Abstract
With the demographic evolution of the population, patients undergoing surgery today are older and have an increasing number of sometimes complex comorbidities. Cardiac implantable electronic devices (CIED) are also getting more and more complex with very sophisticated programming algorithms. It may be generally assumed that magnet application reverts pacing to an asynchronous mode in pacemakers and disables tachycardia detection/therapy in internal cardioverter-defibrillators. However, depending on device type, manufacturer and model, the response to magnet application may differ substantially. For these reasons, perioperative management of CIED patients is getting more and more challenging. With this review article we provide an overview of optimal perioperative management of CIED patients with a detailed description of CIED response to magnet application depending on manufacturer and device-type, which may help in providing a safe perioperative management plan for the CIED patient.
Highlights
The clinical adoption of novel therapies which were developed over the last two decades, including cardiac implantable electronic devices (CIEDs) for patients with cardiovascular diseases, resulted in a substantially improved quality of life and survival of these patients
Given the increasing complexity of CIED programming, peri- and intra-operative management of CIED patients by surgeons, anesthesiologists, internal specialists and cardiologists require a good understanding of the device function and behavior in case a CIED is exposed to electromagnetic interference (EMI) during surgery
Anesthesiologists refer to clinical practice recommendations by the American Society of Anesthesiologists for the management of CIED patients [6]
Summary
The clinical adoption of novel therapies which were developed over the last two decades, including cardiac implantable electronic devices (CIEDs) for patients with cardiovascular diseases, resulted in a substantially improved quality of life and survival of these patients. More CIED patients are possibly exposed to diseases in need of surgery during their lifetime [1,2,3]. Anesthesiologists refer to clinical practice recommendations by the American Society of Anesthesiologists for the management of CIED patients [6]. These guidelines, do not focus on CIED behavior and possible issues occurring during magnet application. We provide an overview of perioperative management of CIED patients and summarize the CIED response to magnet application depending on device manufacturer, device type and its programming
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