A patient with left hemiparesis and a demand-type cardiac pacemaker should have which intervention used only with extreme caution?

A patient with left hemiparesis and a demand-type cardiac pacemaker should have which intervention used only with extreme caution?

• A. Manual resistive exercise on the non-affected side
• B. Active exercise on the affected upper extremity
• C. Biofeedback to the affected side
• D. Functional electrical stimulation to the affected side

Answer: (D)

Electrical energy near an implanted cardiac device can disrupt how the pacemaker senses heart activity and delivers pacing. A demand-type pacemaker relies on correctly interpreting intrinsic rhythms, and external electrical stimulation can produce electromagnetic interference that may cause inappropriate pacing or inhibition. When functional electrical stimulation would be applied to the affected side, especially close to the chest where the device is usually located, this interference risk is present, so it should be used only with extreme caution and appropriate medical oversight. Other modalities—manual resistive exercise on the non-affected side, active exercise on the affected upper extremity, and biofeedback—do not involve delivering electrical energy that could affect the pacemaker, making them safer in this context.

Electrical energy near an implanted cardiac device can disrupt how the pacemaker senses heart activity and delivers pacing. A demand-type pacemaker relies on correctly interpreting intrinsic rhythms, and external electrical stimulation can produce electromagnetic interference that may cause inappropriate pacing or inhibition. When functional electrical stimulation would be applied to the affected side, especially close to the chest where the device is usually located, this interference risk is present, so it should be used only with extreme caution and appropriate medical oversight.

Other modalities—manual resistive exercise on the non-affected side, active exercise on the affected upper extremity, and biofeedback—do not involve delivering electrical energy that could affect the pacemaker, making them safer in this context.