Implanted Defibrillator (ICD) Shock Storm and Pacemaker Malfunction¶

Millions of people worldwide live with a Cardiovascular Implantable Electronic Device (CIED) tucked beneath the skin of the upper chest (or abdomen/left side): either a Permanent Pacemaker (PPM) that prevents the heart from beating too slowly (bradycardia), an Implantable Cardioverter-Defibrillator (ICD) that detects and shocks lethal fast rhythms (ventricular tachycardia or ventricular fibrillation), or a Cardiac Resynchronization Therapy (CRT-P or CRT-D) biventricular device for heart failure. When an ICD delivers a sudden internal high-voltage jolt (which patients describe as "feeling like being kicked squarely in the chest by a horse"), or when a pacemaker fails to capture the heart muscle (pulse dropping below \(40\text{ beats per minute}\) with dizziness or fainting), or when the skin over the device pocket becomes red, swollen, or eroded, knowing the exact "1-Shock vs. 2-or-More-Shocks (Electrical Storm)" triage rule, knowing that touching a patient during an ICD shock is 100 percent safe for bystanders, and knowing how to place Automated External Defibrillator (AED) pads around an implanted device saves lives.

Do this now¶

1. Have the person sit or lie down flat immediately so they cannot fall and hit their head if the heart rhythm triggers another shock or brief blackout.
2. Apply the "1-Shock vs. Multiple-Shocks" Triage Rule (Heart Rhythm Society & AHA Guidelines):
   • CALL 911 / 112 / 999 IMMEDIATELY IF: The person received 2 or more ICD shocks within 24 hours; OR received 1 shock and has ANY ongoing symptoms (chest pain, shortness of breath, lightheadedness, palpitations, confusion, or nausea); OR the person fainted (lost consciousness) before or during the shock. Dial 911 in the United States and Canada, 112 across the European Union, 999 in the United Kingdom, or see all emergency numbers.
   • IF THE PERSON RECEIVED ONLY 1 SINGLE SHOCK and feels 100% normal, alert, and symptom-free within 60 seconds: Keep them lying or sitting calmly at home, have them trigger a manual remote transmission on their bedside home monitor (or smartphone app), and call their Cardiology / Device Clinic emergency on-call number immediately for same-day interrogation instructions. (If they start feeling unwell or get a second shock at any point, call 911 / 112 / 999 immediately.)
3. If the person collapses and is unresponsive and not breathing normally, start hands-on CPR immediately and attach an AED: NEVER hesitate out of fear of being shocked by their internal ICD.
4. Bystander Safety Fact: An internal ICD delivers about \(30\text{ to }40\text{ Joules}\) deep inside the heart muscle. If you are performing chest compressions or holding a patient at the exact millisecond their internal ICD fires, you cannot be injured, at most, you will feel a harmless, mild tingling buzz on their chest skin (if wearing nitrile medical gloves, you will feel nothing at all).
5. AED Pad Placement Rule Over a Pacemaker/ICD: Look and feel for the hard metal rectangle bulge under the skin below the left or right collarbone. Place the sticky AED pad at least \(2.5\text{ centimeters}\) (\(1\text{ inch}\)) away from the implanted device (or use front-and-back [anterior-posterior] pad placement), and let the AED analyze and shock normally.
6. If the ICD is firing repeatedly while the patient is WIDE AWAKE, calm, and talking normally ("Inappropriate ICD Shocks" from a broken wire or fast atrial fibrillation):
7. Keep the patient lying completely still and calm (crying, panicking, and moving speeds up the heart rate into the ICD's "shock zone," causing even more shocks).
8. Call 911 / 112 / 999 immediately and tell the dispatcher: "The patient is wide awake and being shocked repeatedly by their implanted ICD; we need advanced life support paramedics with a 12-lead ECG and a clinical device magnet."
9. Move any smartphone, smartwatch, magnetic wireless charger (MagSafe), e-cigarette/vape, or magnetic therapy brace at least \(15\text{ centimeters}\) (\(6\text{ inches}\)) away from the chest.
10. If the patient has a Pacemaker (or ICD) and develops severe dizziness, near-fainting, extreme fatigue, or a slow wrist pulse below \(40\text{ to }50\text{ beats per minute}\) (or constant rhythmic hiccuping/chest twitching):
11. Suspect Pacemaker Failure to Capture, Lead Dislodgement, or Battery Depletion. Lay the patient flat with legs slightly elevated, call 911 / 112 / 999, and retrieve their Wallet Pacemaker/ICD Identification Card (which lists the manufacturer: Medtronic, Abbott/St. Jude, Boston Scientific, Biotronik, or MicroPort, model number, and programmed settings).
12. Inspect the skin over the device pocket on the chest: If the skin over the pacemaker or ICD shows redness, swelling, warmth, tenderness, fluid/pus drainage, a purple blister, or the silver metal edge/wire poking through thinned skin (erosion), go to the Emergency Department the same day. Never squeeze, poke, or put a needle into a swollen pacemaker pocket, and never ignore a low-grade fever in a pacemaker/ICD patient (CIED infective endocarditis).

