above, your breath smells fruity, you are vomiting and can’t keep food or drink down, or you have trouble breathing (CDC).
  • Ventilator alarms or power failure. Respond quickly to every alarm, and know when to call your doctor or 911 — your team should teach you and your caregivers this before you go home (NHLBI). If you depend on a device to keep you alive, the FDA says to seek emergency services immediately when something goes wrong in a disaster (FDA).
  • Implanted drug pump (for example a baclofen pump). If a pump malfunction or withdrawal is suspected, the FDA-approved label says to go to a hospital immediately (FDA-approved label, DailyMed).
  • CPAP or BiPAP mask with magnets. If you or anyone close to the mask has a pacemaker, ICD or other listed implant, the FDA says to stop using a recalled magnetic mask and switch to a non-magnetic one (FDA).

Don’t wait for a chiropractic, acupuncture, massage or coaching appointment with any of these.

Who this guide is for

Many people rely on a device that does part of the body’s job: it keeps a heart rhythm steady, delivers insulin, doses a medicine into the spine, or breathes for them. This guide covers the main kinds — pacemakers and ICDs, insulin pumps and glucose monitors, implanted drug pumps and home ventilators, CPAP and BiPAP — with a focus on safety around everyday life and around the complementary care MBHA members ask about. It does not replace your device clinic or manufacturer’s instructions. For the conditions behind the devices, see our Heart guide, Diabetes guide, and, for implants more broadly, Metal Implants & Safety. A guide to sleep apnea is planned.

What these devices do

  • Pacemaker: sends small electrical pulses to help the heart beat at a normal rate and rhythm (NHLBI).
  • ICD: monitors your heart rhythm and delivers shocks if it senses a dangerous rhythm; most new ICDs can also act as pacemakers (MedlinePlus).
  • Insulin pump: delivers insulin under the skin through a small plastic tube, continuously, on demand before meals, or to correct high glucose (FDA). A continuous glucose monitor (CGM) uses a small sensor to estimate your glucose every few minutes and can sound an alarm when it is too low or too high (NIDDK).
  • Home ventilator: a mechanical ventilator, or breathing machine, moves air in and out of the lungs when a condition makes it very hard to breathe (NHLBI). It can be used at home when the need is long term and your condition is stable, usually through a trach tube or face mask (NHLBI).

Magnets and everyday electronics

Many implanted devices have a “magnet mode” that doctors use on purpose. The FDA says consumer electronics with strong magnets, such as certain phones and smart watches, can switch some devices into that mode until the magnet is moved away. A defibrillator might then be unable to detect a fast heart rhythm, or a pacemaker might change how it paces (FDA).

  • Keep it six inches away. The FDA recommends keeping such electronics at least six inches (15 centimeters) from an implanted device, not carrying them in a pocket over it, and using your home monitoring system to check the device if you have one. The FDA believes the risk is low and is not aware of adverse events from this issue (FDA).
  • Phones and headphones. Use speaker phone or hold the phone to the ear on the opposite side from your device, don’t keep it in a shirt pocket, and wear headphones, which usually contain a magnet, as far from the device as possible (NHLBI).
  • Household items. Microwave ovens, major appliances, electric blankets and heating pads are usually safe if working properly, but powerful electrical or industrial equipment such as welding machines or electric pet fences can interfere (NHLBI). For an ICD, also keep a safe distance from power tools and avoid leaning over car engines (NHLBI).
  • If something seems to disrupt your device, step away from it so the device can return to normal, and talk to your doctor (NHLBI).

Magnetic masks and magnet products

In 2024 the FDA told patients about recalled ResMed AirFit and AirTouch CPAP and BiPAP masks with magnetic headgear clips. The magnets can cause injury or death if they interfere with implants such as pacemakers, ICDs, neurostimulators, shunts, aneurysm clips, cochlear implants and “implantable ports and pumps (such as insulin pumps)”. The risk applies to anyone in close physical contact with the mask, not only the wearer, and the FDA says to keep the mask at least six inches from such a device (FDA). Check any mask you use, and ask your supplier if you are unsure.

Magnet therapy products raise the same question. NCCIH says some magnets may interfere with medical devices such as pacemakers and insulin pumps (NCCIH); see our Magnet Therapy guide. We did not find an FDA or NIH statement about magnetic mattress pads, bracelets or pillows specifically. MBHA caution: ask your device clinic before using any magnet product, and don’t sleep on one that a device-wearing partner shares until they have checked.

