101
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Fowler LH. Nursing Management for Patients Postoperative Cardiac Implantable Electronic Device Placement. Crit Care Nurs Clin North Am 2018; 31:65-76. [PMID: 30736936 DOI: 10.1016/j.cnc.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
As cardiac implantable electronic devices (CIEDs) continue to evolve and patients continue to live longer, the use of these devices increases. CIEDs include permanent pacemakers, implanted cardioverter-defibrillators, and cardiac resynchronization therapy devices. Over the last 2 decades, the functionality of these devices has increased and can be complex. Critical care nurses should be equipped with the knowledge to care for patients immediately postoperative CIED placement and for patients admitted to critical care units with CIEDs already in place. Patients with CIEDs are a vulnerable population with special needs and considerations for management.
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Affiliation(s)
- Leanne H Fowler
- LSU Health New Orleans School of Nursing, 1900 Gravier Street, New Orleans, LA 70112, USA.
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102
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Sameera V, Pandia MP, Bindu B, Goyal K. Anesthetic considerations and successful management of a patient with permanent pacemaker for cervical spine instrumentation. Saudi J Anaesth 2018; 12:634-636. [PMID: 30429749 PMCID: PMC6180689 DOI: 10.4103/sja.sja_125_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Patients with permanent pacemaker posted for cervical spine instrumentation pose special challenges for modern-day anesthesiologist since the field of surgery is in proximity to the pacing apparatus. The important considerations in this regard are pacemaker dependency, prior reprogramming to asynchronous mode, perioperative interference with pacemaker function due to electrolyte, acid-base disturbances, and electromagnetic interference leading to pacemaker failure and hemodynamic compromise. We report successful anesthetic management of a patient of postlaminectomy kyphosis with compressive myelopathy with permanent pacemaker in situ who underwent C5–C6 corpectomy and instrumentation under general anesthesia.
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Affiliation(s)
- Vattipalli Sameera
- Department of Neuroanesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Mihir P Pandia
- Department of Neuroanesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Barkha Bindu
- Department of Neuroanesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Keshav Goyal
- Department of Neuroanesthesia, All India Institute of Medical Sciences, New Delhi, India
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103
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Neubauer H, Wellmann M, Herzog-Niescery J, Wutzler A, Weber TP, Mügge A, Vogelsang H. Comparison of perioperative strategies in ICD patients: The perioperative ICD management study (PIM study). PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1536-1542. [PMID: 30264871 DOI: 10.1111/pace.13514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 09/01/2018] [Accepted: 09/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of patients with implanted cardioverter defibrillators (ICDs) and the frequency of surgery on these patients are steadily on the rise. Guidelines recommend preoperative ICD reprogramming, although this is sometimes difficult in clinical practice. Placing a magnet on the ICD is a practical alternative and even no inactivation is possible in selected cases. METHODS In this prospective observational study, we compared different perioperative ICD management strategies depending on the location of the surgery and the type of electrocautery used. Patients undergoing surgery above the umbilicus with monopolar electrocautery had their ICD therapy inactivated by reprogramming. When surgery below the navel or surgery above the navel with bipolar electrocautery was completed, ICD inactivation was performed using a magnet. No inactivation was performed on patients undergoing lower extremity surgery with bipolar electrocautery. Only ICD patients who were not pacemaker dependent were enrolled. After surgery, the ICDs were assessed regarding documented arrhythmias and parameters. RESULTS Out of 101 patients included in this study, the ICD was preoperatively reprogrammed in 42 patients (41.6%), a magnet was used on 45 patients (44.5%), and ICDs were not deactivated at all in 14 patients (13.9%). No intraoperative electromagnetic interference was detected. Postoperative ICD analysis demonstrated no changes of preset parameters. CONCLUSIONS All three tested ICD management strategies were proved safe in this study. Keeping the location of surgery and the type of electrocautery in mind, an intraoperative magnet or even no ICD deactivation at all could be feasible alternatives in surgery on patients with ICDs.
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Affiliation(s)
- Horst Neubauer
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Malte Wellmann
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Jennifer Herzog-Niescery
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Alexander Wutzler
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Thomas Peter Weber
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Andreas Mügge
- Cardiovascular Center, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Heike Vogelsang
- Department of Anaesthesiology and Intensive Care Medicine, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
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104
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Rav Acha M, Corn BW. Revisiting the impact of radiation therapy on cardiac implantable electronic device (CIED) function. J Cardiovasc Electrophysiol 2018; 29:1276-1279. [DOI: 10.1111/jce.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Moshe Rav Acha
- Cardiology Department, Shaare Tzedek HospitalHebrew University Jerusalem Israel
| | - Ben W. Corn
- Radiation Oncology Department, Shaare Tzedek HospitalTel Aviv University School of Medicine Tel Aviv Israel
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105
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Gifford J, Saleem M. Evaluation of surgical electromagnetic interference in leadless pacemakers. HeartRhythm Case Rep 2018; 4:570-571. [PMID: 30581734 PMCID: PMC6301881 DOI: 10.1016/j.hrcr.2018.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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106
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Larimer K, Saleem M, Burke M. Appropriate Classification and Filtering of Electromagnetic Interference by the S-ICD Sensing Algorithm During Surgery. J Perianesth Nurs 2018; 33:512-517. [PMID: 30077295 DOI: 10.1016/j.jopan.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 11/29/2016] [Accepted: 12/11/2016] [Indexed: 10/19/2022]
Abstract
The subcutaneous implantable cardioverter defibrillator (S-ICD) is a new device used for the prevention of sudden cardiac death. Best practices in the perioperative management of the S-ICD are not established; therefore, clinicians typically deactivate the device during surgery, with reinterrogation and activation postoperatively. This could put the patient at risk for being discharged with the device "off." We present two cases where electromagnetic interference was appropriately detected by the S-ICD and filtered. These cases present an important clinical finding that could lead to less deactivation of devices during surgery. Further research will be required to define which surgical procedures require magnet, reprogramming, or no changes.
