Can You Weld With A Pacemaker Rules

Can You Weld With A Pacemaker Using A Safety Vest?

Can you weld in safety when fitted with a pacemaker? If you have suffered heart problems in the past, you know that wearing a pacemaker can be a restriction in more ways than one. One of the areas which seem to offer a lot of conflicting information is the workshop; many sources say that welding can interfere with how your pacemaker works, possibly leading to a life-threatening event. Others tell us that under certain conditions, pacemakers are low risk when welding.

You are probably either already fitted with a pacemaker or you have been discussing the possibility of having one placed with your cardiologist if you have come to this page. I can also guarantee that you have probably not found the information you have been looking for online – at least not everything you need to know from a single source.

Well, your search has come to an end.

Can You Weld With A Pacemaker?

Yes, it is possible to weld with a pacemaker, but some safety precautions have to be taken. In order to weld safely with a pacemaker, you will first need to know:

  • The type and specifications (amps) of the welding equipment you use;
  • Whether the welding equipment is properly maintained;
  • How sensitive your pacemaker settings have been programmed.

What you definitely need to do before welding, is to consult your cardiologist. This is the one person who knows exactly at what range your pacemaker will fire. The settings on these devices make a lot of difference when working with electrical equipment. Without being aware of just how sensitive your pacemaker is, there is a risk that the electromagnetic energy emanating from your equipment could cause your pacemaker to misfire.

If you wear extra protective welding equipment, electrocution risks can be reduced, but vests won’t be able to significantly block electromagnetic waves. If you really have to weld, then you must be able to answer the three questions above and work according to what I call the pacemaker welding rules (see below).

By the way, if the answer to rule one in the following section is ‘yes’, then you should avoid welding – period – until you are given the go-ahead by your cardiologist.

The Pacemaker Welding Rules

The following rules are gathered from various, up to date sources and based upon pacemakers made less than ten years ago. For older models, these rules do not apply. Well, they might, but the risk will be higher.

If you are still waiting to be fitted with a pacemaker, now is the time to ask your cardiologist for a model which better suits your hobby or career. However, a specialist cannot guarantee at which setting your future pacemaker will optimally function. Until a device is fitted, it is impossible to know whether its settings will need to be highly sensitive to electrical impulses or not.

If you already have a pacemaker of fewer than ten years old in place, the following pacemaker welding rules apply:

  1. Ask your cardiologist if your pacemaker settings are low (sensitive);
  2. Never work with machines which have not been safety tested;
  3. Only work on machines which use less than 400 Amps;
  4. Keep welding cables and arc at least 60cm from your pacemaker device;
  5. Should you begin to feel dizzy or get the sensation that your heart is beating at an unusual rhythm, stop what you are doing immediately.

What Do Pacemaker Manufacturers Recommend?

I recently contacted some pacemaker manufacturers about the effects of welding. They all responded with rather generic material. In a society which sues, avoiding any legal implications takes priority – especially in the field of medicine. The manufacturers were still able to give some good advice. Here are a few of the responses I got:

  • Abbott (formerly St Jude Medical) sent me a link to a PDF which states, “Many patients with St. Jude Medical devices use or have been in close proximity to electric welders with no apparent problems … several reports have documented the absence of interference when patients with ICDs used arc welding machines”.
  • Biotronik sent a rather dated copy of a 2005 Tech Note (technology has since improved) which tells us that their “pacemaker devices have highly selective filters designed to avoid sensing of electromagnetic interference (EMI) … when patients follow certain recommendations, they should be free of inappropriate device behaviors even in work environments such as factories, steel mills, and power plants”.
  • A second email from Abbott told me, “Regarding arc welding specifically, many patients continue to weld as their profession while following our recommendations … welding below 400 amps greatly reduces the risk of interference”.

The medical world is never able to give a 100% guarantee. You only need to read the information on a bottle of aspirin to see all the possible side effects. By listing them, the pharmaceutical company is covered for any eventuality.

This is the same for the makers of your pacemaker. They are not allowed to say, ‘Weld with a pacemaker according to our recommendations? Sure! No problem!’ But one thing is for sure – there are very, very few reports of pacemaker interference caused by welding out there.

