| Electrosurgery |
-
1.
Maximize distance between site of monopolar electrosurgery and the CIED. Consider bipolar electrosurgery if required near the CIED.
-
2.
Use the minimum power settings required for adequate electrosurgery.
-
3.
For monopolar electrosurgery, place the return electrode at a site where the current path is kept as far as possible from the CIED. Often, the thigh on the leg contralateral to the CIED will be the best location.
-
4.
For surgeries below the umbilicus, often no specific procedures are required for CIEDs. However, in some cases (patients with ICD or who are pacemaker dependent), reprogramming or magnet application may be considered.
-
5.
Procedures above the umbilicus are more likely to be associated with EMI, and reprogramming or magnet application may be required, particularly if the patient has an ICD or is pacemaker dependent.
-
6.
Using short bursts of electrosurgery may be required if inhibition is observed.
-
7.
Continuously monitor the patient with plethysmography or arterial pressure.
-
8.
After the surgery, address any preoperative programming changes that were made, and consider interrogation for any surgery with a higher likelihood of EMI.
|
| MRI (see Table 2) |
| LVAD |
-
1.
Surgeons implanting the HeartMate II LVAD should be notified and be aware of possible loss of ICD telemetry in some types of ICDs.
-
2.
Interrogate before and immediately after LVAD implantation.
-
3.
If there is loss of ICD telemetry, metal shielding and/or implanting an ICD from a different manufacturer may be required.
|
| Radiation therapy |
-
1.
Avoid direct irradiation of the CIED.
-
2.
Consider relocation of the device if it is within the radiation field.
-
3.
Review with the manufacturer the susceptibility of the device to radiation effects.
-
4.
Establish the pacemaker dependency of the patient.
-
5.
Shield the pulse generator if possible.
-
6.
The absorbed dose to be received by the ICD should be estimated before treatment.
-
7.
Continuously monitor the patient's ECG.
-
8.
Consider intermittent testing of the CIED during and after radiation therapy.
|
| Cardioversion |
-
1.
Use an anterior‐posterior patch position, with the patches positioned as far from the CIED as possible (>8 cm).
-
2.
Evaluate CIED function after cardioversion.
|
| TENS |
-
1.
Assess the likelihood and patient risk of TENS for CIED interaction: location of TENS, pacemaker dependency, ICD vs pacemaker.
-
2.
Perform initial supervised testing of TENS use with monitoring to evaluate for interference.
-
3.
Set pacemaker sensing polarity to bipolar.
-
4.
Program OFF impedance‐based sensors such as minute ventilation.
-
5.
Place the TENS electrodes close to each other and perpendicular to the device leads.
-
6.
Avoid treatment in the chest area; TENS can often be done safely in the lower extremities.
|
| Radiofrequency ablation, lithotripsy, ECT |
-
1.
Generally, no specific programming is required.
-
2.
It is reasonable to have a magnet available.
-
3.
Cardiac monitoring is reasonable, particularly in those patients who are pacemaker dependent.
|
