The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the Perioperative Management of Patients with Implantable Defibrillators, Pacemakers and Arrhythmia Monitors: Facilities and Patient Management

Society position statement

“…The American Society of Anesthesiologists (ASA) has published 7 and updated 8 a practice advisory; as has the Heart Rhythm Society (HRS) 9 and the Medicines and Healthcare products Regulatory Agency of the UK Department of Health.…”

The Effects of Catheter Ablation on Permanent Pacemakers and Implantable Cardiac Defibrillators

“…26 However, it is generally accepted that there is an increased chance of lead dislodgement up to 3 months after implant. 27 Therefore, we recommend allowing for a minimum of 6 weeks after CIED implantation, but ideally 3 months, to pass before an ablation procedure is performed.…”

“…In certain cases, myocardial thermal lesions may occur at the tip of the pacemaker and ICD leads from transmitted RF energy applied to the distal electrode. 27 Therefore, tissue alterations at the lead/myocardial tissue interface may result in decreased sensing or an increase in capture threshold, either transiently or permanently. This hypothesis was tested in vitro by Dick et al 28 using an RF ablation catheter at 55 W applied for 60 s on four different pacing and defibrillating leads at different sites, starting 1 cm from the tip of the lead in a tissue bath.…”

Perioperative Assessment of Patients With Cardiac Implantable Electronic Devices

“…Although this topic has been analyzed in a number of review articles and book chapters, no formal guidelines have been developed by the American College of Cardiology (ACC), the AHA, or the Heart Rhythm Society. 5 However, there are formal recommendations for the management of cardiac devices in a practice advisory that has been recently published by the American Society of Anesthesiologists (ASA) 1 and in a brief section of the ACC/AHA Guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. 6,7 Of note, all the recommendations are based on experts' opinions and small case reports or series, given that there are no data from randomized clinical trials.…”

“…However, besides technologic advancements, multiple current factors have been frequently reported to cause confusion regarding the perioperative care of this particular group of patients. 1 Therefore, it is extremely valuable to understand the complexity of CIEDs, as well as their functional limitations, to prevent iatrogenic complications and detect a potential failure in an early stage. The aim of this article is to provide a concise review for perioperative physicians as well as an understanding the complexity of advanced operation and troubleshooting of CIEDs in order to involve electrophysiologists when required.…”