Handling Pacemakers and Implantable Cardioverter Defibrillators in the Operating Room

The high rate of utilization of cardiac implantable electronic devices (CIEDs) and the high stakes in case of malfunction makes it crucial that we understand and optimize the perioperative management of CIEDs. Several professional societies have addressed the topic. The function of CIED can be altered by electromagnetic interference (EMI), potentially causing iatrogenic adverse outcomes. There are several sources of EMI in the operating room. A comprehensive preoperative assessment for patients with CIED undergoing elective surgery should be performed. Device interrogation and appropriate reprogramming, if necessary, should be done before the surgical intervention. Reprogramming can be performed using a reprogramming machine or through magnet application in certain conditions. Several factors should be considered during the intraoperative period that are centered on continuous monitoring and preparedness for emergencies. Transcutaneous/defibrillator pads should be placed on the patient during the surgical procedure. Postoperative management includes reactivation of CIED and appropriate device interrogation to check for any malfunction during or following the surgical procedure.