Which area is contraindicated for E-stim in patients with demand-type pacemakers or ICDs?

• A. Trunk or heart region in patients with demand-type pacemakers or implantable cardioverter defibrillators
• B. Anterior neck
• C. Across cranium
• D. Over damaged skin

Answer: (A)

The key idea is that electrical stimulation can cause electromagnetic interference with implanted cardiac devices. The trunk or heart region is where a demand-type pacemaker or an ICD is typically implanted, including the pulse generator and leads. Stimulation in that area can send currents that are picked up by the device, potentially inhibiting pacing when the heart needs to beat or triggering an ICD shock inappropriately. That risk makes the trunk/heart region contraindicated for E-stim in these patients.

Other areas aren’t as directly aligned with the device itself, so they’re not inherently contraindicated for this reason, though you’d still avoid stimulation directly over the device site. Always coordinate with the patient’s cardiology team before applying any stimulation in patients with pacemakers or ICDs.