Emergency triage decision tree: ICD shocks, pacemaker failure, & pocket infection¶

Use this clinical flowchart within the first 60 seconds to manage any implanted cardiac device emergency.

flowchart TD
    Start["Emergency in a Patient with an Implanted<br/>Pacemaker (PPM), Defibrillator (ICD), or CRT Device"] --> EventType{"What is the Primary<br/>Device Problem?"}

    EventType -->|"PATIENT UNRESPONSIVE<br/>& Not Breathing Normally"| Arrest["CARDIAC ARREST (ICD Failed to Convert Rhythm):<br/>1. Call 911 / 112 / 999 & Start Chest Compressions NOW<br/>   (Safe to touch patient even if internal ICD fires)<br/>2. Attach AED: Place pad >= 2.5 cm (1 inch) away from<br/>   device bulge (or use Front-to-Back AP pad placement)<br/>3. Follow AED prompts without delay"]

    EventType -->|"ICD DELIVERED SHOCK(S)<br/>(Conscious Patient)"| ShockCount{"How Many Shocks Occurred<br/>& How Does Patient Feel?"}

    ShockCount -->|"2 OR MORE Shocks in 24 Hours<br/>(>= 3 Shocks = 'ICD ELECTRICAL STORM')<br/>OR 1 Shock WITH Chest Pain, Dyspnea,<br/>Dizziness, Fainting, or Palpitations"| StormER["IMMEDIATE 911 / 112 / 999 EMERGENCY:<br/>1. Lay patient flat & completely still (lowers adrenaline)<br/>2. Suspect VT/VF Electrical Storm OR Inappropriate Shocks<br/>   (from fractured lead / rapid AFib / T-wave oversensing)<br/>3. EMS/ER places 12-lead ECG; if inappropriate shocks on<br/>   monitor, clinician tapes Ring Magnet over ICD to inhibit<br/>   shocks while keeping pacemaker backup intact"]

    ShockCount -->|"1 SINGLE SHOCK ONLY<br/>+ Patient Feels 100% Normal & Symptom-Free<br/>Within 1 Minute"| SingleShock["URGENT CARDIOLOGY / DEVICE CLINIC CONTACT:<br/>1. Rest seated/lying down; do NOT drive<br/>2. Send manual Remote Home Monitor transmission NOW<br/>3. Call Device Clinic on-call number for instructions<br/>4. If a 2nd shock or ANY symptom occurs -> Call 911"]

    EventType -->|"DIZZINESS, FAINTING, OR PULSE < 40-50 BPM<br/>(or Rhythmic Diaphragm Hiccups / Pectoral Twitch)"| PacerFail["SUSPECT PACEMAKER MALFUNCTION:<br/>(Failure to Capture, Lead Perforation, or Oversensing)<br/>1. Call 911 / 112 / 999 Immediately; lay patient flat<br/>2. Remove any phones/magnets within 15 cm of chest<br/>3. Bring Wallet Device ID Card for ER interrogation"]

    EventType -->|"AUDIBLE BEEPING OR VIBRATING ALERT<br/>From Inside the Chest"| BeepAlert["INTERNAL DEVICE ALERT TONE:<br/>Indicates Battery ERI, Lead Impedance Change, or Mag Mode.<br/>If patient feels fine -> Call Device Clinic today.<br/>If dizzy, short of breath, or shocked -> Go to ER NOW."]

