Monomorphic Ventricular Tachycardia Caused by Electrocautery during Pacemaker Generator Change in a Patient with Normal Left Ventricular Function

Abstract

Pacemaker generator replacement is a simple procedure that is mostly done on outpatient basis. Electrocautery is almost universally used for bleeding control and tissue dissection. Ventricular fibrillation (VF) caused by electrocautery in these procedures is a very uncommon occurrence and an underappreciated possibility with modern day devices. We report a case of monomorphic ventricular tachycardia induced by electrocautery in a patient with normal left ventricular ejection fraction during elective pacemaker generator change.

A Perioperative Management Algorithm for Cardiac Rhythm Management Devices: The PACED‐OP Protocol

“…Although case reports have published instances of bizarre CRMD behavior in the setting of intraoperative EMI, prior reports suggest that most instances of intraoperative EMI occur when electrocautery is used in close proximity to the device . In addition, several small cross‐sectional studies have not shown any evidence of device malfunction other than minor changes in sensing or threshold measurements .…”

“…Although case reports have published instances of bizarre CRMD behavior in the setting of intraoperative EMI, [9][10][11][12] prior reports suggest that most instances of intraoperative EMI occur when electrocautery is used in close proximity to the device. 6,9,13,14 In addition, several small crosssectional studies have not shown any evidence of device malfunction other than minor changes in sensing or threshold measurements. 6,7,15,16 After appropriate precautions were taken (magnet use and reprogramming certain CRMDs to a safety mode), the patients in either cohort of our study had similar outcomes to the ones in these previous reports (i.e., an absence of inappropriate device function).…”

Empfehlungen zum Einsatz von Elektrokautern bei Patienten mit Herzschrittmachern und implantierten Defibrillatoren

“…Meist handelt es sich hierbei um ältere, teils multimorbide Patienten, die sich gehäuft unterschiedlichen operativen Eingriffen unterziehen müssen. Hierbei ist eine Vielzahl von Stör-beeinflussungen von Herzschrittmachern und implantierten Defibrillatoren durch den Einsatz von Elektrokautern bekannt [3,4,5,6,7,8,9]. Diese sind in .…”