Review ArticleUpdate on Cardiovascular Implantable Electronic Devices for Anesthesiologists
Section snippets
Permanent Transvenous Pacemakers
Improvements in technology have resulted in smaller and more sophisticated devices since permanent pacemakers initially were implanted more than 6 decades ago. These advancements, the improvement in quality of life, and reduction in mortality in specific patient populations have led to approximately 250,000 devices being implanted in the United States annually.1 Even though a detailed description of all the devices and programming options available would be impractical, a review of a few
Transvenous Implantable Cardioverter Defibrillators
A transvenous ICD is a CIED that is able to sense, detect, and treat malignant ventricular tachyarrhythmias with antitachycardia pacing (ATP) or defibrillator shock via shock coils in the RV and occasionally in the superior vena cava. Treatment of identified ventricular tachyarrhythmias via overdrive pacing (ie, ATP) or defibrillation depends on the diagnosis of either ventricular tachycardia or ventricular fibrillation. ATP, or overdrive pacing, typically occurs at lower rates (ie, ventricular
Device Recognition
Important device information can be obtained from a wallet card provided by the patient, patient history and medical records, or the manufacturing company. Other approaches such as trialing programmers from all 5 device companies to determine the manufacturer, assuming the device is functional, or calling all 5 companies are time consuming and may not yield useful information. Alternatively, magnet application to a pacemaker can narrow the field of potential manufacturers by the magnet mode
Current Recommendations
Current recommendations from the ASA and HRS focus on an individualized, multidisciplinary approach with less reliance on direction from industry-employed allied health professionals and increased involvement of the primary CIED management team.17, 37 Alternative protocols for device management, such as the PACED-OP protocol, advocate for more selective criteria for CIED reprogramming in an effort to operate within the confines of restricted resources and to avoid reprogramming errors (Table 5).
Cardiovascular Implantable Electronic Device Milestones
Since the first pacemaker was implanted in 1958, there have been many improvements in the programming, leads, battery life, and sizing of CIEDs.44 However, reliance on the transvenous placement of leads has persisted through the development and implantation of the ICD and CRT. Even though slight deviations from the transvenous model have occurred (eg, epicardial pacing) since its introduction, it has taken nearly 50 years for the leadless pacemaker to come to market (Fig 7).1 The production of
Indication and Features
The S-ICD system (Boston Scientific) consists of a single subcutaneous electrode and a pulse generator and has emerged as an excellent alternative to conventional transvenous ICD systems for the prevention of sudden cardiac death. The S-ICD provides sensing, detection, and defibrillation therapy (synchronous, biphasic shock energy of 80 J) of malignant ventricular tachyarrhythmias in patients who have no need for ATP or bradycardia pacing and avoids complications associated with chronic
Conclusions
CIED technology is evolving rapidly and presents challenges to anesthesiologists. This evolution has led to newer devices that are implanted in the myocardium or extrathoracically and have different functionality from traditional transvenous CIEDs. Similarly, there is room for the role of the anesthesiologist in CIED management to expand and evolve. Progress already is under way at some large academic centers where comprehensive perioperative CIED services are staffed by anesthesiologists.67, 68
References (68)
- et al.
Transesophageal atrial pacing for intraoperative sinus bradycardia or AV junctional rhythm: Feasibility as prophylaxis in 200 anesthetized adults and hemodynamic effects of treatment
J Cardiothorac Vasc Anesth
(1993) - et al.
Difficulty of extraction of chronically implanted tined ventricular endocardial leads
J Am Coll Cardiol
(1984) - et al.
Multidisciplinary approach to transvenous lead extraction: A single center’s experience
J Cardiothorac Vasc Anesth
(2015) - et al.
Impact of rate-modulated pacing on quality of life and exercise capacity—evidence from the Advanced Elements of Pacing Randomized Controlled Trial (ADEPT)
Heart Rhythm
(2007) - et al.
Perioperative management of patients with cardiac implantable electronic devices
Br J Anaesth
(2011) - et al.
Pacemaker-induced tachycardia during general anaesthesia: A case report
Br J Anaesth
(1989) - et al.
ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities
Heart Rhythm
(2008) - et al.
Patients with pacemaker or implantable cardioverter-defibrillator
Med Clin North Am
(2013) - et al.
Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: Frequency, mechanisms, predictors, and survival impact
J Am Coll Cardiol
(2008) - et al.
Cardiac rhythm device identification algorithm using x-rays: CaRDIA-X
Heart Rhythm
(2011)
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
In vitro tests reveal sample radiofrequency identification readers inducing clinically significant electromagnetic interference to implantable pacemakers and implantable cardioverter-defibrillators
Heart Rhythm
Pacemaker backup-mode reversion and injury during cardiac surgery
Ann Thorac Surg
Unintentional deactivation of implantable cardioverter-defibrillators in health care settings
Mayo Clin Proc
Leadless cardiac pacemakers: Back to the future
J Am Coll Cardiol
Incidence and predictors of short- and long-term complications in pacemaker therapy: The FOLLOWPACE study
Heart Rhythm
Perioperative management of a leadless pacemaker: The paucity of evidence-based guidelines
J Cardiothorac Vasc Anesth
Extraction of a Micra transcatheter pacing system: First-in-human experience
HeartRhythm Case Rep
Communicating antitachycardia pacing-enabled leadless pacemaker and subcutaneous implantable defibrillator
J Am Coll Cardiol
Cardiac resynchronization therapy with wireless left ventricular endocardial pacing: The SELECT-LV Study
J Am Coll Cardiol
Perioperative considerations for patients with subcutaneous implantable cardioverter-defibrillators undergoing noncardiac surgery
J Cardiothorac Vasc Anesth
Permanent leadless cardiac pacemaker therapy: A comprehensive review
Circulation
2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society
J Am Coll Cardiol
The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group
Pacing Clin Electrophysiol
Myocardial rupture after pulling out a tined atrial electrode with continuous traction
Pacing Clin Electrophysiol
The nonextractable tined endocardial pacemaker lead
Can J Cardiol
Tensile force of pacing lead extraction. A comparison between tined type and screw-in type
Jpn Heart J
Cardiac pacing, defibrillation and resynchronization: A clinical approach
Cardiac rhythm management devices (part I): Indications, device selection, and function
Anesthesiology
Current perioperative management of the patient with a cardiac rhythm management device
Semin Cardiothorac Vasc Anesth
Anesthetic implications for patients with rate-responsive pacemakers
Semin Cardiothorac Vasc Anesth
Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: Pacemakers and implantable cardioverter-defibrillators: An updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices
Anesthesiology
Electrocautery-induced tachycardia in a rate-responsive pacemaker
Anesthesiology
Cited by (19)
Evaluation and Interventional Management of Cardiac Dysrhythmias
2022, Surgical Clinics of North AmericaStandardized Perioperative Note to Improve Perioperative Management of Patients With Cardiac Implantable Electronic Devices
2022, Journal of Perianesthesia NursingCitation Excerpt :However, magnet application should not be a substitute for individualized patient management due to unexpected or unwanted effects of magnet use.3,9 These effects include inappropriate CIED therapy, asystole, and patient injury from inappropriately delivered shocks.3,16 In order to eliminate the surgical delays and cancellations caused by the lack of available clinicians that can reprogram CIEDs preoperatively, implementation of an anesthesiology-based service has been shown to reduce surgical delays while maintaining patient safety.1,15
The perioperative management of small animals with previously implanted pacemakers undergoing anaesthesia
2022, Veterinary Anaesthesia and AnalgesiaCitation Excerpt :Bipolar cautery can only be used for coagulation but not for dissection (Prutkin & Poole 2016). The use of transcutaneous electrical nerve stimulators, specifically peripheral nerve stimulators used for locoregional anaesthesia, can potentially induce EMI (Castro-González et al. 2018; Cronin & Essandoh 2018). The key factors are the distance between the neurostimulation needle and the pacemaker (the farther the better), the distance between positive and negative electrodes of the neurostimulator (as short as possible) and the duration of the applied stimulus (ideally < 0.5 ms) (Castro-González et al. 2018).
Perioperative management of epicardial pacemakers: A case report
2021, Journal of Clinical AnesthesiaImplementation of a Postoperative Electronic Health Record Alert for Cardiac Implantable Electronic Device Patients
2021, Journal of Perianesthesia NursingPerioperative Interrogation of Medtronic Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists
2020, Journal of Cardiothoracic and Vascular Anesthesia