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Cardiovascular System - Pacemakers

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - Hi there, I am a very active diver and I've recently been told I need to have a pacemaker fitted. My cardiac surgeon has said that there is physically no reason why I shouldn't be able to continue to dive as my heart would be able to cope under heavy loads as before. He however fits Medtronic PaceMakers and from what I have recently read it would appear they only are rated to 10m. I've also seen that the St. Jude range of PaceMakers are rated to a much deeper depth. Can you confirm if I am correct in these assumptions and if I would be wise to ask the surgeon to fit a St. Jude model in order to allow me to continue to dive?

A - In days gone by you would have been hard pressed to find anyone who would certify someone with a pacemaker as fit to dive. Nowadays we need a good reason NOT to pass someone as fit, and this change in the default option means looking at things in much more detail, with as much reference to available evidence as possible. So in this case we need to know why the pacemaker is needed in the first place, what assurances there are that the heart is able to cope with the demands diving places on it, and whether the pacemaker is rated to sufficient depth by the manufacturer. As a diver I would be happier to have one rated to at least 40m, and also rated to withstand rapid pressure changes, such as on descent/emergency ascent. The St. Jude models, from what I have read, are said to be rated to around 70m, whilst the Medtronics have, as you say, not been tested to the same depths. The moral of the story is clear: research and evaluating the pacemakerís suitability for your particular lifestyle and activities is key.

Q - Three years ago, I was fitted with a cardiac pacemaker due to a slow heart rate causing dizzy spells and two blackouts. The pacemaker immediately stopped these symptoms. My cardiologist considered that I was safe to dive to 100 feet, and gave me a copy of the manufacturer's test report detailing the results of hyperbaric tests on the device.

After a week of work as a diving instructor in the Middle East, I was sacked when I mentioned my pacemaker. The dive centre had consulted the Naval hyperbaric specialist, who stated that I should not be diving at all, let alone instructing, despite any medical certification.

I understand that the limitations are purely due to distortion of the titanium casing when subjected to pressure, but he suggested that temperature differences may also be a problem.

The manufacturer has not replied to my emails on the subject, hence my career as an instructor is on hold. Can you help?

A - Yes, donít instruct, but you can dive. Sadly the rules are, in the UK at least, that an Instructor canít teach if they have a pacemaker. If there was failure, which can happen, but is very very rare, your poor students would be left hovering around wondering why their man was floating of to the bottom of the ocean. Panic would set in, and as you have responsibility as an Instructor, the lawyers would be after your estate.

As an individual diver, the rules are a bit more accommodating, as the responsibility is on you. The pacemaker maker has Okíed the pressure to 100ft, 30 metres, or 4 atm. If that's what it will stand, then thatís what it will stand, so you can dive to that depth. Temperature is not really an issue, as I assume you will suit up to keep at a reasonable warmth, but for Godís sake donít go naked ice-diving, or boil yourself in a volcanic geyser as that would be into the realms of daft and then the titanium might bend and affect the pacing.

On a tangent, I used to play cricket against a mate who had one. Fearing my extreme pace, he used to wear bizarre things to protect the machinery from the super-quikkie. Ladiesí sanitary towels were one of the oddest.

(other dive medical questions)



   


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