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Pluymaekers NAHA, Dudink EAMP, Boersma L, Erküner Ö, Gelissen M, van Dijk V, Wijffels M, Dinh T, Vernooy K, Crijns HJ, Balt J, Luermans JGLM. External electrical cardioversion in patients with cardiac implantable electronic devices: Is it safe and is immediate device interrogation necessary? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1336-1340. [PMID: 30080928 DOI: 10.1111/pace.13467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/09/2018] [Accepted: 07/27/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Atrial tachyarrhythmias are common in patients with cardiac implantable electronic devices (CIEDs). Restoration of sinus rhythm by external electrical cardioversion (eECV) is frequently used to alleviate symptoms and to ensure optimal device function. OBJECTIVES To evaluate the safety of eECV in patients with contemporary CIEDs and to assess the need for immediate device interrogation after eECV. METHODS We conducted a retrospective observational study of 229 patients (27.9% female, age 69 ± 10 years) with a CIED (104 pacemakers, 69 implantable cardioverter defibrillators, and 56 biventricular devices) who underwent eECV between 2008 and 2016 in two centers. Data from device interrogation before eECV, immediately afterwards, and at first follow-up (FU) after eECV were collected. CIED-related complications and adverse events during and after eECV were recorded. RESULTS No significant differences between right atrial (RA) and right ventricular (RV) sensing or threshold values before eECV, immediately afterwards, or at FU were observed. A small yet significant decrease was observed in RA and RV impedance immediately after eECV (484 Ω vs 462 Ω, P < 0.001 and 536 Ω vs 514 Ω, P < 0.001, respectively). The RV impedance did not recover to the baseline value (538 Ω vs 527 Ω, P = 0.02). The impedance changes were without clinical consequences. No changes in left ventricular lead threshold or impedance values were measured. No CIED-related complications or adverse events were documented following eECV. CONCLUSION eECV in patients with contemporary CIEDs is safe. There seems to be no need for immediate device interrogation after eECV.
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Affiliation(s)
- Nikki A H A Pluymaekers
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Elton A M P Dudink
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Lucas Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Ömer Erküner
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Marloes Gelissen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Vincent van Dijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Maurits Wijffels
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Trang Dinh
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Harry J Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Jippe Balt
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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2
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Sumler ML, Hollon M. Anesthesia for Cardioversion. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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3
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Gold RL, Rios JC. Iatrogenic Cardiovascular Disease Secondary to Diagnostic and Therapeutic Procedures. J Intensive Care Med 2016. [DOI: 10.1177/088506668700200107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The number of diagnostic and therapeutic procedures performed in cardiology continues to grow. These pro cedures are generally considered safe or of minimal risk to the patient. However, it is important to remember that significant complications may occur, and in each patient the risk: benefit ratio must be carefully weighed. In this review, the complications documented in the medical literature resulting from the use of cardiologic interventions and procedures are discussed. A thorough knowledge of these complications and their precipitat ing factors can help minimize the risk to the patient.
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Affiliation(s)
- Robert L. Gold
- Division of Cardiovascular Medicine, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA 01605
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4
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Rapsang AG, Bhattacharyya P. Pacemakers and implantable cardioverter defibrillators--general and anesthetic considerations. Braz J Anesthesiol 2014; 64:205-14. [PMID: 24907883 DOI: 10.1016/j.bjane.2013.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/28/2013] [Indexed: 11/28/2022] Open
Abstract
A pacemaking system consists of an impulse generator and lead or leads to carry the electrical impulse to the patient's heart. Pacemaker and implantable cardioverter defibrillator codes were made to describe the type of pacemaker or implantable cardioverter defibrillator implanted. Indications for pacing and implantable cardioverter defibrillator implantation were given by the American College of Cardiologists. Certain pacemakers have magnet-operated reed switches incorporated; however, magnet application can have serious adverse effects; hence, devices should be considered programmable unless known otherwise. When a device patient undergoes any procedure (with or without anesthesia), special precautions have to be observed including a focused history/physical examination, interrogation of pacemaker before and after the procedure, emergency drugs/temporary pacing and defibrillation, reprogramming of pacemaker and disabling certain pacemaker functions if required, monitoring of electrolyte and metabolic disturbance and avoiding certain drugs and equipments that can interfere with pacemaker function. If unanticipated device interactions are found, consider discontinuation of the procedure until the source of interference can be eliminated or managed and all corrective measures should be taken to ensure proper pacemaker function should be done. Post procedure, the cardiac rate and rhythm should be monitored continuously and emergency drugs and equipments should be kept ready and consultation with a cardiologist or a pacemaker-implantable cardioverter defibrillator service may be necessary.
