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Some divers have a tiny battery-powered medical device that generates electrical pulses to the heart muscle, such as when the sinoatrial (SA) node fails to work as it should.
So, if you are trying to determine whether it is safe to go scuba diving with a pacemaker, you will find the answers right here in these current health and safety guidelines.
Simply put, the pacing impulses delivered by all cardiac pacemakers is trying to achieve three principle functions:
When they are set correctly, the same objectives apply to the recipient no matter whether they are active or at rest.
During the insertion, a cardiologist will implant the device underneath the skin, almost always on the left side of the chest, and a few inches below the clavicle (collarbone). Tiny wires thread through the major blood vessels into the heart.
In some cases, the pacemaker only needs to provide intermittent stimulation to the heart, such as when there is a long pause between two beats. However, some patients will depend on the device for regular electrical impulses to maintain a normal heartbeat.
Another small cardiac therapy device, called an implantable cardioverter-defibrillator, is also powered by a battery and implanted in the same way.
An ICD can also detect cardiac dysrhythmia and it aims to stop arrhythmias (irregular heartbeats) from developing into life threatening situations. Therefore, it monitors the heartbeat and is able to deliver electric shocks when it is appropriate to do so.
Here's the thing:
Even though both types of cardiac stimulators look similar, there are several important differences between an ICD and a pacemaker.
So, why would a recipient need to have an ICD implant? The typical reasons would be for ventricular tachycardia (fast heartbeat) or when someone has a weak myocardium (cardiac muscle) and worsening irregular heartbeats may become life threatening.
Pro Tip: Some of the modern cardiac devices combine the functions of a pacemaker and an ICD. Plus, some ICDs have a modem for telemonitoring. Thus, it can send important medical data to the hospital even while you are at home.
Our free scuba diving lessons blog explains more about ambient pressures that divers experience as they descend in water. In the same way, a pacemaker is going to experience the same pressure changes. So, it must be able to function at the maximum depth for recreational diving (40 metres or 133 feet).
The main section explains what medical conditions can stop you from scuba diving - and why! Nonetheless, having a cardiac defibrillator implanted is an outright contraindication for diving.
Because ICDs can deliver defibrillator intervention, they are for people with a high risk of suffering sudden cardiac arrest (SCA).
So, a scuba diver with an implantable cardioverter-defibrillator (ICD) would be prone to suffering periods of altered consciousness. Thus, the likelihood of drowning and near drowning incidents, including death from asphyxia, would increase.
But wait - there's more:
A doctor will assess whether the underlying medical problem reduces someone's "fitness" to dive. But, it's also fair to say that the grounds for each pacemaker insertion will differ between individuals - including the actual cause of the condition.
For that reason, there will be two determining factors that a diving physician will consider if you want to go scuba diving after a pacemaker implant:
Pro Tip: A recent search of the Internet suggests most Medtronic pacemakers are suitable for scuba diving. Some of their cardiac devices can last up to 15 years before they need battery replacements. Plus, Medtronic SureScan technology used in their portfolio of pacing systems also provides access to safe, full-body MRI scans.
Some of the coolest dive sites in the world exist in remote locations. In other words, many of them are long distances from adequate medical facilities.
One of the key reasons to have diving insurance is to receive emergency care if something bad happens. It is even more important for any diver with a cardiovascular condition who decides to go scuba diving with a cardiac pacemaker implant.
If you're running a scuba diving business you will need to consider the health status of every customer on a case-by-case basis.
Furthermore, you should discourage anyone with poor exercise tolerance from participation in water-based activities. All divers must have adequate cardiovascular reserve so they can respond to the most common cause of diver emergencies.
Moving on...
Assessing someone’s cardiovascular fitness to dive is beyond the scope of a dive instructor. When in doubt, encourage your client to present a medical clearance to scuba dive signed by their physician and keep a copy for your records.
Dive staff (e.g. divemasters, instructors) should not give medical advice and clearance for customers to go diving. Instead, they can contact the Divers Alert Network (DAN) if they have questions about someone's medical fitness to dive.
Divers with heart issues should be medically evaluated before diving. In reality, coronary artery disease is a major contributor to the scuba diving fatality rate each year.
The DAN® Right of Refusal guidelines will help you make consistent and appropriate decisions when divers pose risks for staff and the business.
Important: The tutorial video [2:57 seconds] presented by DAN explains simplified answers to the FAQ about scuba diving with a pacemaker.