Perioperative Sensor and Algorithm Programming in Patients with Implanted ICDs and Pacemakers for Cardiac Resynchronization Therapy.

Alexander Niedermeier,Harald Rittger,Wolfgang Kirste,Veronica Buia,Theodor Fischlein,Dirk Bastian,Laura Vitali-Serdoz,Janusch Walaschek

doi:10.3390/s21248346

Abstract

Background: ICDs and pacemakers for cardiac resynchronization therapy (CRT) are complex devices with different sensors and automatic algorithms implanted in patients with advanced cardiac diseases. Data on the perioperative management and outcome of CRT carriers undergoing surgery unrelated to the device are scarce. Methods: Data from 198 CRT device carriers (100 with active rate responsive sensor) were evaluated regarding perioperative adverse (device-related) events (A(D)E) and lead parameter changes. Results: Thirty-nine adverse observations were documented in 180 patients during preoperative interrogation, which were most often related to the left-ventricular lead and requiring intervention/reprogramming in 22 cases (12%). Anesthesia-related events occurred in 69 patients. There was no ADE for non-cardiac surgery and in pacemaker-dependent patients not programmed to an asynchronous pacing mode. Post-operative device interrogation showed significant lead parameter changes in 64/179 patients (36%) requiring reprogramming in 29 cases (16%). Conclusion: The left-ventricular pacing lead represents the most vulnerable system component. Comprehensive pre and post-interventional device interrogation is mandatory to ensure proper system function. The type of ICD function suspension has no impact on each patient’s outcome. Precautionary activity sensor deactivation is not required for non-cardiac interventions. Routine prophylactic device reprogramming to asynchronous pacing appears inessential. Most of the CRT pacemakers do not require surgery-related reprogramming.

Highlights

Among all cardiac implantable electronic devices (CIED) carriers, patients with implanted systems for cardiac resynchroThe study analyzes comprehensive data from 198 non-CIED-associated orperioperative nization therapy (CRT) form a specific subpopulation requiring surgical particular catheter-interventional procedures performed in Compared patients implanted with cardiac resynchronization therapy (CRT)-ICDs attention and care for several reasons
One hundred ninety-eight invasive procedures were performed in 134 patients implanted with a CRT-D (68%) and 64 patients with a CRT-P at a mean age of 72.2 ± 9.6 years
The development of modern drugs as well as CIED-based therapy such as CRT, cardiac contractility modulation, or conductive system pacing has led to a significant reduction of morbidity and mortality of heart failure [22,23,24,25]

Summary

Introduction

Patients with cardiac implantable electronic devices (CIED) undergoing non-device associated surgery require an individual peri-interventional management, in particular with regard to possible side effects of electromagnetic interferences (EMI, Figure 1) [1]. Sensors 2021, 21, 8346management and outcome of patients with implanted CRT devices undergoing nonCIED-related surgery or catheter interventional procedures with special focus on the programming of sensors and automatic algorithms. Data on the perioperative management and outcome of CRT carriers undergoing surgery unrelated to the device are scarce. Methods: Data from 198 CRT device carriers (100 with active rate responsive sensor) were evaluated regarding perioperative adverse (device-related) events (A(D)E) and lead parameter changes. Results: Thirty-nine adverse observations were documented in 180 patients during preoperative interrogation, which were most often related to the left-ventricular lead and requiring intervention/reprogramming in 22 cases (12%). Precautionary activity sensor deactivation is not required for non-cardiac interventions

Methods

Discussion

Conclusion