Perioperative Assessment of Patients With Cardiac Implantable Electronic Devices

Abstract

Worldwide, nearly 4 million patients currently have cardiac implantable electronic devices. Due to the increasing number of candidates to receive either pacemakers or implantable cardiac defibrillators, there is no doubt that primary care physicians or anesthesiologists are very likely to interact and deal with this particular patient population. However, besides technologic advancements, several factors have been frequently reported to cause confusion regarding their perioperative care. Therefore, it has become extremely valuable to understand the basic functions and operation of these devices, as well as their functional limitations, to prevent iatrogenic complications and detect potential failure in an early stage. Mt Sinai J Med 79:25-33, 2012.

Analyzing the impact of preoperative interrogation of cardiac implantable electronic devices

“…[ 7 12 14 ] There appears to be an assumption that the lack of preoperative interrogation or improper magnet use results in patient mortality and morbidity; however, there is a dearth of scholarly work demonstrating this association. [ 18 ] Patients who developed perioperative cardiac events as described in Table 5 were admitted to the intensive care unit for 24-hour cardiac telemetry observation. Additionally, reassessment of the device was made by either the electrophysiology team or a company representative remotely.…”

Guideline for electrosurgical safety

“…1,6,7 In an emergent situation when the team managing the IED is unavailable, the anesthesia professional and preoperative nurse or RN circulator should consult the IED manufacturer via a 24-hour hotline to determine the necessary interventions. 1,7,8 In either scenario, the anesthesia professional or nurse should…”

“…“If perioperative personnel do not follow proper procedures outlined in this section of the guideline, injuries to the patient and IED malfunctioning may occur.” When electrosurgery is planned for patients with IEDs, the anesthesia professional and perioperative nurse should consult with the team managing the IED before surgery to define interventions required to safely manage the device intra‐ and postoperatively 1,6,7 . In an emergent situation when the team managing the IED is unavailable, the anesthesia professional and preoperative nurse or RN circulator should consult the IED manufacturer via a 24‐hour hotline to determine the necessary interventions 1,7,8 . In either scenario, the anesthesia professional or nurse should provide the folowing information: the patient’s reliance on the IED; availability of someone to reprogram the IED, if needed; the planned surgery; if cardioversion or defibrillation is expected to be performed; the patient’s position intraoperatively; the possibility of electromechanical interference based on the device being used and other possible sources of electromechanical interference; the location of the generator; the procedure room location; and the patient’s disposition after surgery 1,6,9 …”

Clinical Issues—December 2020

“…When a patient with a pacemaker is scheduled for an operative or other invasive procedure in which an electrosurgical device will be used and there is adequate time, the perioperative RN and anesthesia professional should consult with the team managing the pacemaker (eg, cardiologist, electrophysiologist, health care industry representative) to determine the correct course of action to take perioperatively 1-3 . If the team managing the CIED is not available for consultation, then the representative from the perioperative team should contact the manufacturer of the device.…”

“…If the team managing the CIED is not available for consultation, then the representative from the perioperative team should contact the manufacturer of the device. Many manufacturers have a consultation hotline available for this situation 1-3 …”