    EventType -->|"RED, SWOLLEN, DRAINING, OR ERODED SKIN<br/>Over Device Pocket (or Unexplained Fever)"| PocketInf["CIED POCKET INFECTION / ENDOCARDITIS:<br/>1. Same-Day Emergency Department Evaluation<br/>2. NEVER squeeze or needle-aspirate the pocket<br/>3. Needs blood cultures, IV antibiotics, & total extraction"]

Part 1: Implantable Cardioverter-Defibrillator (ICD) Shocks and "Electrical Storm"¶

How an ICD treats arrhythmias before and during a shock¶

Modern Implantable Cardioverter-Defibrillators (ICDs), including transvenous ICDs (with wires threaded through a vein into the heart) and subcutaneous ICDs (S-ICDs) (placed under the skin along the left ribcage), actually have two tiers of therapy when they detect a dangerously fast rhythm: 1. Tier 1: Anti-Tachycardia Pacing (ATP, Painless): When the ICD detects a regular fast ventricular rhythm (monomorphic ventricular tachycardia [VT]), it first tries to break the circuit painlessly by delivering a rapid burst of 8 to 10 tiny pacing pulses slightly faster than the arrhythmia (overdrive pacing). Patients do not feel ATP at all (or feel only a 2-second flutter). 2. Tier 2: High-Voltage Defibrillation Shock (\(30\text{ to }41\text{ Joules}\)): If painless ATP fails to stop the rhythm, or if the rhythm accelerates into Ventricular Fibrillation (VF) or very fast VT (\(>200\text{ bpm}\)), the ICD charges its internal capacitor for 5 to 10 seconds and delivers a high-voltage shock directly across the heart muscle. - Because the patient is often still conscious during VT (or regains consciousness 2 seconds after the shock), they experience a sudden, blinding flash in their vision (phosphenes), a violent contraction of their chest and shoulder muscles, and the sensation of a heavy blow to the breastbone.

True "Appropriate" Electrical Storm vs. "Inappropriate" ICD Shocks¶

When a patient receives multiple shocks in a row (ICD Electrical Storm, strictly defined as \(\ge 3\text{ episodes of sustained VT/VF or ICD shocks within a 24-hour period}\)), paramedics and emergency physicians use a 12-lead ECG monitor to immediately distinguish two completely different causes:

How Clinical Ring Magnets Work on Pacemakers vs. ICDs (important Medical Rule)¶

Many patients and even some healthcare workers are confused about what happens when a strong clinical ring magnet (or a consumer neodymium magnet in a phone/vape) touches the chest over an implanted cardiac device. A magnet does the exact OPPOSITE thing to a Pacemaker versus an ICD:

1. Effect of a Magnet on an Implantable Defibrillator (ICD):
2. Placing a magnet directly over an ICD SUSPENDS / TURNS OFF ALL TACHYARRHYTHMIA DETECTION AND HIGH-VOLTAGE SHOCKS (so the ICD will not shock the heart while the magnet is held on the chest), while leaving the ICD's slow-heart-rate backup pacemaker function 100% UNAFFECTED.
3. The moment you lift the magnet off the chest, the ICD immediately turns its shock protection right back on.
4. Why Consumer Magnets (MagSafe iPhones, Smartwatches, Magnetic Vape Pens, CPAP Magnetic Clips) Are Dangerous in a Shirt Pocket: If an ICD patient puts a smartphone with a magnetic wireless charging array (like Apple MagSafe), an electronic cigarette/vape with a magnetic cap, or a magnetic CPAP mask clip inside their breast pocket within \(15\text{ centimeters}\) (\(6\text{ inches}\)) of their ICD, or falls asleep with their phone resting on their chest, the magnet silently disables their lifesaving defibrillator shocks while it rests there. Always keep smartphones, smartwatches, wireless earbuds, and magnetic clasps at least \(15\text{ cm}\) (\(6\text{ inches}\)) away from a pacemaker or ICD (\(30\text{ cm}\) [\(12\text{ inches}\)] for high-powered equipment).
5. Effect of a Magnet on a Permanent Pacemaker (PPM):
6. Placing a magnet over a standard pacemaker does NOT turn the pacemaker off, instead, it switches the pacemaker into "Asynchronous Pacing Mode" (DOO or VOO mode), where the pacemaker ignores the patient's own heartbeat and fires at a fixed preset rate (usually \(85\text{ to }100\text{ bpm}\)). (Only trained emergency clinicians on a live ECG monitor should ever apply a clinical magnet to a pacemaker or ICD.)

Part 2: Performing CPR and Using an AED on a Patient with a Pacemaker or ICD¶

If a person with a pacemaker or ICD collapses, is unresponsive, and is not breathing normally (or is only gasping), their implanted device has failed to save them (either because the rhythm is non-shockable PEA/asystole, the heart muscle is too ischemic to respond, or the battery/lead failed). Immediate bystander CPR and an external Automated External Defibrillator (AED) are their only chance of survival.

