Application of Radiofrequency Energy in Surgical and Interventional Procedures:

Abstract

During surgical and interventional procedures, interference may occur between ICDs and electrical cautery or with the application of RF energy. This may lead to the false induction of ICD therapies or could even result in device malfunction, which represents a potential perioperative hazard for the patient. This study analyzed the intraoperative interactions in 45 consecutive ICD patients in reference to different surgical and interventional procedures. A total of 33 surgical operations (general surgery [n = 14], urologic [n = 5], abdominal [n = 10], gynecological [n = 2], thoracic [n = 1], neurosurgical [n = 1]) and 12 interventional therapies (RF catheter ablation [n = 10], endoscopic papillotomy [n = 2]) were performed. The ICD devices were all located in left pectoral position and consisted of 25 single and 20 dual chamber defibrillators. During the procedure, tachyarrhythmia detection (VF 296 +/- 20 ms, VT 376 +/- 49 ms) of the devices was maintained active (monitoring mode), only ICD therapies were inactivated. The indifferent electrode of the electrical cauter/RF generator was placed in standard positions (right/left mid-femoral position [n = 27/8], thoracic spine area [n = 10]). After the procedure, the ICD memory was checked for detections and for changes in the programming. There was no oversensing, reprogramming, or damage of any defibrillator caused by RF energy. Despite the lack of undesired interactions, ICDs should be inactivated preoperatively to assure maximum patient safety. However, should inactivation not be possible, or the achievement uncertain, electromagnetic interference is highly unlikely.

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

“…179 These studies varied in patient population, definition of perioperative complications, and what was done with the results of preoperative testing, including decisions about the appropriateness of proceeding with surgery. However, a consistent finding among the studies was that a low anaerobic threshold was predictive of perioperative cardiovascular complications, 171,173,177 postoperative death, 172,174,175 or midterm and late death after surgery. 174,179,180 An anaerobic threshold of approximately 10 mL O 2 /kg/ min was proposed as the optimal discrimination point, with a range in these studies of 9.9 mL O 2 /kg/min to 11 mL O 2 / kg/min.…”

“…See Cardiopulmonary exercise testing has been studied in different settings, including before abdominal aortic aneurysm surgery [172][173][174]180 ; major abdominal surgery (including abdominal aortic aneurysm resection) [175][176][177] ; hepatobiliary surgery 178 ; complex hepatic resection 171 ; lung resection 181 ; and colorectal, bladder, or kidney cancer surgery. 179 These studies varied in patient population, definition of perioperative complications, and what was done with the results of preoperative testing, including decisions about the appropriateness of proceeding with surgery.…”

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

“…Cardioversion can have similar effects on pacemaker or ICD function. Although the probability of any of these adverse interactions occurring has fallen dramatically owing to the almost universal use of bipolar leads (which greatly reduces the probability of electromagnetic interference) and improved pacemaker and ICD design, they still may occur (442)(443)(444)(445)447).…”

Perioperative management of patients with implanted pacemakers or cardioverter/defibrillators

“…Allerdings kann der bipolare Kauter EMI nicht völlig verhindern und ist zum Schneiden nur eingeschränkt verwendbar. Obwohl es Berichte über eine sichere Anwendung von Hochfrequenzchirurgie bei ICD-Patienten gibt [32,39], besteht dennoch das Risiko einer falschen Arrhythmiedetektion und damit der Abgabe eines inadäquaten Schocks [6,34].…”