Air Travel and Cardiovascular Disease

Stephen E. Possick, MD; Michèle Barry, MD, FACP

Disclosures

J Travel Med. 2004;11(4) 

In This Article

Implantable Cardioverter/Defibrillators and Pacemakers

As implantable pacemaker and implantable cardioverter/defibrillator (ICD) technology has advanced, a substantial percentage of patients with cardiac disease have undergone the implantation of such devices. Many pacemakers and ICDs can be interrogated and adjusted externally via a wireless communications link. Magnets producing a strong enough field will inhibit tachycardia therapy when placed on top of almost all ICD models while the magnet is in place.[22] These features present several potential problems for those wishing to travel by air. The major manufacturers of pacemaker and ICD technology assert that their devices will not be harmed by airport security systems, although they caution that either device may be temporarily affected.

Both ICDs and pacemakers may, in rare cases, set off airport metal detectors.[23] All patients should carry a card from a physician or the manufacturer of the device. Pacemakers and ICDs may, theoretically, undergo temporary malfunction when exposed to airport metal detection equipment, but the few published studies have not shown significant interference with device function.[24,25,26] Cooperman et al. studied the effect of metal detector gates on 103 pacemaker patients in Israel.[24] Patients were monitored with telemetry as they passed through the detector. No pacemaker dysfunction was observed in this small sample. Kattenbeck et al. studied the interaction between metal detectors and ICDs in 45 patients.[25] Each patient walked through an airport metal detector gate and was subjected to testing with a hand-held metal detector. Each ICD was interrogated prior to and following exposure to both systems. No changes in ICD parameters were observed, although the alternating magnetic field of a hand-held metal detector would not be expected to alter ICD parameters. The study did not evaluate ICD function or parameters while the individuals were exposed to the two systems.[25] Kolb et al. exposed 200 patients with implanted pacemakers and 148 patients with ICDs to a standard airport metal detector gate.[26] Patients remained within the electromagnetic field of the metal detector gate for at least 20s. All devices were interrogated before and after exposure. An external six-lead electrocardiogram was recorded during exposure. No change in parameters, inappropriate detection of nonsustained ventricular arrhythmias or suspension of therapies was observed.[26]

Although the major manufacturers of ICD technology have not received any reports of delivery of ICD therapy due to exposure to hand-held metal detectors, there is a theoretical risk that the alternating magnetic field created by the hand-held wand might be detected by the device and lead to delivery of inadvertent shock therapy and/or temporarily inhibit an ICD's pacemaker output. The FAA has yet to publish specific guidelines on this issue. The National Institute of Justice currently requires that all hand-held metal detectors carry a warning that they may interfere with personal medical electronic devices.[27] It is therefore advised that patients with ICDs do not allow a search with a hand-held device and instead request a hand search. If a hand-held device must be used, the examiner should be cautioned not to hold the magnet over the device for more than a few seconds. If a hand-held wand must be passed over the device more than once, at least 30s should elapse between each pass. Neither ICDs nor pacemakers should be affected by the in-flight environment (Tisch D, personal communication, 5 June 2002; Dostalek J, personal communication, 22 June 2002). Many manufacturers maintain websites and help-lines to advise patients and physicians regarding their devices during travel.

Patients with ICDs may be shocked with an AED if their device fails while in flight, although device failure is no more common during air travel than at other times. All patients with implantable devices should carry an ID card detailing the type of device, their physician's contact information and the date of implantation. It is also advised that patients carry a copy of an ECG taken with and without pacing. A summary of recommendations and resources for the traveler with implanted devices is given in Table 4 .

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