Have Any Welders Experienced Pacemaker Problems?

There is very little data available, which is basically the same as saying this happens very, very infrequently. Welding might be slightly niche, but it’s not that niche. If welding with a pacemaker was so dangerous, wouldn’t there would be a lot more information available?

To find out more, I looked up a few scientific studies. The only problem was that these were all pretty outdated and referred to older models of pacemakers. I also looked at welding and pacemaker forums. There was a lot of conflicting information. A lot of people had been told never to weld with a pacemaker device ever again; others were referred to the recommendations of pacemaker manufacturers. In fact, I only came across two posts that admitted, ‘I had a problem with my pacemaker when I was welding’. There were many, many more that said they had not had any negative experiences.

What’s A Pacemaker?

This article isn’t meant to be a scientific paper. Far from it. But it is meant to improve anyone’s understanding of the potential hazard of welding for pacemaker wearers. The aim is to make this text easy to read, highly informative and full of the right answers. Basically, if you know why pacemakers and welding are considered risky, you also know how to reduce this risk and continue in your trade or hobby.

So let’s get started on the basics. A pacemaker is composed of two distinct parts:

  • Pulse Generator (and battery)
  • Pacing Leads or Electrodes (going into the chamber(s) of the heart)

In short – and I mean really short:

  • A sensor built into the pulse generator responds when a heartbeat has been missed, or is occurring at too slow or too fast a rate (or a mixture of both)
  • The sensor sends a signal to the pulse generator
  • The pulse generator sends electric pulses through the electrodes and into the heart muscle
  • The pacing leads or electrodes to make the heart muscle contract at the correct time and restore a normal heart rhythm

What Types Of Pacemaker Are There?

There are newer, wireless models available. This might give the impression that there are no electrodes fitted. This is not the case. Wireless, often called MRI-compatible, pacemakers allow the pacing and response to be controlled via a remote device. But you still need the electrodes or leads.

Heart patients can also be fitted with implantable cardioverter defibrillators or ICDs.  ICDs shock the heart back into action if it stops. They function both as pacemakers and defibrillators. Together, pacemakers and ICDs are grouped under the name ‘cardiovascular implantable electronic devices’ or CIEDs. We’ll keep it simple here and simply refer to all of the different types as pacemakers.

The most common reason for fitting a pacemaker is heart arrhythmia, or the irregular beating of the heart. There are plenty of other reasons why these devices need to be fitted to people both young and old, but to cut a long story short, they all concern problems with the electrical circuitry of the heart.

How Can Welding Affect A Pacemaker?

First of all, let’s remember that abnormal firing is not very common in devices. Misfiring usually happens to pacemakers which are programmed to be highly sensitive in small electrical impulses, or when external electrical impulses mimic those of the heart. It also happens more frequently in the early stages after fitting, when the cardiologist has to fine-tune the device to work optimally.

To give you some idea of how resilient (and clever) these devices are, an experiment once subjected a pacemaker to five-second bursts of high voltage from a Taser – yes, a Taser – without any negative effect. When worrying about pacemaker behavior when welding, we’re actually worrying about the possible effects of electromagnetic radiation on the sensing function of the pacemaker.

Electromagnetic Interference and Pacemakers

Electromagnetic interference or EMI isn’t the easiest principle to explain, especially when linking it to a medical device. For more detailed explanations there are plenty of online scientific sources available. However, I will keep this as simple as possible.

  • Even when an electrical wire or device is insulated, electricity still escapes into the surrounding air. This escaped energy is what we call electromagnetic radiation.
  • The more potent the electrical source, the higher the level of electromagnetic radiation.
  • The more damaged the insulation layer, the higher the level of electromagnetic radiation
  • Electromagnetic energy can, therefore, be transferred, via the air, to another electrical circuit.
  • The closer the other electrical circuit is to the source of the electromagnetic energy, the higher the chance of electromagnetic interference

So if you are working with welding equipment which emits high levels of electromagnetic radiation and you are wearing a pacemaker, what’s to stop it from reaching your device?

And what’s to stop the sensor in the pulse generator thinking that this energy is actually coming from your heart?

If it can’t make the distinction, your pacemaker will try to control these foreign signals. It will misfire.

