Perioperative management of patients with implanted pacemakers or cardioverter/defibrillators

Gombotz, Hans; Monti, Mattia; Leitgeb, Norbert; Nürnberg, Michael; Strohmer, Bernhard

doi:10.1007/s00101-009-1553-9

Cited by 22 publications

(6 citation statements)

References 109 publications

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“…In addition to the type of surgery, the peri-interventional risk of patients with CIEDs depends predominantly on the underling disease but also on the implanted device [1,21]. Adverse outcomes may be clinical (e.g., hypotension, brady-or tachyarrhythmia, death) or CIED associated such as hardware damage, changed pacing behavior (e.g., sensor-induced tachycardia), or shock delivery caused either by EMI or mechanically [17].…”

Section: Discussionmentioning

confidence: 99%

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Perioperative Sensor and Algorithm Programming in Patients with Implanted ICDs and Pacemakers for Cardiac Resynchronization Therapy

Niedermeier

Vitali-Serdoz²,

Fischlein

et al. 2021

Sensors

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Background: ICDs and pacemakers for cardiac resynchronization therapy (CRT) are complex devices with different sensors and automatic algorithms implanted in patients with advanced cardiac diseases. Data on the perioperative management and outcome of CRT carriers undergoing surgery unrelated to the device are scarce. Methods: Data from 198 CRT device carriers (100 with active rate responsive sensor) were evaluated regarding perioperative adverse (device-related) events (A(D)E) and lead parameter changes. Results: Thirty-nine adverse observations were documented in 180 patients during preoperative interrogation, which were most often related to the left-ventricular lead and requiring intervention/reprogramming in 22 cases (12%). Anesthesia-related events occurred in 69 patients. There was no ADE for non-cardiac surgery and in pacemaker-dependent patients not programmed to an asynchronous pacing mode. Post-operative device interrogation showed significant lead parameter changes in 64/179 patients (36%) requiring reprogramming in 29 cases (16%). Conclusion: The left-ventricular pacing lead represents the most vulnerable system component. Comprehensive pre and post-interventional device interrogation is mandatory to ensure proper system function. The type of ICD function suspension has no impact on each patient’s outcome. Precautionary activity sensor deactivation is not required for non-cardiac interventions. Routine prophylactic device reprogramming to asynchronous pacing appears inessential. Most of the CRT pacemakers do not require surgery-related reprogramming.

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Section: Discussionmentioning

confidence: 99%

“…Patients with cardiac implantable electronic devices (CIED) undergoing non-device associated surgery require an individual peri-interventional management, in particular with regard to possible side effects of electromagnetic interferences (EMI, Figure 1) [1].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Sensor and Algorithm Programming in Patients with Implanted ICDs and Pacemakers for Cardiac Resynchronization Therapy

Niedermeier

Vitali-Serdoz²,

Fischlein

et al. 2021

Sensors

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“…Diese Eingriffe werden bei den am schwersten kardial eingeschränkten Patienten mit z. T. langen Eingriffsdauern durchgeführt. Somit werden durch zahlreiche umfangreiche Studien und technische Neuerungen der letzten Jahren die Indikationen zur AICD-Implantationen erweitert und Erfahrungen mit diesen Verfahren gesammelt ( [1,15,24,25,36,50,90]; . Tab.…”

Section: > Ventrikuläre Arrhythmien Können Detektiert Und Terminiert unclassified

Implantation von Kardioverter-Defibrillatoren

et al. 2010

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Updated cardiologic guidelines constitute the background for an extended spectrum of indications for the implantation of automatic implantable cardioverter defibrillators (AICDs) and lead to an increasing number of operative implantations of AICDs. Moreover, during implantation of devices for cardiac resynchronization therapy the anesthesiologist is responsible for the most critically ill patients with the longest duration of surgery. As a result anesthesiologists face an increasing number of critically ill patients, whose management contributes to perioperative outcome. Automatic implantable cardioverter defibrillators can be implanted either during general anesthesia, local anesthesia or during a combination of local anesthesia combined with deep conscious sedation accomplished by an anesthesiologist. Besides economic aspects there is an increasing demand for anesthesia with the least cardiovascular side effects and rapid recovery in the often seriously ill patient with preexisting limitations of cardiac and pulmonary functions. Accordingly procedure and anesthesia-associated risks are reviewed and an algorithm for anesthesia management is suggested.

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“…Eine steigende Anzahl multimorbider Patientinnen mit SM/ICD, sowie die Vielfalt und Zunahme der Komplexität der einzelnen Systeme, verschärft durch die zunehmende Zahl von operativen Eingriffen haben dazu geführt, dass für diese Patientengruppe entsprechende Richtlinien erarbeitet wurden und gerade bei Einrichtungen mit nicht ausreichendem 7 kardiologischen "support" sollten diese Empfehlungen dringende Beachtung finden [12]. Bei Operationen innerhalb der kritischen Zeitintervalle nach Stent-Implantation sollte eine Antikoagulation fortgeführt werden…”

Section: Herz-kreislauf-systemunclassified