Perioperative Pacemaker-Mediated Tachycardia in the Patient with a Dual Chamber Implantable Cardioverter-Defibrillator

Abstract

Patients with cardiac implantable electronic devices are at additional risk for arrhythmias while undergoing surgical procedures. In this case report, we present a patient with a dual chamber implantable cardioverter-defibrillator who developed intraoperative pacemaker-mediated tachycardia causing significant hemodynamic instability. Management of this arrhythmia can be particularly challenging, because standard application of a magnet does not affect the pacing functions of an implantable cardioverter-defibrillator. Awareness by the anesthesiologist and timely coordination with the cardiac electrophysiology team helped to optimize care for this patient.

Simulation of Intraoperative Pacemaker Failure

“…In this scenario, the surgery is inferior to the umbilicus. 7 In the section entitled ''Debriefing Points,'' the best method for determining pacing dependency was not discussed. Thus, magnet placement is unlikely to be indicated.…”