Here’s how to place AED pads on a patient with a pacemaker for safe, effective defibrillation.

How should an AED be used when a patient has an artificial pacemaker?

• A. AED cannot be used
• B. Place pads away from the pacemaker
• C. Use the AED continuously until help arrives
• D. Adjust the settings for the pacemaker

Answer: (B)

When using an automated external defibrillator (AED) on a patient with an artificial pacemaker, it is essential to place the AED pads away from the location of the pacemaker. This is crucial because placing the pads too close to the pacemaker may interfere with its function and could potentially cause harm by delivering an inappropriate shock to the device, rather than to the heart. The recommended distance ensures that the defibrillation therapy is effective and that the pacemaker operates correctly. Additionally, AEDs are designed to be safe and effective even in patients with pacemakers. The devices can be used without any significant risk if the pads are positioned properly. The other options do not provide appropriate protocols for safely using an AED with a pacemaker. Therefore, placing the pads away from the pacemaker is the best practice when applying AED therapy in such situations.

Outline:

• Hook: Pacemakers are common; so is sudden cardiac arrest. Here’s how AEDs fit into that reality.

• Core idea: The correct approach is to place AED pads away from a pacemaker, not over it.

• How to position pads: Keep a safe distance from the device, use standard pad placement when possible, and adjust only to avoid the pacemaker.

• Why it’s safe: AEDs are designed to be safe around implanted devices; the goal is to deliver a shock to the heart, not to tamper with the device.

• What not to do: Don’t try to alter AED settings or ignore the device’s location; don’t delay defibrillation.

• Practical tips for responders: Quick steps, a mental map for pad placement, and the value of teamwork in a busy scene.

• Quick recap: The bottom line, with a few memorable cues.

• Closing thought: Stay calm, stay informed, and act decisively.

How to use an AED when a patient has an artificial pacemaker

Let’s set the scene. You’re rushing to help a person who’s unconscious and not breathing. The pulse checker says “no.” You grab an AED. It’s a moment when every second counts, and the last thing you want is any confusion about where to place those sticky pads. For people with implanted pacemakers, there’s one simple rule that keeps everyone safe: place the pads away from the pacemaker.

The right answer, in real-life terms, is B: Place pads away from the pacemaker. That’s the foundation. A pacemaker is a small, confident device doing its job under the skin, often on the chest. If you put a defibrillator pad right over it, you risk interfering with the device or delivering a shock into the device rather than into the heart. The goal of the AED is to reset the heart’s rhythm, not to disrupt the device that keeps the heart beating in the first place. So we keep a clear buffer between the pads and the metal or electronics inside the chest.

Let me explain what that looks like in practice, because it’s easier to remember with a picture in your head.

How to position AED pads when a pacemaker is present

• Start with the standard rhythm: Place one pad on the upper right chest and the other on the left side of the chest, below the armpit, toward the side of the body. This is the classic anterior-lateral placement many AEDs use.

• Create space around the device: If the pacemaker sits on the left chest near the front, don’t align a pad exactly over it. Move the left pad a little farther down or out to the left side, or switch to the right side when feasible so the pads aren’t directly over the device.

• If you can’t avoid the device entirely: The bottom line is still to avoid the device as much as possible. If the patient’s clothing or injuries prevent ideal pad placement, place the pads where the heart’s electrical current can still reach effectively, and document the situation if your team needs to report it later.

• Back-up options: In some situations, a second pad placement on the back (posterior) is allowed if you’re trained to do so and it doesn’t compromise the heart rhythm assessment. For most lay responders using an automated external defibrillator, the recommended approach is anterior-lateral, adjusted to keep distance from the pacemaker.

• Follow the AED’s prompts: The device will guide you through the analysis and shock sequence. Don’t overthink it. If the pads are a bit offset from the pacemaker, that’s okay—as long as you’re avoiding direct contact with the device, you’re aligning with safety.

Why this approach matters

AEDs are built with safety in mind. They’re designed to deliver a life-saving shock to the heart with minimal risk to the patient. The energy travels through the chest to reset the heart’s rhythm. A pacemaker is a delicate piece of hardware that can be sensitive to external electrical currents. When a pad is placed away from the pacemaker, you reduce the chance of interference or unintended device behavior while still delivering the crucial jolt to the heart.