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Affiliation(s)
- Amy G Rapsang
- Department of Anesthesiology & Intensive Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
| | - Prithwis Bhattacharyya
- Department of Anesthesiology & Intensive Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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5
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Rapsang AG, Bhattacharyya P. Marcapassos e cardioversores desfibriladores implantáveis – considerações gerais e anestésicas. Braz J Anesthesiol 2014; 64:205-14. [DOI: 10.1016/j.bjan.2013.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/28/2013] [Indexed: 11/24/2022] Open
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Assumpção AC, de Oliveira PPM, Vilarinho KADS, Eghtesady P, Silveira Filho LM, Lavagnoli CFR, Severino ESBDO, Petrucci O. Ventricular pacing threshold after transthoracic external defibrillation with two different waveforms: an experimental study. Europace 2012; 15:297-302. [PMID: 23143858 DOI: 10.1093/europace/eus288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Although an increase in the ventricular pacing threshold (VPT) has been observed after administration of transthoracic shock for ventricular defibrillation, few studies have evaluated the phenomenon with respect to the defibrillation waveform energy. Therefore, this study examined the VPT behaviour after transthoracic shock with a monophasic or biphasic energy waveform. METHOD AND RESULTS Domestic Landrace male piglets implanted with a permanent pacemaker stimulation system were divided into three groups: no ventricular fibrillation (VF) induction and transthoracic shock with monophasic or biphasic energy (group I); VF induction, 1 min of observation without intervention, 2 min of external cardiac massage, and transthoracic shock with monophasic or biphasic energy (group II); and VF induction, 2 min of observation without intervention, 4 min of external cardiac massage, and transthoracic shock with monophasic or biphasic energy (group III). After external shock, the VPT was evaluated every minute for 10 min. A total of 143 experiments were performed. At the end of the observation period, groups I and II showed steady VPT values. Group III showed an increase in VPT with monophasic or biphasic external energy, with no difference between the external energy sources. The monophasic but not the biphasic waveform was associated with higher VPT values when the VF was longer. CONCLUSION Defibrillation does not have a significant impact on pacing threshold, but a longer VF period is related to a higher VPT after defibrillation with monophasic waveform.
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Affiliation(s)
- Antonio Carlos Assumpção
- Department of Cardiac Surgery, Faculty of Medical Science, State University of Campinas-UNICAMP, Campinas, SP, Brazil
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Israel C, Nowak B, Willems S, Bänsch D, Butter C, Doll N, Eckardt L, Geller J, Klingenheben T, Lewalter T, Schumacher B, Wolpert C. Empfehlungen zur externen Kardioversion bei Patienten mit Herzschrittmacher oder implantiertem Kardioverter/Defibrillator. DER KARDIOLOGE 2011. [DOI: 10.1007/s12181-011-0372-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: pacemakers and implantable cardioverter-defibrillators: an updated report by the american society of anesthesiologists task force on perioperative management of patients with cardiac implantable electronic devices. Anesthesiology 2011; 114:247-61. [PMID: 21245737 DOI: 10.1097/aln.0b013e3181fbe7f6] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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9
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Nishida T, Nakajima T, Goryo Y, Ishigami KI, Kawata H, Horii M, Uemura S, Saito Y. Pacemaker System Malfunction Resulting from External Electrical Cardioversion: A Case Report. J Arrhythm 2009. [DOI: 10.1016/s1880-4276(09)80005-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Abstract
An increasing number of patients are now treated cardiac pacemakers and implantable cardioverter defibrillators and the technology of these is constantly changing. It is vital to have a good understanding of how they function and what the real risks are. Understanding how the device should work when functioning normally, and the possible effects of electromagnetic interference, is paramount to their safe management in the peri-operative period. Knowing when a device should be disabled or reprogrammed requires careful consideration. Information from the patient's pacemaker clinic should be sought whenever possible and can be invaluable. In addition, the Medicines Healthcare products Regulatory Agency have published the first set of UK guidelines on the management of implantable devices in the presence of surgical diathermy and this will undoubtedly provide a firm foundation on which anaesthetists can base much of their practice.
