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. Author manuscript; available in PMC: 2014 Dec 24.
Published in final edited form as: Circulation. 2013 Dec 24;128(25):2799–2809. doi: 10.1161/CIRCULATIONAHA.113.005697

Table 4.

Management of patients undergoing electrosurgery

General considerations:

  • The perioperative management of CIEDs must be individualized to the patient, the type of CIEDs and the procedure being performed.

  • All patients with pacemakers and ICDs undergoing elective surgery should have had a device check as part of routine care within the past 12 and 6 months, respectively.

  • Maximize the distance between the electrosurgery current path and the CIED. Consider the use of bipolar cautery.

  • Use the minimum power settings required for adequate electrosurgery. Using short bursts may also be required if inhibitions are observed.

  • Emergency equipment should be easily accessible to the procedure area. External defibrillation equipment is required in the procedure room.

  • All patients with pacemakers or ICDs require blood pressure monitoring for all surgical and sedation procedures.

  • Use an ECG monitor with a pacing mode set to recognize pacing stimuli.

  • Keep a magnet immediately available for all patients with CIEDs who are undergoing a procedure that may involve EMI.

  • If central venous access is required, guide wires should be advanced carefully particularly if the CIEDs lead has been recently placed, and should not contact the sensing electrodes of an ICD lead (which may include the distal coil). Delivery of a shock as a result of inappropriate detection of noise or to treat a real arrhythmia when the guide wire has created a short circuit by touching the high voltage anode and cathode may result in catastrophic pulse generator failure.

  • After the surgery, reprogram CIEDs to pre-surgical settings.

Specific considerations:

  • If the current path is distant and appropriate monitoring is available, programing to an asynchronous mode (VOO/DOO) in pacemaker dependent patients is not a universal requirement.

  • If the current path is distant, turning off ICD arrhythmia detection is not a universal requirement for all procedures. ICD arrhythmia detection can be turned off by placement of a magnet over the pulse generator, provided the pulse generator is accessible. However, placing a magnet over an ICD generator will not render pacemaker function asynchronous. All patients with ICDs deactivated should be on a cardiac monitor, and defibrillation patches should be placed.

  • Turning off ICD arrhythmia detection (by programming or magnet application) is recommended for all procedures above the umbilicus that utilize monopolar electrosurgery or radiofrequency ablation.

  • For procedures below the umbilicus pacemaker programming is typically unnecessary.

  • Because of interactions with monitoring, ventilation, and other impedance monitoring operative devices, deactivation of minute ventilation sensors should be considered.