[Safety rules for patients with artificial cardiac pacemaker]

The recent progress in cardiac pacing increased the usefulness of artificial pacemakers. The initial purpose of avoiding Stokes-Adams attacks, was changed by a complex way to completely give back the physiologic response of cardiac rate and atrioventricular synchronism. However, this process forced the patients to take care of their pacemakers, and to spend more time in follow-up procedures. Additionally, the pacemakers became more vulnerable to environmental and hospital interferences. Basic rules, for all patients, are described in this paper, in order to improve their quality of life. Follow-up procedures are related in detail. It is described how programmed electronic evaluations can contribute to avoid complications, to detect subclinic problems and to improve the patient's haemodynamics and physical capacity. It shows also how to use complementary examinations, like thoracic X-rays, exercise testing and Holter monitoring to optimize the cardiac pacing system. Interferences in pacemakers are focused with special attention to myo-potentials, environmental electromagnetic fields, and damage to system owing to medical procedures, like therapeutic radiation, defibrillation and electrocauterization. The approach to infective processes in pacemakers gives special emphasis to prevention of direct surgical contamination, erosion of the skin, and haematogenic dissemination of distant infective focus.