Follow these 3 Official AHA / ERC Resuscitation Rules for patients with implanted devices:

1. Never Delay Chest Compressions: Place your hands in the exact standard spot, the center of the chest on the lower half of the breastbone (sternum), and push hard and fast (\(100\text{ to }120\text{ compressions per minute}\), \(5\text{ to }6\text{ cm}\) [\(2\text{ to }2.4\text{ inches}\)] deep). Because pacemaker and ICD generators are implanted up beneath the left or right collarbone (clavicle) (or under the left armpit for a subcutaneous ICD), your hands on the center of the breastbone are nowhere near the metal box.
2. What If the Internal ICD Shocks While My Hands Are on the Chest?
3. Keep doing CPR: Even if the internal ICD fires a \(35\text{-Joule}\) shock while your bare hands are pressing on the chest, the electricity stays inside the chest cavity between the internal heart coil and the titanium can. Less than 1 volt reaches the skin surface. You will not be harmed.
4. (Note: If you see the patient's chest suddenly jolt from an internal ICD shock during CPR, simply allow 1 to 2 seconds for the shock to finish and continue CPR/AED evaluation.)
5. Where to Stick the External AED Pads:
6. When you bare the chest, look for a \(3\text{ to }5\text{ cm}\) surgical scar and a firm rectangular bulge under the skin below the right or left collarbone (or along the left lower ribs for an S-ICD).
7. Never stick an AED pad directly on top of the metal pacemaker/ICD bulge: The metal casing under the skin blocks the external AED shock from reaching the heart and destroys the device circuitry.
8. Place the AED pad at least \(2.5\text{ centimeters}\) (\(1\text{ inch}\)) to the side or below the implanted device bulge (or place the pads in the Anterior-Posterior [Front-and-Back] position: one pad on the front center-left chest away from the device, and the other pad on the back between the shoulder blades).

Part 3: Recognizing Pacemaker Malfunction and Post-Implant Complications¶

The 5 Emergency Signs of Pacemaker or Lead Malfunction¶

If a person with a pacemaker or ICD develops any of the following symptoms, transport them to an emergency department immediately:

1. Symptomatic Bradycardia ("Failure to Capture" or "Failure to Output"):
2. The person feels dizzy, lightheaded, weak, short of breath, confused, or faints (syncope), and checking their pulse at the wrist or neck reveals a heart rate significantly slower than their pacemaker's programmed lower rate limit (almost all pacemakers are set to never let the heart drop below \(50\text{ or }60\text{ beats per minute}\)).
3. Important Pulse Oximeter / Smartwatch Warning: Do NOT trust an ECG screen alone if the patient feels faint. In "Failure to Capture", the pacemaker still sends out tiny electrical spikes that a cardiac monitor might count as \(70\text{ bpm}\), but the heart muscle is not actually squeezing, so the real mechanical pulse at the wrist or finger pulse oximeter is only \(30\text{ bpm}\). Always feel the actual radial or carotid pulse with your fingers.
4. Constant Rhythmic Hiccuping or Twitching of the Chest/Stomach Muscle (Lead Dislodgement or Perforation):
5. If thepatient suddenly starts having continuous, metronome-regular hiccups (\(60\text{ to }80\text{ times a minute}\), matching their exact heartbeat) or rhythmic twitching of their chest pectoral muscle with every beat, a pacemaker/ICD wire has either slipped out of place into the superior vena cava (stimulating the Phrenic Nerve that controls the diaphragm) or perforated through the thin wall of the right ventricle, risking pericarditis or cardiac tamponade.
6. Sudden Swelling, Purple Discoloration, or Bulging Veins in ONE Arm (Subclavian Vein Thrombosis):
7. Because pacemaker and ICD leads pass through the subclavian and axillary veins under the collarbone, a blood clot (upper-extremity deep vein thrombosis) can form around the wires, causing the left or right arm, hand, and side of the neck to swell up, ache, and turn reddish-purple.
8. Pacemaker Syndrome & Twiddler's Syndrome:
9. If a patient unconsciously flips, rotates, or plays with their pacemaker box through their skin (Twiddler's Syndrome), the wires wind up like a fishing reel and pull right out of the heart wall. Never twist or push on the device box under the skin.
10. Audible Beeping, Chirping, or Vibrating Alerts from Inside the Chest:
11. Modern ICDs and CRT devices (Medtronic, Boston Scientific, Abbott, Biotronik) have a built-in speaker or vibration motor that emits a high-pitched beeping tone (like a watch alarm or ambulance siren) or strong vibration at set times every day when the device detects a critical alert: Battery reaching Elective Replacement Indicator (ERI), abnormal lead wire impedance (broken wire), or prolonged high-rate arrhythmia.
12. If a patient hears their chest beep or feel it vibrate: If they feel completely well, call their Device Clinic the same day; if they have any dizziness, shortness of breath, or shocks, go to the Emergency Department immediately.