Electrical treatments, heat and body work

NHLBI lists several medical and dental procedures that can affect a pacemaker, including MRI, electrocautery in surgery, microwave diathermy for physical therapy, radiation therapy, shock-wave lithotripsy and TENS (transcutaneous electrical nerve stimulation); the effects depend on your device, and you should always tell any doctor or dentist and show your ID card (NHLBI). Research reports show why:

  • A case report described a man with a biventricular ICD who felt dizzy and had a slow heart rate when he used his TENS unit; testing found interference with pacing, though initial testing right after implant had been normal (Pyatt et al., 2003).
  • A hospital review of ICD patients found seven who got inappropriate shocks after exposure to outside electrical interference, including a hydro-massage bath and TENS (Occhetta et al., 2006).
  • A review of case reports of electroacupuncture lists ICD shock and cardiac emergencies among the events clinicians should be cautious about (Park et al., 2020).

We did not find an FDA or NIH statement on infrared saunas or far-infrared heat and pacemakers. NHLBI says heating pads and electric blankets are usually safe if working properly (NHLBI), and the FDA’s heat-and-humidity tips for home devices include wiping them dry and keeping them out of direct sunlight (FDA). MBHA caution: before using a sauna, hot tub or infrared device, read your pump or implant instructions and ask your device clinic or diabetes team.

MRI, X-rays and radiation

Tell the MRI technologist about any implant, including pacemakers and drug pumps, and bring your implant card; some devices are MR Safe or MR Conditional, meaning they can be scanned under specific conditions (FDA). NHLBI notes that MRI can interfere with some ICDs, that people with newer models may be able to have one safely, and that older ICDs can also be scanned when precautions are in place (NHLBI).

For wearable diabetes devices, most manufacturers recommend removing an insulin pump or CGM and leaving it outside the room for diagnostic X-ray imaging or radiation therapy. The FDA supports this when safe and practical, but notes that pausing a device may be a bigger risk than wearing it for a very low-risk scan, so decide with your doctor beforehand (FDA).

Airport security

  • Pacemaker or ICD: tell the TSA officer. TSA says you should not be screened by the walk-through metal detector if you have an internal medical device such as a pacemaker, and to consult your physician before flying (TSA). Carry your device ID card (NHLBI).
  • Insulin pump or glucose monitor: tell the officer where it is on your body; if it alarms, expect a self pat-down of the device and a hand test for trace explosives (TSA). Ask your pump supplier whether the pump can go through screening, and pack your pump supplies and insulin in carry-on luggage (FDA).
  • CPAP, BiPAP and APAP machines: they, with masks and tubing, may stay in their carrying case for X-ray screening, but may need to come out of the carry-on (TSA).

Insulin pumps and glucose monitors: day-to-day safety

  • Have a backup plan. The FDA advises working out, with your provider, how to resume your insulin if the pump fails, and keeping backup supplies and insulin injection supplies on hand (FDA).
  • Check the pump. Regularly check for leaks, kinks, air bubbles and blockages. Most pumps can detect blockages, though not always right away, and in general pumps cannot detect leaks (FDA).
  • Don’t ignore alarms, including low battery alerts, and keep spare batteries (FDA). Act quickly on a CGM alarm, and confirm a reading that doesn’t match how you feel with a finger-stick (NIDDK, FDA).
  • Know DKA. Early signs are being very thirsty and urinating a lot; later signs include fast, deep breathing, fruity breath, nausea and vomiting and stomach pain (CDC). NIDDK calls DKA a medical emergency (NIDDK).
  • Skin and products. Bug spray, sunscreen and lotions can damage a pump; wash and dry your hands first. Tell your provider about pain, leaking, pus-like discharge or redness at the pump site (FDA).

Implanted drug pumps

An implanted pump can deliver a medicine such as baclofen into the fluid around the spinal cord. The FDA-approved baclofen label warns not to stop it abruptly: sudden withdrawal, from any cause, has led to high fever, altered mental status, rebound spasticity and muscle rigidity, and in rare cases to organ failure and death. Early symptoms may include more spasticity, itching and tingling of the limbs. The label says sudden withdrawal occurs most often because of a catheter or pump problem or a missed refill, and tells patients and caregivers to attend scheduled refills, pay careful attention to pump alarms, and call right away if they miss a refill. Symptoms usually appear within hours to a few days (FDA-approved label, DailyMed). Other implanted pumps have different rules, so follow your own pump’s manual and clinic.

