Perioperative management of patients with a pacemaker or implantable cardioverter-defibrillator
- Marc A Rozner, PhD, MD
Marc A Rozner, PhD, MD
- Professor of Anesthesiology and Perioperative Medicine
- Professor of Cardiology
- University of Texas MD Anderson Cancer Center
- Peter M Schulman, MD
Peter M Schulman, MD
- Associate Professor of Anesthesiology and Perioperative Medicine
- Oregon Health & Science University
- Section Editors
- Jonathan B Mark, MD
Jonathan B Mark, MD
- Section Editor — Cardiac Anesthesiology
- Professor of Anesthesiology
- Duke University Medical Center
- Chief, Anesthesiology Service
- Veterans Affairs Medical Center
- Mark S Link, MD
Mark S Link, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Tufts Medical School
More than three million people in the United States have a conventional pacemaker (PM) and more than 300,000 have an implantable cardioverter-defibrillator (ICD) with pacing capabilities [1,2]. Use of these cardiac implantable electronic devices (CIEDs) is increasing throughout the world, and these patients are presenting with increasing frequency for surgical and other interventional procedures .
Creation of perioperative care algorithms for patients with CIEDs is complicated by the diverse programming capabilities of currently manufactured devices, the presence of functioning older (legacy) devices in some patients, continuing evolution in CIED technology (eg, leadless PMs and subcutaneous ICDs), and confusion regarding the differences between PMs and ICDs, including variable responses to magnet application [4,5].
Perioperative advisories have been developed by four professional societies: the American Society of Anesthesiologists (ASA), the Heart Rhythm Society (HRS), the Canadian Anesthesiologists' Society (CAS) in conjunction with the Canadian Cardiovascular Society (CCS), and the Medicines and Healthcare products Regulatory Agency (MHRA), a British governmental agency [6-9]. The recommendations of these agencies differ with respect to intraoperative magnet use and the need for device interrogation and/or reprogramming for surgery (table 1).
This topic discusses management of patients with CIEDs during the preoperative, intraoperative, and immediate postoperative periods. Other aspects of CIED technology are discussed separately:
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- ELECTROMAGNETIC INTERFERENCE
- Risks of electromagnetic interference
- Sources of electromagnetic and other interference
- PREOPERATIVE ASSESSMENT
- Device interrogation
- Planning device management
- - Reprogramming with a programming machine
- - Magnet application
- Preanesthesia consultation
- INTRAOPERATIVE MANAGEMENT
- Placement of transcutaneous pacing/defibrillator pads
- Management of the cardiac implantable electronic device
- Management of electromagnetic interference
- Central venous catheterization
- Anesthetic agents
- Intraoperative emergencies
- EMERGENCY SURGERY
- POSTOPERATIVE MANAGEMENT
- SUMMARY AND RECOMMENDATIONS