Part 4: Device Pocket Infection, Skin Erosion, and CIED Endocarditis¶

Why a tiny pimple, crust, or wire showing over a pacemaker is a surgical emergency¶

Unlike a skin infection on an arm or leg that can be cured with a 7-day bottle of oral antibiotic pills, any bacterial infection touching a pacemaker or ICD pocket or its wires is a life-threatening cardiovascular emergency: - Bacteria (especially Staphylococcus aureus and Staphylococcus epidermidis) form a slimy protective shield (biofilm) on the plastic and metal insulation of the pacemaker leads that antibiotics cannot penetrate. - Because those leads travel directly down through the veins and screw into the inside of the right atrium, tricuspid valve, and right ventricle, a minor-looking pocket infection tracks directly down the wires into the heart valves and bloodstream, causing CIED Infective Endocarditis and Sepsis (which carries a 20 to 30 percent mortality rate if device extraction is delayed).

Red Flag Checklist for Device Pocket Infection & Erosion (Go to ER / Cardiology Today)¶

Inspect the chest skin over the pacemaker or ICD in bright light: - [ ] Redness (erythema), warmth, swelling, or new throbbing tenderness over the device pocket (whether 2 weeks after surgery or 5 years later). - [ ] Fluid buildup (fluctuance), pus, yellow crusting, or clear/bloody drainage leaking from the surgical scar. - [ ] Pre-erosion or Frank Skin Erosion: The skin over a corner of the metal device or wire becomes paper-thin, shiny, taut, and purplish-red (adherent to the metal underneath), or a piece of silver metal casing or white/clear wire insulation is visibly poking out through a tiny hole in the skin. (CRITICAL RULE: Even if there is zero pus and zero pain, if any part of the metal device or wire is exposed to the outside air through the skin, the entire device and all heart wires are 100% contaminated with bacteria and must be surgically removed in a specialized hospital. Cover it loosely with a sterile dry gauze pad, do NOT try to push the metal back under the skin, and go to the hospital today.) - [ ] Unexplained Fever, Chills, or Night Sweats in ANY Patient with a Pacemaker or ICD: Even if the chest pocket skin looks 100 percent normal, any unexplained fever (\(>38^\circ\text{C}\) [\(100.4^\circ\text{F}\)]) or bloodstream infection requires urgent blood cultures and a transesophageal echocardiogram (TEE) to check for vegetations on the heart leads.

Exact communication script for 911 / 112 / 999 and hospital triage¶

Always carry your Pacemaker / ICD Wallet Identification Card (or save a clear photo of the front and back of the card in your smartphone's Medical ID screen). Use these exact scripts during an emergency:

• For Multiple ICD Shocks ("Electrical Storm") or 1 Shock with Symptoms:

  "I need an emergency Advanced Life Support ambulance at [Exact Address]. The patient is a [Age]-year-old with an implanted [Manufacturer: Medtronic / Boston Scientific / Abbott / Biotronik] Defibrillator (ICD) who has received [Number] shocks in the past [minutes/hours] [and has chest pain / dizziness / shortness of breath]. We have the patient lying flat and completely still, and need immediate 12-lead ECG monitoring and transport to a hospital with cardiac device interrogation capabilities."

• For Suspected Pacemaker Failure (Slow Pulse, Fainting, or Diaphragm Twitching):

  "Emergency triage: this patient has an implanted [Manufacturer] Pacemaker and is experiencing acute dizziness/near-fainting with a mechanical wrist pulse of only [Number] beats per minute [or continuous rhythmic diaphragm hiccuping at 70 bpm]. We suspect acute Pacemaker Failure to Capture or Lead Perforation/Dislodgement and need an immediate 12-lead ECG, chest X-ray, and stat device interrogation."

