Introduction
People with cardiovascular implantable electronic devices (CIEDs) may wish to participate in scuba diving (SD). To best advise these patients, health care providers must have the necessary knowledge about CIEDs, including the impact of hyperbaric pressure, the indications, and the individual characteristics and limitations of different CIEDs.
Objective
To review literature on CIEDs and SD and to present the latest information on CIEDs relating to hyperbaric pressure and the current CIEDs guidelines relevant to diving.
Methods
The literature on CIEDs and SD, including technical documents of CIEDs from 4 major manufacturers (Biotronik, Boston Scientific, Medtronic, and St. Jude), and practice guidelines of CIEDs were reviewed. Testing methods, results, differential effects on the types of CIEDs (pacemaker, defibrillator, and loop recorder), and case reports were obtained from the manufacturers.
Results
Existing literature on hyperbaric pressure and CIEDs contain outdated information. Recommendations regarding CIEDs and SD lack specifics on different types of CIEDs and do not address the underlying heart conditions. Indications for CIEDs range from mild symptoms to life-threatening conditions that will limit SD. CIED test pressure varies from 3 to 7 ATM among manufacturers. Casing deformation can occur, but no component integrity or electronic function is compromised. Devices using piezoelectric sensors may cause undesired heart rate acceleration. No case of device malfunction related to diving or hyperbaric pressure has been reported to the manufacturers during the past 10 years. Some CIEDs are capable of wireless transmission using cellular and WiFi communicators best suited for remote monitoring.
Conclusions
The underlying cardiac conditions should be the most important determinant when advising people with CIEDs who wish to engage in SD. Current generations of CIEDs function well under tested pressures. Knowing the individual characteristics and limitations of different CIEDs will help in selecting specific devices before implantation and in advising divers with existing devices.