Can You Use An AED On Someone With A Pacemaker Or ICD?
Short answer: Yes. A pacemaker or implantable cardioverter defibrillator does not prevent AED use. Place the defibrillation pad about an inch clear of the implanted device rather than directly over it, then run the AED normally. The implant is a placement adjustment, not a contraindication.
This is the exception responders hesitate over most, and the hesitation is understandable. There is a visible device under the skin. It is a cardiac device. Putting a second cardiac device on top of it feels like something that needs permission.
It does not. Here is what is actually going on, and what changes.
How To Recognize An Implanted Device
You will see it before you feel it. Look for a firm rectangular or oval lump roughly the size of a matchbox sitting just under the skin, almost always below the left collarbone, with a healed surgical scar over it. Right-side placement happens and is less common. Some patients also carry a wallet card or wear a medical bracelet naming the device.
You do not need to identify which kind of device it is. A pacemaker and an implantable cardioverter defibrillator are handled identically from the outside.
| Device | What It Does | Effect On AED Use |
|---|---|---|
| Pacemaker | Paces a heart that beats too slowly | Offset the pad. Nothing else changes |
| Implantable cardioverter defibrillator | Detects and shocks dangerous rhythms internally | Offset the pad. May discharge on its own |
| Subcutaneous ICD | Same function, lead runs along the breastbone | Offset the pad and the visible lead track |
Why The Pad Gets Moved
Two reasons, and both are about where the current goes.
A pad placed directly over the metal generator casing can shunt part of the delivered energy around the housing instead of through the heart muscle. The shock still happens. It is simply less of it arriving where it needs to be. Moving the pad an inch clear restores the intended current path.
The second reason is the implant itself. Defibrillation energy applied straight onto the generator can damage the device or its programming, which matters enormously for a patient who survives. The goal is a successful resuscitation and a working implant afterward, not one at the cost of the other.
Where To Put The Pad Instead
If the implant occupies the upper right chest where the first pad normally goes, shift that pad lower and more toward the outside of the chest, keeping clear of the device. If that leaves you short of space, use front-to-back placement: one pad on the center of the chest and one on the back between the shoulder blades.
The 2025 American Heart Association guidelines describe anterolateral, anteroposterior, anterior-left infrascapular, and anterior-right infrascapular positions as comparably effective, which is the formal way of saying you have room to work with. The recommendation reads that it is reasonable to place pads on the exposed chest in an anterolateral or anteroposterior position. An implant in the way is exactly the situation that flexibility exists for.
What If The Implanted Defibrillator Fires While You Are Working?
It can happen, and it is startling rather than dangerous. An ICD delivers a much smaller amount of energy than an external defibrillator and delivers it internally. A rescuer in contact with the patient may feel a light tingle. It is not a reason to stop compressions and it is not a reason to step back from the patient.
If you see the patient's muscles twitch while you are working, the implant has discharged. Continue. The AED will complete its own analysis and advise its own shock independently.
What Does Not Change
Everything else. Call 911 or have someone call. Start compressions. Turn the AED on as soon as it arrives and follow its prompts. Do not delay the first shock hunting for a device or reading a medical bracelet. If you find the implant while placing pads, adjust. If you do not notice it until later, the shock you already delivered was still the right call.
The 2025 guidelines are unambiguous about sequencing: CPR is recommended until a defibrillator or AED is applied, and in unmonitored arrest it is reasonable to provide a brief period of CPR while the defibrillator is being obtained and readied.
What This Means For Your AED Program
Two practical consequences worth building into how your site operates.
First, this belongs in your refresher training, not your equipment list. No AED model handles implanted devices differently. What differs is whether the responder recognizes the lump and adjusts without freezing. A two-minute scenario in an annual drill fixes that permanently.
Second, it argues for front-to-back capability. If your pads are a fixed pair sized only for chest placement, your responder has fewer options when the standard position is occupied. Check what your unit's pads support and keep a spare set with every device. Our brand-by-brand guide to pad and battery replacement covers what your model takes and how long it lasts.
Related Reading
This article is part of our series on AED exceptions. The overview covering every scenario is who can an AED be used on. Also relevant: AED use during pregnancy, whether an AED can be used on someone who is breathing, and how to use an AED step by step.
Sources
Pad placement guidance is drawn from the 2025 American Heart Association Guidelines for CPR and ECC, Part 7: Adult Basic Life Support, published October 2025, and from American Red Cross AED guidance, which states that AEDs are safe to use on patients with implanted devices provided the pad is not placed over the device.
This article describes published resuscitation guidance. It is not a substitute for hands-on training or for the manufacturer's instructions for use supplied with your specific AED, which govern that unit.
Questions About Your Unit?
We have specialized in AEDs since 2003 and can tell you what your model's pads support, what spares it takes, and what your responders should be drilling. Call 888-541-2337.