• For Device Pocket Infection or Skin Erosion:

  "The patient has an implanted cardiac device on the [left/right] chest and has developed [acute pocket redness and swelling / fluid drainage / exposed metal or wire eroding through the skin / unexplained fever]. According to Heart Rhythm Society guidelines, we have NOT squeezed or punctured the pocket and have kept the patient Nothing by Mouth (NPO) for blood cultures and cardiology evaluation."

Frequently asked questions¶

Will I get electrocuted if I am holding my family member or doing CPR on them when their internal ICD shocks them?¶

No, you cannot be injured or electrocuted if you are touching a person when their internal Implantable Cardioverter-Defibrillator (ICD) fires. Because the shock is delivered deep inside the chest between the heart wire and the device casing (about 30 to 40 Joules internally, ten times smaller than an external hospital paddle shock), almost all of the electrical energy stays inside their body; at most, a bystander touching their bare skin will feel a harmless mild muscle twitch or static tingle, and wearing medical gloves blocks even that sensation completely.

Why do I need to go to the emergency room for 2 ICD shocks in 24 hours, when 1 shock sometimes only requires calling my cardiologist?¶

If your ICD delivers 1 single shock and you immediately feel 100 percent fine with zero chest pain, dizziness, or shortness of breath, it means the ICD successfully stopped a single arrhythmia episode and your heart is back in a stable rhythm (requiring an immediate phone call and remote upload to your cardiology clinic). However, receiving 2 or more shocks within 24 hours (or 3+ shocks, called an "Electrical Storm") means either the lethal heart rhythm keeps coming right back because of a new heart attack, low potassium, or heart failure, or a broken wire is shocking you inappropriately, both of which are life-threatening emergencies requiring an immediate ambulance.

Can an iPhone (MagSafe), smartwatch charger, or magnetic vape pen really turn off an implanted defibrillator (ICD)?¶

Yes, every Implantable Cardioverter-Defibrillator contains a magnetic reed or Hall-effect switch designed so doctors in a hospital can place a strong ring magnet over the chest to temporarily suspend shocks. Modern smartphones with wireless magnetic charging rings (like Apple MagSafe), magnetic smartwatch chargers, e-cigarettes/vapes with magnetic caps, and magnetic CPAP mask clips contain powerful neodymium magnets that can activate that switch if placed within 15 centimeters (6 inches) of your chest (such as in a breast pocket), silently disabling your ICD's ability to shock a lethal rhythm until the magnet is moved away.

Why can't a doctor just prescribe oral antibiotic pills or lance a swollen, infected pacemaker pocket like a regular skin boil?¶

Once bacteria enter the pocket around a pacemaker or ICD, or if the skin thins out so even a millimeter of the metal device shows through the skin, bacteria form an indestructible slimy biofilm on the plastic and metal wires that leads directly down through your veins into the inside of your heart. Never lance or needle-poke a pacemaker pocket, and never rely on oral pills alone: curing a confirmed device infection requires hospital intravenous antibiotics and complete surgical removal of the generator and wires so the infection does not cause fatal heart-valve endocarditis.

Sources checked¶

• Heart Rhythm Society (HRS, United States), European Heart Rhythm Association (EHRA), and Asia Pacific Heart Rhythm Society (APHRS): HRS/EHRA/APHRS Expert Consensus Statement on the Diagnosis and Management of Ventricular Arrhythmias (Electrical Storm Management and ICD Shock Triage) and HRS Consensus Statement on Cardiovascular Implantable Electronic Device (CIED) Lead Management and Extraction (pocket infection and erosion mandates).
• American Heart Association (AHA, United States): Clinical Management of Patients With Implantable Cardioverter-Defibrillators (1-Shock vs. Multiple-Shock Patient Action Plan), AHA Adult Basic and Advanced Life Support Guidelines (AED Pad Placement in Patients with Pacemakers/ICDs), and Journal of the American Heart Association (JAHA) Warnings on High-Field Consumer Magnets (MagSafe / Electronic Cigarettes) and CIED Interference.
• European Society of Cardiology (ESC) and European Resuscitation Council (ERC): ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy and Management of Infective Endocarditis.
• National Health Service (NHS, United Kingdom) and British Heart Foundation (BHF, United Kingdom): Implantable Cardioverter Defibrillator (ICD) What to Do After a Shock and Pacemaker Safety Guidance.

Related guides¶

• Adult and child CPR and AED guide
• Sudden racing heart (SVT), modified Valsalva maneuver, and arrhythmia red flags
• Heart attack recognition and first aid
• Fainting (syncope) first aid and cardiac red flags
• Sepsis and septic shock recognition