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Predictors of intraoperative electrosurgery-induced implantable cardioverter defibrillator (ICD) detection

  • Hannah Friedman
  • John V. Higgins
  • James D. Ryan
  • Thomas Konecny
  • Samuel J. Asirvatham
  • Yong-Mei ChaEmail author
Article

Abstract

Background

In the USA, the number of people needing implantable cardioverter defibrillators (ICDs) has grown dramatically. Many ICD recipients will need to undergo a surgical procedure at some point following ICD implantation. Most surgeries involve the use of electrocautery. Currently, the effects of electrocautery-induced electromagnetic interference (EI-EMI) on ICDs are poorly understood. The aim of this study was to study EI-EMI using prospectively collected clinical data.

Methods

We analyzed prospectively collected ICD data from patients undergoing a surgical procedure at Mayo Clinic between 2011 and 2012. Information on clinical, device history, device interrogation pre- and post-surgery, and surgical information were collected for all patients. ICDs were programmed with detections on and therapies off. The patients were then categorized into two groups: those with EI-EMI inappropriate arrhythmia detection and those without detection. The stored electrograms were reviewed. Clinical and device parameters were analyzed to identify predictors of EI-EMI.

Results

Of 103 patients studied, bipolar cautery did not induce EI-EMI (0/11 cases), whereas monopolar cautery resulted in noise detection in 11/92 procedures. Among 11 inappropriate episodes of detection, 10 had surgery at chest, neck, and upper extremity sites with cautery current across the ICD lead tip; 1 had abdominal surgery; and none had back or low extremity surgery. On average, the near-field electrogram amplitude values were greater than the far-field amplitude values.

Conclusions

EI-EMI does not occur when bipolar cautery or monopolar cautery is used below the hips with the dispersive ground pad applied to the lower extremities. In contrast to external EMI, EI-EMI may be larger on near-field than far-field electrograms.

Keywords

Electrocautery Pacemaker Implantable cardioverter defibrillator 

Abbreviations

ICD

Implantable cardioverter defibrillator

EI-EMI

Electrocautery-induced electromagnetic interference

Notes

Compliance with ethical standards

Financial support

None

References

  1. 1.
    Josephson M, Wellens H. Implantable defibrillators and sudden cardiac death. Circulation. 2004;109:2685–91.CrossRefPubMedGoogle Scholar
  2. 2.
    Mirowski M, Reid PR, Watkins L, Weisfeldt ML, Mower MM. Clinical treatment of life-threatening ventricular tachyarrhythmias with the automatic implantable defibrillator. Am Heart J. 1981;102:265–70.CrossRefPubMedGoogle Scholar
  3. 3.
    Guertin D, Faheem O, Ling T, Pelletier G, McComas D, Yarlagadda RK, et al. Electromagnetic interference (EMI) and arrhythmic events in ICD patients undergoing gastrointestinal procedures. PACE. 2007;30:734–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Madigan J, Choudhri A, Chen J, Spotnitz HM, Oz MC, Edwards N. Surgical management of the patient with an implanted cardiac device. Ann Surg. 1999;230(5):639.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cheng A, Nazarian S, Spragg DD, Bilchick K, Tandri H, Mark L, et al. Effects of surgical and endoscopic electrocautery on modern-day permanent pacemaker and implantable cardioverter-defibrillator systems. PACE. 2008;31:344–50.CrossRefPubMedGoogle Scholar
  6. 6.
    Donnelly P, Pal N, Herity NA. Perioperative management of patients with implantable cardioverter defibrillators. Ulster Med J. 2007;76(2):66–7.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Pinksi S, Trohman R. Interference in implanted cardiac devices, part II. J Pacing Clin Electrophysiol. 2002;25(10):1496–509.CrossRefGoogle Scholar
  8. 8.
    Schoenfeld MH. Contemporary pacemaker and defibrillator device therapy: challenges confronting the general cardiologist. Circulation. 2007;115(5):638–53.CrossRefPubMedGoogle Scholar
  9. 9.
    Fiek M, Dorwarth U, Durchlaub I, Janko S, Bary CV, Steinbeck G, et al. Application of radiofrequency energy in surgical and interventional procedures: are there interactions with ICDs? PACE. 2004;27:293–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Peter NM, Ribes P, Khooshabeh R. Cardiac pacemakers and electrocautery in ophthalmic surgery. Orbit. 2012;00:1–4.Google Scholar
  11. 11.
    Hoyt R, Johnson W, Leiserowitz A. Monopolar electrosurgery interactions with the implantable defibrillator. Poster presented at Heart Rhythm 2010. 31st Annual Scientific Sessions. 2010 May 12-15; Denver, CO.Google Scholar
  12. 12.
    Crossley GH, Poole JE, Rozner MA, Asirvatham SJ, Cheng A, Chung MK, Ferguson TB Jr, Gallagher JD, Gold MR, Hoyt RH, Irefin S, Kusumoto FM, Moorman LP, Thompson A. 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 this document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Heart Rhythm. 8(7): 1114–1154.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Hannah Friedman
    • 1
  • John V. Higgins
    • 1
  • James D. Ryan
    • 1
  • Thomas Konecny
    • 1
  • Samuel J. Asirvatham
    • 1
  • Yong-Mei Cha
    • 1
    • 2
    Email author
  1. 1.Heart Rhythm ServicesMayo ClinicRochesterUSA
  2. 2.Division of Cardiovascular MedicineMayo ClinicRochesterUSA

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