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107
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Cardio-oncology: a new and developing sector of research and therapy in the field of cardiology. Heart Fail Rev 2018; 24:91-100. [DOI: 10.1007/s10741-018-9731-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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108
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Cronin B, Essandoh MK. Update on Cardiovascular Implantable Electronic Devices for Anesthesiologists. J Cardiothorac Vasc Anesth 2018; 32:1871-1884. [DOI: 10.1053/j.jvca.2017.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 11/11/2022]
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109
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Kaplan RM, Wasserlauf J, Bandi RH, Lange EM, Knight BP, Kim SS. Inappropriate defibrillator shock during gynecologic electrosurgery. HeartRhythm Case Rep 2018; 4:267-269. [PMID: 30023268 PMCID: PMC6050424 DOI: 10.1016/j.hrcr.2017.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/16/2017] [Accepted: 10/13/2017] [Indexed: 12/01/2022] Open
Affiliation(s)
- Rachel M Kaplan
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jeremiah Wasserlauf
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rachel H Bandi
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elizabeth M Lange
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bradley P Knight
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Susan S Kim
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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110
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Perioperative management of cardiac rhythm assist devices in ambulatory surgery and nonoperating room anesthesia. Curr Opin Anaesthesiol 2018; 30:676-681. [PMID: 28957879 DOI: 10.1097/aco.0000000000000532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Patients with cardiac implantable electronic devices (CIEDs) frequently undergo various surgical procedures and in the past perioperative management involved only placing magnet over the device. New programming features, development of implantable cardiac defibrillator (ICD), cardiac resynchronization therapy, and increasing complexity of the operating room equipment have led to new sources of electromagnetic interference (EMI). A comprehensive understanding of the CIED is necessary to provide a timely and optimal care to the patients. RECENT FINDINGS Technological advancements and direct implantation of the transvenous implantable cardiac defibrillators into the heart have led to less clear lines between the pacemakers and the ICD. Subcutaneous ICD as well as the leadless transcatheter deployed intracardiac pacemaker development has complicated the issue further. SUMMARY Rapidly developing technologies and increasing number of patients with these devices coming for noncardiac surgeries necessitate continuous education of the anesthesia team regarding perioperative management of such devices.
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111
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Bravo‐Jaimes K, Samala V, Fernandez G, Moravan MJ, Dhakal S, Shah AH, Messing S, Singh K, Aktas MK. CIED malfunction in patients receiving radiation is a rare event that could be detected by remote monitoring. J Cardiovasc Electrophysiol 2018; 29:1268-1275. [DOI: 10.1111/jce.13659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Katia Bravo‐Jaimes
- Department of CardiologyUniversity of Texas Health Science Center at Houston Houston TX USA
| | - Vikram Samala
- Department of MedicineCheshire Medical and Dartmouth‐Hitchcock Keene Keene NH USA
| | - Genaro Fernandez
- Department of CardiologyUniversity of Minnesota Minneapolis MN USA
| | - Michael J. Moravan
- Department of Radiation OncologyUniversity of Rochester Medical Center Rochester NY USA
| | - Sughosh Dhakal
- Department of Radiation OncologyUniversity of Rochester Medical Center Rochester NY USA
| | - Abrar H. Shah
- Sands Constellation Heart InstituteRochester Regional Health Rochester NY USA
| | - Susan Messing
- Department of Biostatistics and Computational BiologyUniversity of Rochester Rochester NY USA
| | - Kyra Singh
- Department of Biostatistics and Computational BiologyUniversity of Rochester Rochester NY USA
| | - Mehmet K. Aktas
- Department of CardiologyUniversity of Rochester Medical Center Rochester NY USA
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112
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Zecchin M, Artico J, Morea G, Severgnini M, Bianco E, De Luca A, Fantasia AZ, Salvatore L, Milan V, Lucarelli M, Dissegna R, Cannatà A, Sinagra G. Radiotherapy and risk of implantable cardioverter-defibrillator malfunctions. J Cardiovasc Med (Hagerstown) 2018; 19:155-160. [DOI: 10.2459/jcm.0000000000000623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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113
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Cronin B, Essandoh MK. Perioperative Interrogation of St. Jude Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists. J Cardiothorac Vasc Anesth 2018; 32:982-1000. [DOI: 10.1053/j.jvca.2017.11.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 11/11/2022]
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114
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Dalia AA, Cronin B, Stone ME, Turner K, Hargrave J, Vidal Melo MF, Essandoh M. Anesthetic Management of Patients With Continuous-Flow Left Ventricular Assist Devices Undergoing Noncardiac Surgery: An Update for Anesthesiologists. J Cardiothorac Vasc Anesth 2018; 32:1001-1012. [DOI: 10.1053/j.jvca.2017.11.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Indexed: 12/16/2022]
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115
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De Silva S. Perioperative management of implantable cardioverter defibrillators. J Perioper Pract 2018; 28:31-32. [PMID: 29376778 DOI: 10.1177/1750458917742056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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116
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Trivedi K, Patel KM. Anesthetic Considerations in the Patient with an Implanted Cardiac Device. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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117
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Causes and Prevention of Inappropriate Implantable Cardioverter-Defibrillator Shocks. Card Electrophysiol Clin 2017; 10:67-74. [PMID: 29428143 DOI: 10.1016/j.ccep.2017.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Use of implantable cardioverter-defibrillators as a primary prevention therapy has been shown to reduce mortality in patients after cardiac arrest and also with left ventricular systolic dysfunction. Yet, inappropriate shocks are variably reported and associated with a reduction in quality of life. Inappropriate shocks are the result of environmental causes leading to electromagnetic interference and inappropriate sensing of external noise, device-related causes from inappropriate sensing of physiologic or pathologic signals, and supraventricular arrhythmias. Strategies to reduce inappropriate shocks include aggressive treatment of supraventricular tachycardia, changes in device programming including prolonged detection time, programming antitachycardic pacing and using discriminator algorithms, and cardiac rehabilitation.
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118
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Yeung C, Chacko S, Glover B, Campbell D, Crystal E, Ben-Dov N, Baranchuk A. Radiotherapy for Patients with Cardiovascular Implantable Electronic Devices: A Review. Can J Cardiol 2017; 34:244-251. [PMID: 29395701 DOI: 10.1016/j.cjca.2017.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/16/2022] Open
Abstract
Because cardiovascular implantable electronic devices are increasingly indicated in older patients, and the burden of cancer is rising with the growth and aging of the world population, the management of patients with cardiac devices who require radiotherapy for cancer treatment is a timely concern. Device malfunctions might occur in as high as 3% of radiotherapy courses, posing a substantial issue in clinical practice. A nonsystematic comprehensive review was undertaken. We searched PubMed and the MEDLINE database for randomized controlled trials, meta-analyses, systematic reviews, observational studies, in vitro/in vivo studies, and case reports. Articles were selected by 2 independent reviewers, and emphasis was given to information of interest to a general medical readership. The pathophysiology and predictors of cardiovascular implantable electronic device malfunction due to radiotherapy are reviewed, recommendations for the management of patients with such devices undergoing radiotherapy are summarized, and the clinical significance and future directions of this field are discussed. Radiotherapy-induced device malfunctions are rare, but because of the potential complications, the development of evidence-based guidelines for the management of patients with cardiovascular implantable electronic devices undergoing radiotherapy is a timely concern.