Home ventilators, CPAP and BiPAP

NHLBI says home ventilation is an option when you need a ventilator for the long term and are stable. Before you go home, your team should teach you and your caregivers to use and maintain the equipment and to recognize a serious problem. NHLBI lists a backup ventilator, an extra oxygen tank, batteries for sudden power loss, a suction machine, a humidifier, a pulse oximeter and a nebulizer as equipment you may need. Keep close watch over the ventilator, respond quickly to alarms, avoid secondhand smoke, keep your cell phone charged, and never change settings unless your doctor directs it (NHLBI). A guide to sleep apnea, where many people use CPAP, is planned.

See the power-cut and emergency plan below. Medicare Part B covers medically necessary durable medical equipment, including CPAP therapy (Medicare.gov), and Medicare makes monthly rental payments for frequently serviced items like ventilators for as long as they are medically necessary (Medicare booklet).

Dialysis and other equipment

Some people use several devices at once. Our Dialysis guide covers kidney machines. The FDA notes that medical devices such as dialyzers and IV pumps need safe water, so follow public announcements and your supplier’s instructions (FDA).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Regular device-clinic checks, in person and by remote monitoring; an ID card; device-specific advice on MRI and procedures; a diabetes team for pumps; a home-ventilation team and equipment supplier for ventilators. Medicare Part B covers medically necessary durable equipment such as CPAP and glucose monitors, generally 20% of the approved amount after the deductible. Other costs: cost estimate being researched. Devices work best with regular checks, working alarms and a plan for emergencies. Batteries wear out (ICDs last about 5 to 7 years), so replacement is part of the journey.
Chiropractic Gentle spinal care may fit some people, but electrical stimulation or diathermy equipment is a concern near pacemakers and ICDs. Tell your chiropractor about every device. About $55–$100 per self-pay follow-up visit; a first visit about $90–$200. We found little research on chiropractic care for people with these devices. Rare serious problems from spinal manipulation may be likelier with underlying health problems.
Acupuncture Plain needling uses no electric current; electroacupuncture does and needs caution with pacemakers and ICDs. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Reports describe ICD shocks with electroacupuncture, and one case report a pacemaker patient with no problems. Ask your device clinic first.
Herbal medicine Main concern is interactions: St. John’s wort, ginkgo and others with blood thinners and heart medicines; supplements that claim to treat diabetes. Cost estimate being researched. Many herb-drug interactions are theoretical, but a few are well documented. Tell your pharmacist about every supplement.
Massage therapy Gentle massage away from the device site; no firm pressure over a pump, pacemaker or port; no electric massage gadgets near a heart device. At one national chain, about $125–$160 for a 60-minute massage without a membership; memberships about $70–$90 a month. We found little research on massage in people with these devices. One lab study found a shoulder massage machine could interfere with a pacemaker model and an ICD.
MBHA Wellness Coach Emergency and power-cut plans, travel and airport routines, driving rules, alarms and checklists, and support for the worry that comes with a device. Cost estimate being researched. Supports — never replaces — your device clinic. A written plan helps you and your family act quickly.

Approach 1 of 6

Conventional medicine (AMA)

Pacemakers and ICDs

  • Follow-up: after a pacemaker, the NHS schedule is a check about 6 weeks after the procedure, another at 3 to 6 months, then at least every 12 months; the battery usually lasts 6 to 7 years (NHS). NHLBI says the first appointment is typically a month after implant, then every 6 to 12 months (NHLBI).
  • ICD visits are at least every 6 months. Your provider may adjust medicines to mean fewer shocks, check the device and battery (5 to 7 years), review remote-monitoring data and order heart tests (NHLBI).
  • Remote monitoring: your provider will arrange a monitor box at home for a new ICD (NHLBI), and the data may go to the manufacturer, your provider or both (NHLBI). Ask at visits about software updates that make a pacemaker more secure from hacking, and whether the manufacturer has announced any problems (NHLBI).
  • Recovery: avoid driving or heavy lifting for at least a week after a pacemaker, and follow your doctor’s advice on arm movement so wires aren’t shifted (NHLBI).
  • Report problems with an ICD or other device to the FDA’s MedWatch program (NHLBI).

