Pacemakers and Implantable Cardiac Defibrillators in Dermatologic Surgery

Abstract

BACKGROUND Electrosurgery used during dermatologic surgical procedures can cause malfunction of pacemakers and implantable cardiac defibrillators (ICDs), producing problems with rhythm detection, proper function, or alteration of the device. Well‐documented safety data on electrosurgery in patients with cardiac devices are limited. At Mayo Clinic in Rochester, Minnesota, the Pacemaker Clinic manages all patients with pacemakers and ICDs undergoing dermatologic surgery. The preoperative and postoperative evaluations provide a unique opportunity to evaluate the safety of dermatologic surgery with electrosurgery in such patients. OBJECTIVES The objective was to review the evaluation and management, by an experienced cardiology team, of patients with cardiac devices undergoing dermatologic surgery and to characterize perioperative complications. METHODS A retrospective chart review of all patients identified with pacemakers or ICDs undergoing Mohs micrographic or dermatologic excisional surgery with electrosurgery at Mayo Clinic 2001 through 2004 were identified. Data were abstracted to identify any possible complications. RESULTS The 173 patients with pacemakers and 13 with ICDs undergoing dermatologic surgery had no documented complications from electrosurgery. CONCLUSION The lack of complications associated with pacemakers and ICDs with electrosurgery is reassuring. The authors support published recommendations about techniques and precautions to optimize safety during electrosurgery in patients with cardiac devices. The care of patients with ICDs in particular requires special consideration.

Radiowave Surgery versus CO2Laser for Upper Blepharoplasty Incision: Which Modality Produces the Most Aesthetic Incision?

“…The anesthesia personnel must be aware of these possible changes. Radiowave generation can also be problematic with cardiac pacemakers and internal cardiac defibrillators (ICD) 29–33 . Older, not‐shielded pacemakers could be interrupted by radiowaves but contemporary pacemakers are shielded and are not generally problematic.…”

Investigation of Hyfrecators and Their In Vitro Interference with Implantable Cardiac Devices

“…There have been previous reports in the dermatologic literature reviewing the electromagnetic interference (EMI) potential of electrosurgical devices in patients with cardiac devices . They give excellent reviews of the cardiac devices and provided recommended precautionary measures to take when performing surgery on these patients in an office‐based setting, but these precautions are not based on safety guidelines specific to hyfrecators.…”

Electrosurgery and Implantable Electronic Devices: Review and Implications for Office-Based Procedures

“…A retrospective review of 173 patients with a pacemaker and 13 with an ICD who underwent Mohs or dermatologic excisional surgery involving electrosurgery was performed at the Mayo Clinic 45 . All patients had preoperative cardiology evaluation or device information reviewed by a staff member who deemed preoperative cardiology consultation unnecessary.…”

“…Patients received bipolar electrosurgery using short bursts of low‐voltage electrical activity. No operation‐related device malfunctions or complications were identified after postoperative interrogation 45 …”