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Affiliation(s)
- Cynthia Yeung
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Sanoj Chacko
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Benedict Glover
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Debra Campbell
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Eugene Crystal
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nissan Ben-Dov
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
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119
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Harky A, Bashir M, Cheshire N, Rosendahl U. Innominate artery injury during routine laser assisted lead extraction. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0523-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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120
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Essandoh M. Perioperative Management of the Micra Leadless Pacemaker. J Cardiothorac Vasc Anesth 2017; 31:e97-e98. [DOI: 10.1053/j.jvca.2017.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Indexed: 11/11/2022]
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121
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Sumler M, Vadlamudi R. Preanesthetic evaluation of the patient with end-stage heart failure. Best Pract Res Clin Anaesthesiol 2017; 31:179-188. [PMID: 29110791 DOI: 10.1016/j.bpa.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/10/2017] [Accepted: 06/16/2017] [Indexed: 11/15/2022]
Abstract
Heart failure (HF) currently affects more than 5 million patients in the United States [1]. Advanced HF is associated with high mortality and poor quality of life. It is estimated that between 5% and 10% of all patients with HF have an advanced form of the disease [1]. Orthotopic heart transplantation (OHT) is an accepted therapy for stage D HF [3] (Fig. 1). Unfortunately, the number of patients with the disease exceeds the number of available organs. This makes appropriate patient selection vital in the field of heart transplantation. Anesthetic evaluation of the patient presenting for OHT or mechanical circulatory support (MCS) implantation is a vital component of the patient's perioperative course. Patients often have had extensive diagnostic testing and assessment prior to being listed for OHT or considered for MCS implantation. Because of the often urgent nature of these procedures, the cardiac anesthesiologist must conduct a focused review of the relevant information and perform a focused patient interview and physical exam.
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Affiliation(s)
- Michele Sumler
- Emory University, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, United States.
| | - Ratna Vadlamudi
- Emory University, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, United States.
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122
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Ott K, Pressl H, Schramm M, Wutzl A. [Pacemaker, defibrillator and co : Perioperative handling of cardiac implantable electronic devices]. Anaesthesist 2017; 66:803-826. [PMID: 29018871 DOI: 10.1007/s00101-017-0373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The number of patients treated with cardiac implantable electronic devices (CIED) is continously increasing. Knowledge of the medical indications and technical mode of functioning of these devices is a basic prerequisite for the safe perioperative care of this patient cohort. The CIEDs are subjected to a multitude of disturbing influences in the perioperative setting. This can result in potentially dangerous complications, such as exit block and oversensing. The safe performance of interventions is possible as long as some basic rules are followed. An interdisciplinary approach involving all participating disciplines is necessary in order to adequately deal with the high demands placed on the logistics.
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Affiliation(s)
- K Ott
- Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - H Pressl
- Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - M Schramm
- Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - A Wutzl
- Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
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123
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Fermin L, Gebhard RE, Azarrafiy R, Carrillo R. Pearls of Wisdom for High-Risk Laser Lead Extractions: A Focused Review. Anesth Analg 2017; 126:406-412. [PMID: 28991113 DOI: 10.1213/ane.0000000000002540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Due to new indications and improved technology, the incidence of laser lead extraction (LLE) has significantly increased over the past years. While LLE has been well studied and proven to be safe and effective, only few studies are geared toward the anesthesiologist's role during high-risk LLEs. This article utilized both a focused review and authors' experience to investigate anesthetic protocols during LLEs. Through this review, we recommend best practices for the anesthesiologist including appropriate procedure location, onsite availability of a cardiac surgeon, availability of a cardiopulmonary bypass machine, and intraoperative use of echocardiography to detect and address potential complications during high-risk LLEs.
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Affiliation(s)
- Lilibeth Fermin
- From the Department of Anesthesiology, Cleveland Clinic Florida, Weston, Florida
| | - Ralf E Gebhard
- Department of Anesthesiology, Perioperative Medicine and Pain Management
| | - Ryan Azarrafiy
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Roger Carrillo
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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124
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Kumar A, Dhillon SS, Patel S, Grube M, Noheria A. Management of cardiac implantable electronic devices during interventional pulmonology procedures. J Thorac Dis 2017; 9:S1059-S1068. [PMID: 29214065 DOI: 10.21037/jtd.2017.07.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An increasing number of patients are receiving cardiac implantable electronic devices (CIED) now. Many of them need pulmonary procedures for various indications including, but not limited to, lung cancer and benign endobronchial lesions. Over the last two decades, interventional pulmonology (IP) has expanded its scope to include various modalities that use heat and electrical energy and in the process, create electromagnetic field in the vicinity. This raises concerns for electromagnetic interference (EMI) causing abnormal behavior in the CIEDs. While guidelines and recommendations on the peri-procedural management of CIEDs do exist, none of them directly address the pulmonary procedures. In this paper, we strive to review the available literature pertaining to the management of CIEDs in the context of EMI caused by the various IP procedures.