Insulin pumps, CGMs and drug pumps

Your provider gives you starting pump settings, adjusts them at periodic visits, gives you “sick day rules” and emergency numbers, and your pump company runs a 24-hour customer line (FDA). Report pump problems to your provider, your supplier and MedWatch (FDA).

What it costs

Medicare Part B covers medically necessary durable medical equipment, including CPAP therapy and glucose monitors, and you generally pay 20% of the Medicare-approved amount after the Part B deductible (Medicare.gov). Medicare may cover a CGM if you take insulin or have had problems with low blood sugar and you or your caregiver have been trained (Medicare.gov). Part B may cover a non-disposable external insulin pump and the insulin used with it, and Part D may cover certain disposable pumps (Medicare booklet). For other costs, including device surgery: cost estimate being researched.

What to expect

Many people with pacemakers return to regular activities within a few days (NHLBI). Most people with an ICD can exercise, including strenuous activity, but may need to avoid full-contact sports (NHLBI). NHLBI also says you have the right to ask for a pacemaker to be turned off or removed if it is no longer beneficial (NHLBI), and that an ICD’s shock function can be turned off without surgery; you can put your wishes in an advance directive (NHLBI).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

We found little research on chiropractic care for people with pacemakers, ICDs, pumps or ventilators, and we did not find an FDA or NIH statement on it. What we do know comes from the device side. NHLBI lists microwave diathermy and TENS among treatments that can affect a pacemaker (NHLBI), and case reports describe TENS interfering with an ICD system (Pyatt et al., 2003).

MBHA caution: tell your chiropractor about your device before the first visit, bring your ID card, and decline electrical stimulation, diathermy or similar equipment unless your device clinic has approved it. NCCIH says serious side effects of spinal manipulation are very rare but may be more likely in people with underlying health problems that raise the risk of injury (NCCIH). Visits cost about $55–$100 per self-pay follow-up and $90–$200 for a first visit (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

NCCIH describes electroacupuncture as acupuncture where needles are stimulated with small electrical currents (NCCIH). That is the version to avoid until your device clinic agrees.

  • A systematic review of case reports of electroacupuncture found three deaths among its cases and named ICD shock, cardiac emergencies and electrical burns among the events to be cautious about (Park et al., 2020).
  • A case report described a woman with a pacemaker who had many electroacupuncture courses over two years with no complications. The authors note that published reports advise against electroacupuncture with pacemakers because of a theoretical risk, and say each patient should be considered individually (Vasilakos and Fyntanidou, 2011).

Complications from acupuncture generally are relatively few, but have come from non-sterile needles and improper technique (NCCIH). MBHA caution: tell your acupuncturist about your device, ask them to use plain needling without current, and check with your device clinic before electroacupuncture. We found little research on acupuncture for ICD, pump or ventilator users. Visits run about $125–$230 for a first private visit and $90–$185 for follow-ups, or about $50–$90 at community clinics (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Herbs and supplements don’t replace device care. The concern is what they do alongside your medicines, since many people with heart devices take blood thinners or heart rhythm medicines.

  • St. John’s wort speeds up how the body breaks down some drugs, lowering their effects. NCCIH lists heart medicines such as digoxin and ivabradine, and the blood thinner warfarin (NCCIH).
  • Ginkgo taken with warfarin is linked to a higher risk of major bleeding than warfarin alone (NCCIH).
  • Warfarin: MedlinePlus lists coenzyme Q10, echinacea, garlic, ginkgo, ginseng, goldenseal and St. John’s wort as products that may interact, and says not to start any without discussing it with your healthcare provider (MedlinePlus). The NHS says not to take St. John’s wort or vitamin K supplements while on warfarin (NHS).
  • NCCIH cautions that most herb-drug interactions are hypothetical, but attention is needed for drugs with a narrow safety margin, such as warfarin and digoxin (NCCIH).
  • Insulin pump users: NCCIH’s review of supplements for diabetes says a few have weak evidence of benefit for blood sugar, and some, like berberine, may interact with medicines. It reports that the FDA warns against products claiming to cure diabetes or replace diabetes medicine (NCCIH).

Before you start any herb or supplement, show the label to your pharmacist or device-clinic doctor. We don’t list doses here.

