Operating with implants

Cardiovascular implantable electronic devices

• Risk of electromagnetic interference when monopolar diathermy is used
  • Triggering un-needed tachyarrhythmia therapy
  • Electrical reset of pulse generator
  • Oversensing - most common problem - either pacing inhibition or false arrhythmia detection
    • Risk greatest when current path goes near device
    • Review suggests best to only make a pacemaker asynchronous only if significant inhibition is observed, even if the patient is pacemaker-dependent
  • Device reset
    • Very uncommon, can occur with therapeutic radiation
• The risk is much lower below the umbilicus, and when current path is kept away from the device (at least 6 inches), and when bursts are limited to 5 seconds or less
  • Procedures on the lower extremities really shouldn't affect the pacemaker - don't need to do anything different to normal
• GI procedures with electrosurgery can cause interference
• Magnet application
  • Suspends arrhythmia detection and protect the patient from inappropriate EMI sensing, which would be interpreted incorrectly by the decide as an arrhythmia
  • Some devices have been programmed not to respond to the magnet!