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Affiliation(s)
- Abhishek Kumar
- Department of Pulmonary Medicine, Mercy Medical Center, Cedar Rapids, IA, USA
| | - Samjot Singh Dhillon
- Department of Medicine, Pulmonary and Critical Care, Roswell Park Cancer Institute/University at Buffalo, Buffalo, NY, USA
| | - Spandan Patel
- Hospitalist Medicine, Mercy Medical Center, Cedar Rapids, IA, USA
| | - Matthias Grube
- Cardiothoracic Anesthesiology Fellow, Emory University School of Medicine, Atlanta, GA, USA
| | - Amit Noheria
- Cardiovascular Electrophysiology, Washington University School of Medicine, St. Louis, MO, USA
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125
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Salman MM, Kemp HI, Cauldwell MR, Dob DP, Sutton R. Anaesthetic management of pregnant patients with cardiac implantable electronic devices: case reports and review. Int J Obstet Anesth 2017; 33:57-66. [PMID: 28899734 DOI: 10.1016/j.ijoa.2017.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/03/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Abstract
Heart disease is a leading cause of maternal mortality and morbidity. Pregnant women with structural, conduction or degenerative cardiac disease who require rhythm control or who are at high risk of sudden cardiac death may carry a cardiac implantable electronic device or may occasionally require the insertion of one during their pregnancy. These women are now encountered more frequently in clinical practice, and it is essential that a multidisciplinary approach, beginning from the early antenatal phase, be adopted in their counselling and management. Contemporary cardiac rhythm control devices are a constantly evolving technology with increasingly sophisticated features; anaesthetists should therefore have an adequate understanding of the principles of their operation and the special considerations for their use, in order to enable their safe management in the peripartum period. Of particular importance is the potential adverse effect of electromagnetic interference, which may cause device malfunction or damage, and the precautions required to reduce this risk. The ultimate goal in the management of this patient subgroup is to minimise the disruption to cardiovascular physiology that may occur near the time of labour and delivery and to control the factors that impact on device integrity and function. We present the ante- and peripartum management of two pregnant women with an implantable cardioverter-defibrillator, followed by a review and update of the anaesthetic management of parturients with cardiac implantable electronic devices.
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Affiliation(s)
- M M Salman
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - H I Kemp
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - M R Cauldwell
- Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - D P Dob
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
| | - R Sutton
- National Heart & Lung Institute, Imperial College, Hammersmith Hospital, London W12 0NN, UK
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126
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Sinha SK, Chrispin J, Barth A, Rickard JJ, Spragg DD, Berger R, Calkins H, Tomaselli G, Marine JE. Clinical recognition of pacemaker battery depletion and automatic reprogramming. Pacing Clin Electrophysiol 2017; 40:969-974. [PMID: 28617963 DOI: 10.1111/pace.13135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 11/27/2022]
Abstract
All contemporary pacemakers undergo automatic reprogramming upon reaching elective replacement indication due to battery depletion. The majority of such reprogramming will result in changes to both pacing mode and pacing rate. The exact software reprogramming varies considerably among pacemaker manufacturers and may even vary among models of the same manufacturer. Accordingly, it is essential for healthcare providers managing pacemaker patients to have a detailed understanding of the automatic reprogramming seen at elective replacement indication as well as their potential physiological and clinical consequences.
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Affiliation(s)
- Sunil K Sinha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan Chrispin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andreas Barth
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Jack Rickard
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - David D Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gordon Tomaselli
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
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127
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Mulpuru SK, Madhavan M, McLeod CJ, Cha YM, Friedman PA. Cardiac Pacemakers: Function, Troubleshooting, and Management: Part 1 of a 2-Part Series. J Am Coll Cardiol 2017; 69:189-210. [PMID: 28081829 DOI: 10.1016/j.jacc.2016.10.061] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/06/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023]
Abstract
Advances in cardiac surgery toward the mid-20th century created a need for an artificial means of stimulating the heart muscle. Initially developed as large external devices, technological advances resulted in miniaturization of electronic circuitry and eventually the development of totally implantable devices. These advances continue to date, with the recent introduction of leadless pacemakers. In this first part of a 2-part review, we describe indications, implant-related complications, basic function/programming, common pacemaker-related issues, and remote monitoring, which are relevant to the practicing cardiologist. We provide an overview of magnetic resonance imaging and perioperative management among patients with cardiac pacemakers.
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Affiliation(s)
- Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Yong-Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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128
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Madhavan M, Mulpuru SK, McLeod CJ, Cha YM, Friedman PA. Advances and Future Directions in Cardiac Pacemakers: Part 2 of a 2-Part Series. J Am Coll Cardiol 2017; 69:211-235. [PMID: 28081830 DOI: 10.1016/j.jacc.2016.10.064] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/17/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
In the second part of this 2-part series on pacemakers, we present recent advances in pacemakers and preview future developments. Cardiac resynchronization therapy (CRT) is a potent treatment for heart failure in the setting of ventricular dyssynchrony. Successful CRT using coronary venous pacing depends on appropriate patient selection, lead implantation, and device programming. Despite optimization of these factors, nonresponse to CRT may occur in one-third of patients, which has led to a search for alternative techniques such as multisite pacing, His bundle pacing, and endocardial left ventricular pacing. A paradigm shift in pacemaker technology has been the development of leadless pacemaker devices, and on the horizon is the development of batteryless devices. Remote monitoring has ushered in an era of greater safety and the ability to respond to device malfunction in a timely fashion, improving outcomes.
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Affiliation(s)
- Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Yong-Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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129
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Herborn J, Parulkar S. Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery. Anesthesiol Clin 2017; 35:539-553. [PMID: 28784225 DOI: 10.1016/j.anclin.2017.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As solid organ transplantation increases and patient survival improves, it will become more common for these patients to present for nontransplant surgery. Recipients may present with medical problems unique to the transplant, and important considerations are necessary to keep the transplanted organ functioning. A comprehensive preoperative examination with specific focus on graft functioning is required, and the anesthesiologist needs pay close attention to considerations of immunosuppressive regimens, blood product administration, and the risk benefits of invasive monitoring in these immunosuppressed patients. This article reviews the posttransplant physiology and anesthetic considerations for patients after solid organ transplantation.
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Affiliation(s)
- Joshua Herborn
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Suraj Parulkar
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, F5-704, Chicago, IL 60611, USA
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Ellis MKM, Treggiari MM, Robertson JM, Rozner MA, Graven PF, Aziz MF, Merkel MJ, Kahl EA, Cohen NA, Stecker EC, Schulman PM. Process Improvement Initiative for the Perioperative Management of Patients With a Cardiovascular Implantable Electronic Device. Anesth Analg 2017; 125:58-65. [DOI: 10.1213/ane.0000000000001953] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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131
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Ghosh AK, Walker JM. Cardio-Oncology - A new subspecialty with collaboration at its heart. Indian Heart J 2017; 69:556-562. [PMID: 28822531 PMCID: PMC5560887 DOI: 10.1016/j.ihj.2017.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 05/05/2017] [Indexed: 12/20/2022] Open
Abstract
Cardio-Oncology is the care of cancer patients with cardiovascular disease, overt or occult, already established or acquired during treatment. Cancer patients can present with a variety of cardiovascular problems not all of which are directly related to cancer therapy (medications or radiotherapy). The cardiovascular problems of oncology patients can range from ischaemia to arrhythmias and can also include valve problems and heart failure. As such, within cardiology, teamwork is required with members of different cardiology subspecialties. The way forward will be to adopt a multidisciplinary approach to produce optimal individual care. Close collaboration between cardiology and oncology specialists in a Cardio-Oncology setting can make this happen.