Pacemaker Filters

Modern pacemakers are fitted with filters which help them to distinguish between electrical signals within the heart and external interference. But these are not guaranteed to fully protect pacemaker function because there are variables that make this a difficult task. Filters might have trouble when:

  • The level of electromagnetic interference is very high
  • The strength of this interference is similar to the pacing settings on your pacemaker
  • The electromagnetic radiation emits levels of energy similar to your own heart’s electrical activity
  • Your pacemaker has been programmed to accept a wide range of electrical signals, with a  subsequently higher risk of EMI

So Don’t Most Electrical Devices Affect A Pacemaker?

As I’ve just mentioned, modern pacemakers now contain filters which can prevent external (outside of the body) electromagnetic interference from affecting how they work. This means that they are safe in combination with electrical equipment. Old pacemakers without filters might pose a problem. But as old pacemakers have shorter lifespans than newer models, we can safely say that the majority of today’s fitted pacemakers contain filters.

The problem is, a lot of recommendations are still based on these older models. This has led to a number of ‘pacemaker myths’. FDA recommendations are also based on guidelines for older pacemaker models.

Pacemaker Myths?

Mobile phones used to be considered as sources of interference, but filtering means this is no longer the case, even though patients are advised not to keep phones in a chest pocket. Testing done by Carsten Lennerz seems to show that this risk is negligible. But because one out of 308 patients did experience misfiring during testing, the ten-year-old recommendations still stand.

On the other end of the scale, even electric car charging cables don’t appear to affect pacemaker function. But because the test groups are relatively small, no-one is allowed to say that this means someone with a pacemaker is completely safe when handling electric car charging cables.

When close to anti-theft systems in shops and metal detectors it is recommended you do not linger when the sensors are at chest height. There seems to be a common theme here. A common thread for which the medical world is famous. If there’s a tiny, tiny risk, don’t do it.

What’s In A Risk?

There’s a much greater risk when crossing a road or driving a car. But I haven’t come across any recommendations that tell us to avoid taking a stroll or getting the kids to school.

But we’re talking about manufactured medical equipment. The consequences of something going wrong can be catastrophic. So rather than gather up recent data and make a statement that is legally binding, medical equipment manufacturers see risk around every corner. It would be nice to see a recent study that gathers together all of the data on EMI-attributed pacemaker malfunction from the past ten to fifteen years.

But there isn’t one.

Based On Official Guidelines, What Devices Can Affect A Pacemaker?

Here’s a further list of the appliances and procedures you are advised to avoid if fitted with a pacemaker or ICD:

  • Medical procedures which use lasers, electricity, ultrasound, and magnets (X-rays are fine);
  • Industrial engines and machines which are poorly grounded and shielded;
  • Magnetic mattresses and chairs;
  • Gas-powered tools (to be kept at least 12 inches from the chest);
  • Some headphones should not be kept in a chest pocket;
  • Non-grounded tools and devices;
  • TENS machines;
  • For ICD units, keep antenna of CB and Ham radio 1 to 2 foot from the device.

I’m just listing the approved guidelines here, but exactly how careful you need to be with these devices is open to discussion. A study published in 2017 showed that even MRI scans have very little effect on pacemakers, even older models. So after years of being told they are far from compatible, it turns out that many of them are.

On the opposite end of the scale, high sources of EMI in electrocautery equipment during surgical procedures mean that magnets must always be on hand for when pacing is disturbed. A strong magnet placed directly on top of the device prevents it from sensing any electrical impulses at all.

How Can I Weld Safely With A Pacemaker?

Niche forums are full of posts by pacemaker patients who don’t dare to weld. These forums are also packed with posts from pacemaker patients who decided to give it a try and never experienced a problem. As long as you follow recommendations, there’s no reason why you can’t join the second group.

Remember the Pacemaker Welding Rules at the start of this article:

  1. Ask your cardiologist if your pacemaker settings are low (sensitive);
  2. Never work with machines which have not been safety tested;
  3. Only work on machines which use less than 400 Amps;
  4. Keep welding cables and arc at least 60cm from your pacemaker device;
  5. Should you begin to feel dizzy or get the sensation that your heart is beating at an unusual rhythm, stop what you are doing immediately.

