ADULTS AND PARENTS
Heart Conditions

Pacemaker Advice
Most people know that some adults have pacemakers fitted to control their heart rate, but there are also a few children who have pacemakers.

The aim of this page is to provide information for teachers & parents who have a pupil with a pacemaker in their care.

Why might a child need a pacemaker?
The heart beats over 100, 000 times a day. This beating is caused by small electrical impulses, which are produced by the heart’s natural pacemaker (called the sinoatrial or SA node). These impulses spread along specialised conducting pathways and activate muscle fibres in the heart, causing them to contract, making the heart beat and pump blood into the blood vessels which carry it to the rest of the body.

A small number of children have problems with these conducting pathways, or with the natural pacemaker. The child may have been born with this problem, or in some cases it is due to damage which has occurred since birth, for example by infection or by surgery, for example to repair a hole in the heart.

This problem means that the electrical impulse from the hearts natural pacemaker is not transmitted (or is not always transmitted) to the rest of the heart. This means that the heart does not beat as often as it should, giving a very slow heart rate. This slow heart rate is unable to pump blood around the body effectively, so the child becomes ill.

This slow heart rate can be increased by inserting a pacemaker. A pacemaker generates electrical impulses which can replace the impulses from the heart’s natural pacemaker which are not reaching the heart muscle. This is because a pacemaker directly activates the muscle and does not rely on the natural conduction system of the heart.

What is a pacemaker?
A pacemaker is a small electrical device. It has two parts:

1. A small metal box, about 5cm in diameter and 1cm thick. This is the ‘pacemaker’ itself. It is also called a ‘pulse generator’. This metal box contains the battery and the circuitry which makes the electrical impulses and controls the timing of them.
2. The ‘pacing leads’. These are wires which are attached to the heart muscle and to the pacemaker. Impulses travel from the pacemaker down these to stimulate the heart muscle to contract. Depending on the type of pacemaker there may be one or two leads.

The leads are very flexible and can withstand twisting and bending when the child moves.

How is a pacemaker implanted ?
Implantation surgery is a fairly straightforward procedure.

In adults most pacemakers are inserted under the muscles and skin of the chest. In children however, most pacemakers are inserted under the muscles and skin of the abdomen (some children have pacemakers inserted in the chest, especially older children). The pacemaker box may be visible in the child’s tummy.

After the surgery
The child will stay in hospital between 3-5 days after the surgery if there are no complications. After this they will have some time off school.

The wound site must be protected from injury following the surgery until it is fully healed. The child should be closely supervised until the wound is healed, which normally takes about a month after the surgery.

What activities can a child with a pacemaker take part in?
Children with pacemakers should be able to lead a normal life and take part in most school activities.

PE - Children with pacemakers can take part in sports activities except for contact sports. Contact sports are not recommended for children with pacemakers because there is a small risk that the leads to the heart or the pacemaker itself might be damaged.

In school such activities might include:

• Rugby
• Gym apparatus, where pressure is put onto the abdomen e.g. bars.
• Karate
• Judo

Children with pacemakers can safely take part in swimming lessons

Can electrical equipment damage pacemakers?
Modern pacemakers are well shielded from interference from other electrical devices.

Domestic appliances - Children with pacemakers can safely use all domestic appliances, including microwave ovens.

Business studies/IT - Type writers, computers, fax machines, photocopiers and printers should cause no interference.

Science lessons - Children may come into contact with magnets during science lessons. If magnets are held close to the pacemaker they may make it pace at a different rate than usual. However once the child moves away the pacemaker will return to its normal function.

Technology - Wood working shop tools and light metal working shop tools should cause no interference. Welding equipment may cause interference and should be avoided.

Other things to consider
Mobile phones can be used by children with pacemakers but they should be kept more than 15cm away from the pacemaker.

Dodgem cars at the fairground are operated by industrial strength magnets and should be avoided by children with pacemakers. Other fairground rides may exert very strong physical forces which could damage the pacemaker or wire, so should also be avoided.

Children with pacemakers can travel on aeroplanes. The weapon detectors at the airport may detect the pacemaker so the child must carry his or her pacemaker identification card. The weapon detector will not interfere with the pacemaker.

What if interference does occur?
If interference does occur the child will probably realise that something is wrong. They may feel ‘funny’ or dizzy or experience extra heart beats. If it is suspected that an electrical item is interfering with a child’s pacemaker they should move away from or turn off the appliance. The pacemaker will not be permanently affected and will go back to its normal function. The child should be reassured of this since interference may make him or her feel quite strange.

What could go wrong with a pacemaker?
The batteries of the pacemaker are monitored regularly when the child goes to pacemaker clinic at the hospital and are designed to last for several years. If there are any signs that the battery may be running out, a new pacemaker will be fitted. There is no chance that the pacemaker will stop suddenly. There is a small chance of one of the leads to the heart breaking although this should not happen if the precautions listed previously are taken. If this does happen the child may experience the following symptoms:

• difficulty breathing
• dizziness
• fainting spells
• chest pain
• prolonged hiccoughing
• very slow pulse
• If the child experiences any of these symptoms they need medical attention.

Phone the parents or GP or if the symptoms seem severe dial 999.

Allow the child to lie down and rest and reassure the child as anxiety will make the situation worse.

It is important to stay calm in such a situation. Nearly all children with pacemakers still have their own heart beats. This is just very slow and would not allow a child to have enough energy to go about his or her daily activities. The child will not be harmed if the heart is allowed to beat at this rate until he/she reaches hospital.

Conclusion
Having a pacemaker should not greatly affect a child’s school life, as long as the considerations mentioned in this leaflet are borne in mind. It is unlikely that any of the problems outlined in this leaflet will occur, they are included as precaution.

For more information, or if you have any queries, please contact:

• The child's parent

• The Children's cardiac specialist nurses at Leeds General Infirmary Tel. 0113 392 5467 or email us at ccns.LGI@leedsth.nhs.uk

• or Ward 10 Tel. 0113 392 7110

Updated Winter 08/09