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Affiliation(s)
- Arjun K Ghosh
- Barts Heart Centre, St Bartholomew's Hospital and Hatter Cardiovascular Institute, University College London Hospital, United Kingdom.
| | - J Malcolm Walker
- Hatter Cardiovascular Institute, University College London Hospital, United Kingdom
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132
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Indik JH, Gimbel JR, Abe H, Alkmim-Teixeira R, Birgersdotter-Green U, Clarke GD, Dickfeld TML, Froelich JW, Grant J, Hayes DL, Heidbuchel H, Idriss SF, Kanal E, Lampert R, Machado CE, Mandrola JM, Nazarian S, Patton KK, Rozner MA, Russo RJ, Shen WK, Shinbane JS, Teo WS, Uribe W, Verma A, Wilkoff BL, Woodard PK. 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm 2017; 14:e97-e153. [DOI: 10.1016/j.hrthm.2017.04.025] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 11/16/2022]
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133
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Rozner MA, Kahl EA, Schulman PM. Inappropriate Implantable Cardioverter-Defibrillator Therapy During Surgery: An Important and Preventable Complication. J Cardiothorac Vasc Anesth 2017; 31:1037-1041. [DOI: 10.1053/j.jvca.2016.11.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Indexed: 02/03/2023]
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134
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Ip JE, Liu TJ, Chen CL, Lerman BB. Asystole during pacemaker magnet application. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1176-1179. [PMID: 28369968 DOI: 10.1111/pace.13084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/17/2017] [Accepted: 03/27/2017] [Indexed: 01/14/2023]
Abstract
Pacemaker magnet application during surgery for patients who are pacemaker-dependent is often utilized to avoid perioperative inhibition from electromagnetic interference. We present a case during which such routine magnet use resulted in an unexpected response and discuss the limitations and nuances of this common practice.
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Affiliation(s)
- James E Ip
- Division of Cardiology, Department of Medicine, Cornell University Medical Center, New York, NY
| | - Todd J Liu
- Division of Cardiology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carol L Chen
- Department of Anesthesia, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bruce B Lerman
- Division of Cardiology, Department of Medicine, Cornell University Medical Center, New York, NY
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135
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Sklyar E, Bella JN. Evaluation and Monitoring of Patients With Cardiovascular Implantable Electronic Devices Undergoing Noncardiac Surgery. Health Serv Insights 2017; 10:1178632916686073. [PMID: 28469453 PMCID: PMC5398302 DOI: 10.1177/1178632916686073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/08/2016] [Indexed: 11/16/2022] Open
Abstract
In this article, the reader will get some insights into managing patient with implantable cardiac devices while undergoing noncardiac surgery. We will review basic concepts regarding normal function of pacemakers and implantable cardioverter defibrillators, understanding how their function will be influenced during noncardiac surgeries. You will be guided through management steps from preoperative, intraoperative, and postoperative aspects. In an ever-changing world of medicine, it is important to keep up with progress as more and more patients get implantable cardiac devices.
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Affiliation(s)
- Eduard Sklyar
- Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan N Bella
- Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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136
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Lin Y, Melby DP, Krishnan B, Adabag S, Tholakanahalli V, Li JM. Frequency of pacemaker malfunction associated with monopolar electrosurgery during pulse generator replacement or upgrade surgery. J Interv Card Electrophysiol 2017; 49:205-209. [PMID: 28413855 DOI: 10.1007/s10840-017-0241-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/05/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study is to investigate the frequency of electrosurgery-related pacemaker malfunction. METHODS A retrospective study was conducted to investigate electrosurgery-related pacemaker malfunction in consecutive patients undergoing pulse generator (PG) replacement or upgrade from two large hospitals in Minneapolis, MN between January 2011 and January 2014. The occurrence of this pacemaker malfunction was then studied by using MAUDE database for all four major device vendors. RESULTS A total of 1398 consecutive patients from 2 large tertiary referral centers in Minneapolis, MN undergoing PG replacement or upgrade surgery were retrospectively studied. Four patients (0.3% of all patients), all with pacemakers from St Jude Medical (2.8%, 4 of 142) had output failure or inappropriately low pacing rate below 30 bpm during electrosurgery, despite being programmed in an asynchronous mode. During the same period, 1174 cases of pacemaker malfunctions were reported on the same models in MAUDE database, 37 of which (3.2%) were electrosurgery-related. Twenty-four cases (65%) had output failure or inappropriate low pacing rate. The distribution of adverse events was loss of pacing (59.5%), reversion to backup pacing (32.4%), inappropriate low pacing rate (5.4%), and ventricular fibrillation (2.7%). The majority of these (78.5%) occurred during PG replacement at ERI or upgrade surgery. No electrosurgery-related malfunction was found in MAUDE database on 862 pacemaker malfunction cases during the same period from other vendors. CONCLUSIONS Electrosurgery during PG replacement or upgrade surgery can trigger output failure or inappropriate low pacing rate in certain models of modern pacemakers. Cautions should be taken for pacemaker-dependent patients.
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Affiliation(s)
- Yun Lin
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Balaji Krishnan
- Division of Cardiology, Veterans Affairs Medical Center, University of Minnesota, One Veterans Drive, Minneapolis, MN, 55417, USA
| | - Selcuk Adabag
- Division of Cardiology, Veterans Affairs Medical Center, University of Minnesota, One Veterans Drive, Minneapolis, MN, 55417, USA
| | - Venkatakrishna Tholakanahalli
- Division of Cardiology, Veterans Affairs Medical Center, University of Minnesota, One Veterans Drive, Minneapolis, MN, 55417, USA
| | - Jian-Ming Li
- Division of Cardiology, Veterans Affairs Medical Center, University of Minnesota, One Veterans Drive, Minneapolis, MN, 55417, USA.