These five rules should be pacemaker/welder 101. If you work for an employer who is lax when it comes to machine safety, you are at risk. When the pacemaker setting is highly sensitive, there is a risk of it misfiring. When slinging the welding cable over your shoulder, you are asking for trouble. And if you are using an arc welding machine at 800 amps, beware. Is there anything else we can do to prevent misfiring or damage to pacemaker devices?

Protective (Lead) Vest For Welding

“Aprons or vests will not effectively shield your pacemaker or implantable defibrillator from the electromagnetic energy generated by welding equipment”. With electromagnetic interference, distance is the key. You won’t block electromagnetic radiation if your pacemaker is only a few centimeters from the source.

That said, you need shielding to protect yourself from sparks and burns. Use the highest quality apron or jacket you can get your hands on, but don’t be fooled into thinking this will also protect your pacemaker. It won’t.

Cable And Power Supply Position

How and where your EMI sources are positioned can make a huge difference in the number of electric signals that reach and affect the pacemaker sensor. The following are not simply recommendations, they are absolute musts!

  • Place the welding leads on the ground and as close to each other as possible: Both leads produce significant electromagnetic fields, but by twisting the shield cable with the ground lead, these fields basically cancel each other out. Many welders find it easier to sling the welding cable over one shoulder. If you have a pacemaker, you will need to stop this habit. Immediately. Even if you sling the lead over the opposite shoulder, it is still much too close to your device. Even when using a low amp setting, the over-the-shoulder trick is never the right method for anyone with a pacemaker.
  • Stand as far as possible from the main power supply: We’ve talked about distance, not protective vests, that are key when dealing with electromagnetic radiation. Based on the principle of the inverse square law, source radiation dramatically reduces when the distance is increased.
  • Maintain some amount of distance: Keep at least a 24 inch or 60-centimeter distance from the to-be-welded metal and attach a ground clamp as close to the welding point as you can. Exchange intricate or detailed work for work that can be done at a distance. In fact, you might have to rethink your entire setup either at work or at home, repositioning yourself and your equipment to keep high levels of electromagnetic radiation as far as possible from your pacemaker.

You might need to get used to a new technique. Some professional welders have had to end their careers. Is your boss prepared to adapt? Then there’s no reason why you shouldn’t.

Avoiding Electrocution

It might sound obvious, but a heavy-duty electric shock passing through your pacemaker will almost definitely stop it from functioning – either temporarily or permanently. But whether you have a pacemaker or not, playing it safe around welding equipment can save your life:

  • Avoid water and keep clothes dry;
  • Wear rubber gloves under (dry) welding gloves;
  • Use safety boots with rubber soles;
  • Keep the transformer close enough to turn off immediately if necessary, and turn it off when not in use;
  • Always check the equipment thoroughly before proceeding;
  • Use an insulated rod holder;
  • Use insulating mats when welding conductive materials;
  • Do not hold or move the welding electrode holder and the welding return cable simultaneously, unless the power is off;
  • Ground the metal you are working on.

So Are You Telling Me It’s Safe To Weld With A Pacemaker?

Hey, I’m not going to fall for that one! The companies that manufacture pacemakers won’t go that far. As far as pacemakers and welding are concerned, this is a major gray area. There haven’t been many recent studies on this subject. I’ve already mentioned that most of the scientific studies on which current guidelines are based are at least ten years old. Ten years is a long time in the world of medicine.

I am sure the root of the problem lies in the legal system. Medical device manufacturers don’t want to be held accountable when it comes to your health. By not offering guarantees they have breathing space, and the general public is often kept in the dark. Which is certainly the case here. Medical device manufacturers look at the worst case scenario and base their guidelines on these; a one in ten million risk is still a risk and should be avoided.

In the end, it’s your decision. If you follow the guidelines listed above – which come from the most recent sources I could find – there’s no reason you will have to leave your hobby or career behind. Your pacemaker will not explode if exposed to high EMI from regulated welding equipment. Especially not with the equipment in this overview. It will try to remedy what it senses as an abnormal heart rhythm. You might feel palpitations, a little light-headed, or experience discomfort in the chest.

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