It’s reassuring to know that AEDs are capable of working safely in people who have pacemakers or other implants. The device’s job remains unchanged: identify a shockable rhythm and deliver a controlled defibrillating impulse. The key safeguard is proper pad placement. If the pads are too close to the device, you risk unnecessary stimulation of the device or a misdirected shock. By keeping the pads away, you maximize the chances that the energy goes where it needs to go—the heart—without compromising the pacemaker.

What to do and what not to do in the field

What you should do:

• Quickly assess the patient and confirm unresponsiveness and lack of normal breathing.

• Retrieve and attach the AED as soon as you can safely reach the patient.

• Place pads away from the pacemaker, following standard pad placement as closely as possible.

• Follow the AED prompts, and be ready to deliver a shock if advised.

• If you don’t get a shockable rhythm, continue CPR as directed by the device or your team leader.

• Communicate clearly with your teammates about the pacemaker location so everyone stays aware.

What you should not do:

• Don’t try to “tune” the AED to the pacemaker or change any device settings. Let the AED handle the rhythm analysis.

• Don’t place pads directly over the implanted device, even if it means adjusting your usual pad layout.

• Don’t delay defibrillation while you search for the perfect spot. Move the pads, then press the analyze button, and go on with life-saving work.

A quick note on safety and confidence

Some people worry that a shock might harm a person with a pacemaker. In most real-world cases, the benefits of restoring a stable heartbeat far outweigh any potential risks to the implanted device. Modern pacemakers are designed with shielding and safety margins. The AED’s energy is focused on the heart, not on the device in a way that would cause harm to the patient. Still, the practical rule stands: keep the pads away from the pacemaker as you instruct.

A few practical tips you can tuck away

• Visualize the layout before you need it. If you know a patient has a pacemaker, quickly scan the chest area to locate the device and decide pad placement within the first seconds of response.

• If the person is wearing patch ports or has other devices in the way, use the best available alternative pad spots to ensure the energy still reaches the heart effectively.

• Communicate with the bystanders. “Pads off the device,” you can say, to keep everyone on the same page.

• Practice with realism in mind. In training scenarios, you’ll get comfortable with adjusting pad positions without overthinking.

Common questions and quick answers

• Can an AED be used on someone with a pacemaker? Yes. It can be used safely as long as pads are placed away from the device.

• Does the patient need a different defibrillation approach because of the pacemaker? Not a different approach—just mindful pad placement to avoid the device.

• What about other implants, like an ICD? The same principle applies: avoid placing pads directly over the device; keep energy directed toward the heart.

A moment to breathe, then act

Here’s the practical takeaway you can carry into the field: when you’re applying an AED to someone with a pacemaker, the goal is to position the pads away from the device. The rest is straightforward—follow the device’s prompts, deliver a shock if indicated, and start or continue CPR as needed. It’s a rhythm of action, not hesitation, and the patient’s life can hinge on your calm, decisive approach.

Remember, you’re not just following a rule you learned in class. You’re matching real-life dynamics—crowded rooms, stressed teammates, and the uncertainty of a sudden emergency. The more cleanly you execute the pad placement, the more smoothly the energy can reach the heart, and the better the chance for a successful outcome.

Putting it all together

• The correct choice is clear: place the pads away from the pacemaker.

• Keep the device safe by not placing pads over it, and adjust placement as needed to ensure safe clearance.

• Rely on the AED’s guidance; don’t mess with settings or try to reengineer the device.

• Support the patient with immediate CPR if a shock isn’t ready or indicated.

Closing thought

Emergencies don’t come with a script. They come with quick decisions, clear priorities, and a steady hand. Knowing how to use an AED in the presence of a pacemaker isn’t about memorizing a single fact; it’s about applying a simple, repeatable rule that protects both the patient and the device while you focus on reviving the heart.

If you’re ever unsure, return to that core idea: keep the pads away from the pacemaker, follow the AED prompts, and act with purpose. In moments like these, that blend of knowledge and calm confidence can make all the difference.

Would you like a quick, printable one-page reminder you could keep with your first aid gear? I can tailor a compact cheat sheet that highlights pad placement and key safety notes so you’re prepared on the go.