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137
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Darrat YH, Morales GX, Elayi CS. The Effects of Catheter Ablation on Permanent Pacemakers and Implantable Cardiac Defibrillators. J Innov Card Rhythm Manag 2017; 8:2630-2635. [PMID: 32477770 PMCID: PMC7252655 DOI: 10.19102/icrm.2017.080303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/06/2017] [Indexed: 11/06/2022] Open
Abstract
Catheter ablation is a procedure that is frequently performed in patients with cardiac implantable electronic devices. Here, we review all of the potential interactions that can occur among patients undergoing catheter ablation while having implantable cardiac electronic devices, and discuss the precautionary measures to minimize such interactions.
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Affiliation(s)
- Yousef H Darrat
- Cardiology Department, Gill Heart Institute and VAMC, University of Kentucky, Lexington, KY
| | - Gustavo X Morales
- Cardiology Department, Gill Heart Institute and VAMC, University of Kentucky, Lexington, KY
| | - Claude S Elayi
- Cardiology Department, Gill Heart Institute and VAMC, University of Kentucky, Lexington, KY
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138
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Stunder D, Seckler T, Joosten S, Zink MD, Driessen S, Kraus T, Marx N, Napp A. In Vivo Study of Electromagnetic Interference With Pacemakers Caused by Everyday Electric and Magnetic Fields. Circulation 2017; 135:907-909. [PMID: 28242642 DOI: 10.1161/circulationaha.116.024558] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dominik Stunder
- From Research Center for Bioelectromagnetic Interaction, Institute of Occupational Medicine (D.S., T.S., S.J., S.D., T.K.), and Department of Internal Medicine I (Cardiology, Angiology, Pneumology and Internal Intensive Care Medicine) (M.D.Z., N.M., A.N.), University Hospital, RWTH Aachen University, Germany; and German Social Accident Insurance Institution for Energy, Textile, Electrical and Media Products Sector (BG ETEM), Köln, Germany (S.J.)
| | - Tobias Seckler
- From Research Center for Bioelectromagnetic Interaction, Institute of Occupational Medicine (D.S., T.S., S.J., S.D., T.K.), and Department of Internal Medicine I (Cardiology, Angiology, Pneumology and Internal Intensive Care Medicine) (M.D.Z., N.M., A.N.), University Hospital, RWTH Aachen University, Germany; and German Social Accident Insurance Institution for Energy, Textile, Electrical and Media Products Sector (BG ETEM), Köln, Germany (S.J.)
| | - Stephan Joosten
- From Research Center for Bioelectromagnetic Interaction, Institute of Occupational Medicine (D.S., T.S., S.J., S.D., T.K.), and Department of Internal Medicine I (Cardiology, Angiology, Pneumology and Internal Intensive Care Medicine) (M.D.Z., N.M., A.N.), University Hospital, RWTH Aachen University, Germany; and German Social Accident Insurance Institution for Energy, Textile, Electrical and Media Products Sector (BG ETEM), Köln, Germany (S.J.)
| | - Matthias Daniel Zink
- From Research Center for Bioelectromagnetic Interaction, Institute of Occupational Medicine (D.S., T.S., S.J., S.D., T.K.), and Department of Internal Medicine I (Cardiology, Angiology, Pneumology and Internal Intensive Care Medicine) (M.D.Z., N.M., A.N.), University Hospital, RWTH Aachen University, Germany; and German Social Accident Insurance Institution for Energy, Textile, Electrical and Media Products Sector (BG ETEM), Köln, Germany (S.J.)
| | - Sarah Driessen
- From Research Center for Bioelectromagnetic Interaction, Institute of Occupational Medicine (D.S., T.S., S.J., S.D., T.K.), and Department of Internal Medicine I (Cardiology, Angiology, Pneumology and Internal Intensive Care Medicine) (M.D.Z., N.M., A.N.), University Hospital, RWTH Aachen University, Germany; and German Social Accident Insurance Institution for Energy, Textile, Electrical and Media Products Sector (BG ETEM), Köln, Germany (S.J.)
| | - Thomas Kraus
- From Research Center for Bioelectromagnetic Interaction, Institute of Occupational Medicine (D.S., T.S., S.J., S.D., T.K.), and Department of Internal Medicine I (Cardiology, Angiology, Pneumology and Internal Intensive Care Medicine) (M.D.Z., N.M., A.N.), University Hospital, RWTH Aachen University, Germany; and German Social Accident Insurance Institution for Energy, Textile, Electrical and Media Products Sector (BG ETEM), Köln, Germany (S.J.)
| | - Nikolaus Marx
- From Research Center for Bioelectromagnetic Interaction, Institute of Occupational Medicine (D.S., T.S., S.J., S.D., T.K.), and Department of Internal Medicine I (Cardiology, Angiology, Pneumology and Internal Intensive Care Medicine) (M.D.Z., N.M., A.N.), University Hospital, RWTH Aachen University, Germany; and German Social Accident Insurance Institution for Energy, Textile, Electrical and Media Products Sector (BG ETEM), Köln, Germany (S.J.)
| | - Andreas Napp
- From Research Center for Bioelectromagnetic Interaction, Institute of Occupational Medicine (D.S., T.S., S.J., S.D., T.K.), and Department of Internal Medicine I (Cardiology, Angiology, Pneumology and Internal Intensive Care Medicine) (M.D.Z., N.M., A.N.), University Hospital, RWTH Aachen University, Germany; and German Social Accident Insurance Institution for Energy, Textile, Electrical and Media Products Sector (BG ETEM), Köln, Germany (S.J.).
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139
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Rafiq A, Sklyar E, Bella JN. Cardiac Evaluation and Monitoring of Patients Undergoing Noncardiac Surgery. Health Serv Insights 2017; 9:1178632916686074. [PMID: 28469459 PMCID: PMC5398290 DOI: 10.1177/1178632916686074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/24/2016] [Indexed: 12/25/2022] Open
Abstract
Surgical management of disease has a tremendous impact on our health system. Millions of people worldwide undergo surgeries every year. Cardiovascular complications in the perioperative period are one of the most common events leading to increased morbidity and mortality. Although such events are very small in number, they are associated with a high mortality rate making it essential for physicians to understand the importance of perioperative cardiovascular risk assessment and evaluation. Its involves a detailed process of history taking, patient's medical profile, medications being used, functional status of the patient, and knowledge about the surgical procedure and its inherent risks. Different risk assessment tools and calculators have also been developed to aid in this process, each with their own advantages and limitations. After such a comprehensive evaluation, a physician will be able to provide a risk assessment or it may all lead to further testing if it is believed that a change in management after such testing will help to reduce perioperative morbidity and mortality. There is extensive literature on the significance of multiple perioperative testing modalities and how they can change management. The purpose of our review is to provide a concise but comprehensive analysis on all such aspects of perioperative cardiovascular risk assessment for noncardiac surgeries and provide a basic methodology toward such assessment and decision making.
