Cardiac implantable electronic devices : Electromagnetic interference from electrocauterization, lithotripsy and physiotherapy

Abstract

The management of patients with acardiac implantable electronic device (CIED) poses aparticular challenge in the peri-interventional and perioperative medical environment due to the many forms of possible electromagnetic interference. Although the devices encountered nowadays are of increasing complexity, the vast majority of procedures can be safely performed in patients. The existing position statements and recommendations, however, have alow level of evidence and are often contradictory. In the context of intraoperative electrocauterization, one of the most important sources of electromagnetic interference in the medical environment, recent studies have suggested an increasingly pragmatically perioperative CIED management, which is not represented in the existing recommendations. This article gives an example of these newer findings and reports the currently used and appropriately adapted perioperative CIED management protocol. Extracorporeal shock wave lithotripsy was thought to cause severe interference in CIED patients based on older studies and in vitro experiments. Although electromagnetic interference is possible, clinical observations with modern devices show that the procedure can generally be safely applied in CIED patients. Physiotherapy often utilizes avariety of electromechanical devices, which can be a relevant source of electromagnetic interference. Although some of these therapies can be safely used, coordination with the responsible CIED unit is recommended.