Implantable Cardiac Electronic Devices
Patients with pacemakers or internal cardioverter-defibrillators (ICDs) are at risk for device malfunction or exposure to electromagnetic interference (EMI) from monopolar cautery, magnetic resonance imaging (MRI), radiofrequency ablation, electroconvulsive therapy, lithotripsy, and therapeutic radiation. The most common and potentially life-threatening adverse effects of EMI are inhibition of cardiac pacing (leading to bradycardia or asystole) and inadvertent shocks if an ICD interprets the EMI as a heart rate above the therapy trigger rate. Most experts recommend that a plan for device management for surgery be made by a qualified individual, and that the recommendation be based on knowledge of the proposed surgery and the information gleaned from a recent interrogation of the device. Technological advancement with subcutaneous ICDs and leadless pacemakers has demonstrated the need for continuous education for those taking care of implantable cardiac devices in perioperative period.
KeywordsCardiac implantable electronic device CIED Pacemaker Implantable cardioverter defibrillator Perioperative management
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