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Affiliation(s)
- Arsalan Rafiq
- Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA
- Internal medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eduard Sklyar
- Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA
- Internal medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan N Bella
- Division of Cardiology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA
- Internal medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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140
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Bhandary S. Con: Cardiothoracic Anesthesiologists Are Not Necessary for the Management of Patients With Ventricular Assist Devices Undergoing Noncardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:382-387. [DOI: 10.1053/j.jvca.2016.09.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Indexed: 12/28/2022]
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141
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Stoicea N, Sacchet-Cardozo F, Joseph N, Kilic A, Sipes A, Essandoh M. Pro: Cardiothoracic Anesthesiologists Should Provide Anesthetic Care for Patients With Ventricular Assist Devices Undergoing Noncardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:378-381. [DOI: 10.1053/j.jvca.2016.06.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Indexed: 11/11/2022]
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142
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GIFFORD JANET, LARIMER KAREN, THOMAS CELIA, MAY PATRICIA. ICD-ON Registry for Perioperative Management of CIEDs: Most Require No Change. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:128-134. [DOI: 10.1111/pace.12990] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/14/2016] [Accepted: 11/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - KAREN LARIMER
- School of Nursing; DePaul University; Chicago Illinois
| | | | - PATRICIA MAY
- Advocate Good Samaritan Hospital; Downers Grove Illinois
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143
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Bagur R, Chamula M, Brouillard É, Lavoie C, Nombela-Franco L, Julien AS, Archambault L, Varfalvy N, Gaudreault V, Joncas SX, Israeli Z, Parviz Y, Mamas MA, Lavi S. Radiotherapy-Induced Cardiac Implantable Electronic Device Dysfunction in Patients With Cancer. Am J Cardiol 2017; 119:284-289. [PMID: 27823600 DOI: 10.1016/j.amjcard.2016.09.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
Radiotherapy can affect the electronic components of a cardiac implantable electronic device (CIED) resulting in malfunction and/or damage. We sought to assess the incidence, predictors, and clinical impact of CIED dysfunction (CIED-D) after radiotherapy for cancer treatment. Clinical characteristics, cancer, different types of CIEDs, and radiation dose were evaluated. The investigation identified 230 patients, mean age 78 ± 8 years and 70% were men. A total of 199 patients had pacemakers (59% dual chamber), 21 (9%) cardioverter-defibrillators, and 10 (4%) resynchronizators or defibrillators. The left pectoral (n = 192, 83%) was the most common CIED location. Sixteen patients (7%) experienced 18 events of CIED-D after radiotherapy. Reset to backup pacing mode was the most common encountered dysfunction, and only 1 (6%) patient of those with CIED-D experienced symptoms of atrioventricular dyssynchrony. Those who had CIED-D tended to have a shorter device age at the time of radiotherapy compared to those who did not (2.5 ± 1.5 vs 3.8 ± 3.4 years, p = 0.09). The total dose prescribed to the tumor was significantly greater among those who had CIED-D (66 ± 30 vs 42 ± 23 Gy, p <0.0001). Multivariate logistic regression analysis identified the total dose prescribed to the tumor as the only independent predictor for CIED-D (odds ratio 1.19 for each increase in 5 Gy, 95% confidence interval 1.08 to 1.31, p = 0.0005). In conclusion, in this large population of patients with CIEDs undergoing radiotherapy for cancer treatment, the occurrence of newly diagnosed CIED-D was 7%, and the reset to backup pacing mode was the most common encountered dysfunction. The total dose prescribed to the tumor was a predictor of CIED-D. Importantly, although the unpredictability of CIEDs under radiotherapy is still an issue, none of our patients experienced significant symptoms, life-threatening arrhythmias, or conduction disorders.
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Affiliation(s)
- Rodrigo Bagur
- Cardiology Division, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
| | - Mathilde Chamula
- Cardiology Division, Department of Medicine, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada
| | - Émilie Brouillard
- Department of Radio-Oncology, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada
| | - Caroline Lavoie
- Department of Radio-Oncology, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada
| | | | - Anne-Sophie Julien
- Clinical Research Platform, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada
| | - Louis Archambault
- Department of Radio-Oncology, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada; Department of Physics, Engineering and Optics, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada
| | - Nicolas Varfalvy
- Department of Radio-Oncology, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada; Department of Physics, Engineering and Optics, Cancer Research Center, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada
| | - Valérie Gaudreault
- Cardiology Division, Department of Medicine, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada
| | - Sébastien X Joncas
- Cardiology Division, Department of Medicine, Quebec University Hospital Centre, Laval University, Quebec City, Quebec, Canada
| | - Zeev Israeli
- Cardiology Division, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Yasir Parviz
- Cardiology Division, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care, Keele University, Stoke-on-Trent, United Kingdom
| | - Shahar Lavi
- Cardiology Division, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
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144
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Chakravarthy M, Prabhakumar D, George A. Anaesthetic consideration in patients with cardiac implantable electronic devices scheduled for surgery. Indian J Anaesth 2017; 61:736-743. [PMID: 28970632 PMCID: PMC5613599 DOI: 10.4103/ija.ija_346_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With advances in cardiology and cardiothoracic surgery, several newer implantable cardiac devices have become common in the surgical population. Multichamber pacemakers, implanted cardiac defibrillators and ventricular assist devices are frequent in current day practice. Many of the newer implantable cardiac electronic devices are targeted at managing heart failure. While managing such patients for non-cardiac surgeries, specific issues related to equipment characteristics and troubleshooting should be a priority for the anaesthesiologists. There is a possibility of malfunction of the devices resulting in catastrophic outcomes. Therefore, it is imperative to understand the pathophysiology, device characteristics and troubleshooting before embarking on anaesthetising patients with implantable cardiac electronic devices.