Approach 5 of 6

Massage therapy

We found little research on massage in people with these devices, and we did not find an FDA or NIH instruction on pressure over a device site. NCCIH says the risk of harm from massage appears low, with rare reports of serious effects such as a blood clot, nerve injury or fracture, some involving vigorous deep tissue massage (NCCIH).

MBHA caution: massage can be a comfort when you live with a device, but ask the therapist to avoid firm pressure over a pacemaker or ICD pocket, a pump site, a sensor, an infusion set or an implanted pump. Hold off on any new incision until your care team clears it. Pacemaker infection signs include redness and pain at the device site (NHLBI).

Be wary of electric massage equipment. A laboratory study of a shoulder massage machine with solenoid coils found it could interfere with a test pacemaker at up to 28 centimeters, and ventricular fibrillation was induced when it was brought near the electrode of an ICD in a test model (Yoshida et al., 2014). Massage chairs and handheld massagers were not tested in that study. A hospital review also recorded an inappropriate ICD shock after a hydro-massage bath (Occhetta et al., 2006). At one national chain, a 60-minute massage runs about $125–$160 without a membership (The Pricer).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach doesn’t manage your device, but can help you turn your clinic’s instructions into habits and plans.

Carry the basics

Driving after an ICD or a shock

The rhythms that trigger a shock can cause fainting and loss of control of a vehicle. NHLBI says many states require a wait of 6 months after an ICD placed because of cardiac arrest or a dangerous arrhythmia, and you may need to wait 6 months after a high-energy shock; people with an ICD are not legally allowed to operate commercial vehicles. Some providers aren’t familiar with these rules, so you may need to look them up yourself (NHLBI). After a pacemaker, your doctor will probably ask you to avoid driving for at least a week (NHLBI).

Travel

See the airport notes in the overview. For a pump, pack supplies in your carry-on, ask your supplier about screening, adjust for time zones with your provider, and for trips abroad check whether chargers and batteries will work (FDA).

Feelings about a device

Adjusting to an ICD can cause anxiety and stress, and some people develop post-traumatic stress after a cardiac arrest or ICD shocks; tell your provider (NHLBI). Using a ventilator at home can be stressful for you and your loved ones, so ask for help (NHLBI). See our Depression and Anxiety guides.

Another approach

Power-cut and emergency plan

Outages can last longer and be life-threatening for people who depend on home medical devices, and CDC advises identifying backup power for your medical equipment (CDC).

  • Tell the utilities. Notify your electric company and fire department that you have a medical device that needs power, such as a ventilator (FDA). NHLBI adds that utility companies will try to restore a ventilator household’s service quickly, and your team can write letters for them (NHLBI).
  • Know your options. Read the instructions or call your supplier or manufacturer to find out if your device can run on batteries or a generator (FDA). Keep batteries for sudden power loss and a backup ventilator if your team recommends them (NHLBI).
  • Generators: never run a generator or other gasoline engine inside a home, basement or garage, even with doors open (FDA, CDC); use a battery-powered or battery-backup carbon monoxide detector (CDC).
  • Oxygen and flames: use battery-powered flashlights or lanterns, not gas lights or torches, when oxygen is in use (FDA).
  • When power returns, check your device settings, because devices often reset to a default mode (FDA).
  • Insulin and pumps: keep extra pump parts and batteries, backup insulin supplies you know how to use, and a flashlight; most pump insulin products can be stored for up to 28 days at room temperature, but check yours (FDA). Throw away refrigerated medicine after a day or more without power unless its label says otherwise (CDC).
  • Damaged equipment: Original Medicare may cover repair or replacement of equipment such as a traditional insulin pump damaged or lost in an emergency or disaster (Medicare booklet).
  • Alarms and batteries: if your device appears damaged or you need a backup, call your distributor or manufacturer (FDA); never ignore a low battery alert (FDA).

Another approach

Before you try a new product or treatment

  1. Does it use a magnet, electric current or heat? If so, ask your device clinic first, and don’t rely on the seller’s word.
  2. Is it a mask, pillow, bracelet or mattress with magnets? Check the manufacturer’s implant warnings and consider anyone who shares your bed (FDA).
  3. Will it be near your device (six inches or less)? (FDA)
  4. Did you tell every practitioner about your device and show your ID card?
  5. Does your pharmacist know about every herb and supplement?
  6. Do you have a written plan for alarms, power loss and emergencies?

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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