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Affiliation(s)
- Murali Chakravarthy
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
| | - Dattatreya Prabhakumar
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
| | - Antony George
- Department of Anesthesia, Critical Care and Pain Relief, Fortis Hospitals, Bengaluru, Karnataka, India
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145
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Pacemakers and Implantable Cardioverter Defibrillators. Anesthesiology 2017. [DOI: 10.1007/978-3-319-50141-3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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146
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Bryant HC, Roberts PR, Diprose P. Perioperative management of patients with cardiac implantable electronic devices. BJA Educ 2016. [DOI: 10.1093/bjaed/mkw020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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147
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Williams MR, Atkinson DB, Bezzerides VJ, Yuki K, Franklin K, Casta A, Alexander ME. Pausing With the Gauze: Inhibition of Temporary Pacemakers by Radiofrequency Scan During Cardiac Surgery. Anesth Analg 2016; 123:1143-1148. [PMID: 27644061 DOI: 10.1213/ane.0000000000001599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Radiofrequency identification (RFID) detection systems are used to detect retained surgical sponges and may cause electromagnetic interference (EMI), altering intended function of cardiac pacing systems. Three pediatric patients requiring temporary pacing for postoperative atrioventricular block experienced transient inhibition of ventricular pacing during the use of RFID detection system. Bench testing was performed to evaluate the mechanism of pacemaker inhibition. METHODS Impedance of temporary pacing wires was obtained using a pacing system analyzer. Temporary pacemakers (Medtronic 5388, Medtronic 5392, and Biotronik Reocor D) at nominal settings (VVI 120 bpm, output 10 mA) were attached at the ventricular terminal to temporary pacing wires and a resistor for sham impedance in physiologic range. An RFID detection system and wand (RF Assure, model 200) or mat was tested over wires. Induced current and voltages were recorded via an oscilloscope attached to lead terminals. Inhibition of pacing was determined for the following variables: distance from wires, sham impedance, and programmed sensitivity. RESULTS In bench testing, the RFID system induced a stereotyped EMI signal in temporary pacing wires with peak root-mean-square voltage demonstrating an exponential decay relationship with increasing distance from pacing wires. Induced voltages overlapped with normal sensing range of temporary pacemakers, resulting in pacemaker inhibition at nominal settings (ventricular sensitivity 2.0 mV, distance from wand <23 cm). Increasing height, decreasing device sensitivity, or increasing sham impedance (at fixed sensitivity) attenuated EMI and inhibition for all 3 temporary pacemakers used and with the automated RFID detection mat in place of the wand. Programming pacemakers asynchronously prevented inhibition. CONCLUSIONS Normal operation of RFID detection systems may cause inhibition of temporary pacing systems consistent with oversensing from EMI. Precaution should be taken, including considering pacing asynchronously to avoid effects of inhibition.
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Affiliation(s)
- Matthew R Williams
- From the *Arrhythmia Service, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; †Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; ‡Cardiac Anesthesia Service, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; §Department of Anesthesia, Harvard Medical School, Boston, Massachusetts; and ‖Cardiac Operating Room Service, Boston Children's Hospital, Boston, Massachusetts
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148
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Malagù M, Ferri A, Mancuso O, Trevisan F, Nardozza M, Bertini M. Implantable cardioverter defibrillator management: an update. Future Cardiol 2016; 12:673-688. [PMID: 27762625 DOI: 10.2217/fca-2016-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Implantable cardioverter defibrillator (ICD) is the cornerstone of primary and secondary prevention of sudden cardiac death. In 35 years of technologic improvement and clinical trials, there has been a continuous increase in implantation rate. Purpose of this review is to point out and discuss every aspect related to actual ICD management, investigating implantation procedure and predischarge care, office and remote monitoring follow-up, diagnostic evaluations, management of patients with suspected therapies or malfunctions, heart failure, surgery, radiotherapy and endoscopic procedures. Also, ICD backface such as infections and other complications will be discussed. Finally, we will focus on interesting future perspectives for this setting of patients.
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Affiliation(s)
- Michele Malagù
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Alessandra Ferri
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Ottavia Mancuso
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Filippo Trevisan
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Marianna Nardozza
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Matteo Bertini
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
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149
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Salcedo JD, Pretorius VG, Hsu JC, Lalani GG, Schricker AA, Hebsur SM, McGARRY TJ, Hunter JA, Lewis KE, Krummen DE, Feld GK, Birgersdotter-Green U. Compatibility of Radiofrequency Surgical Sponge Detection Technology with Cardiac Implantable Electronic Devices and Temporary Pacemakers. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1254-1260. [PMID: 27550834 DOI: 10.1111/pace.12938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/13/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radiofrequency (RF) technology has improved detection of retained surgical sponges with a reported 100% sensitivity and specificity. However, the potential for interactions of the RF signals emitted by the detection system with cardiac implantable electronic devices (CIEDs) or temporary pacemakers may limit its use in those patients with these devices. This study investigated whether RF detection technology causes interference or clinically significant changes in the programmed settings of implanted pacemakers and defibrillators or temporary epicardial pacemakers. METHODS Fifty patients who were scheduled either for CIED removal or placement of a temporary epicardial pacemaker (at the time of open heart surgery) were recruited for this study. Device settings and measurements from separate interrogations before and after scanning with the RF detection system were compared. For the temporary pacemakers, we observed for any changes in hemodynamics or signs of pacing interference. RESULTS Twenty (40%) pacemakers, 20 (40%) implantable cardioverter defibrillators, and 10 (20%) temporary pacemakers were analyzed in this study. During scanning, no signal interference was detected in any permanent device, and there were no significant changes in programmed settings after scanning with the RF detection system. However, pacing inhibition was detected with temporary pacing systems when programmed to a synchronous mode (DDD). CONCLUSIONS RF detection technology can be safely used to scan for retained surgical sponges in patients with permanent CIEDs and temporary pacemakers set to asynchronous mode.
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Affiliation(s)
- Jonathan D Salcedo
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Victor G Pretorius
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Jonathan C Hsu
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Gautam G Lalani
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Amir A Schricker
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Shrinivas M Hebsur
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Thomas J McGARRY
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Jessica A Hunter
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Kathryn E Lewis
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - David E Krummen
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Gregory K Feld
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
| | - Ulrika Birgersdotter-Green
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Medicine and Surgery, Sulpizio Cardiovascular Center, University of California, San Diego School of Medicine, La Jolla, California
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150
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Predictors of intraoperative electrosurgery-induced implantable cardioverter defibrillator (ICD) detection. J Interv Card Electrophysiol 2016; 48:21-26. [DOI: 10.1007/s10840-016-0184-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
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