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Affiliation(s)
- M Allen
- Department of Anaesthesia, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK.
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11
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Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Mitsuba N, Hata T, Nakama Y, Kijima Y, Kisaka T. Documentation of Acute Increase in Ventricular Capture Threshold After Direct Current Cardioversion with AutoCapturetm Threshold Record. Pacing Clin Electrophysiol 2005; 28:1009-10. [PMID: 16176548 DOI: 10.1111/j.1540-8159.2005.00206.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This report describes acute and persistent increase in ventricular capture threshold after direct current cardioversion by using AutoCapture threshold record. Careful follow-up is required to be sure that the system continues to function according to its design specifications.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiology, Hiroshima City Hospital, 7-33 Moto-machi, Nakaku, Hiroshima 730-8518, Japan.
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12
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Mohs Micrographic Surgery in a Patient with a Deep Brain Stimulator. Dermatol Surg 2004. [DOI: 10.1097/00042728-200407000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Martinelli PT, Schulze KE, Nelson BR. Mohs Micrographic Surgery in a Patient with a Deep Brain Stimulator: A Review of the Literature on Implantable Electrical Devices. Dermatol Surg 2004; 30:1021-30. [PMID: 15209793 DOI: 10.1111/j.1524-4725.2004.30308.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implantable electrical devices are becoming increasingly common in the patient population presenting for Mohs micrographic surgery. In addition to understanding the potential intraoperative complications with implantable cardioverter-defibrillators and pacemakers, the Mohs surgeon needs to be aware of the relatively new treatment of movement disorders using implanted deep brain stimulators. OBJECTIVE We present only the second reported case of Mohs surgery in a patient with a deep brain stimulator. In an attempt to help minimize adverse events during a procedure, we review the more commonly encountered electrical devices as well as the newer deep brain stimulators. We provide guidelines for the avoidance of electromagnetic interference during an electrosurgical procedure. METHODS This 76-year-old patient with Parkinson's disease and an implanted deep brain stimulator underwent Mohs surgery for excision of a squamous cell carcinoma on the ear. In an attempt to minimize electromagnetic interference with his implanted device, hemostasis was obtained with the aid of a battery-operated heat-generating handheld electrocautery device. RESULTS The patient tolerated the procedure well without complications or reports of discomfort. CONCLUSION Patients with implanted electrical devices are subject to electromagnetic interference during an electrosurgical procedure. Care must be taken in this expanding patient population during a Mohs surgical procedure.
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Affiliation(s)
- Paul T Martinelli
- Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA.
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14
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Kolbitsch C, Eisner W, Kleinsasser A, Biebl M, Fiegele T, Löckinger A, Lorenz IH, Mikuz G, Moser PL. External Cardiac Defibrillation Does Not Cause Acute Histopathological Changes Typical of Thermal Injuries in Pigs with In Situ Cerebral Stimulation Electrodes. Anesth Analg 2004; 98:458-460. [PMID: 14742387 DOI: 10.1213/01.ane.0000096192.33388.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Parkinson's disease patients with long-term L-dopa syndrome may benefit from an implanted cerebral stimulation device. When advanced life support demands cardioversion or defibrillation in these patients, undesired effects of monophasic electroshocks might occur in brain tissue adjacent to the stimulation electrodes (e.g., thermal injury), but also in the stimulation device itself. Thus, in this animal study (n = 6 pigs), we investigated the effects of repeated defibrillation (2 x 200 J [n = 1] and 2 x 360 J [n = 5]) at the implantation site of cerebral stimulation electrodes and on stimulation device function. Repeated external cardiac defibrillation did not cause acute histopathologic changes typical of thermal injury to brain tissue adjacent to the cerebral stimulation electrodes. Functionality of the stimulator device after defibrillation, however, ranged from normal to total loss of function. Therefore, when defibrillation is performed, the greatest possible distance between the defibrillation site and the stimulator device implantation site should be considered. Subsequent testing of the stimulator device's function is mandatory. IMPLICATIONS Repeated cardiac defibrillation did not cause histopathologic changes typical of thermal injury at the implantation site of cerebral stimulation electrodes. The function of the stimulator device after defibrillation, however, ranged from normal to total loss of function.
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Affiliation(s)
- Christian Kolbitsch
- Departments of *Anaesthesia and Intensive Care Medicine, †Neurosurgery, ‡Vascular Surgery, and §Pathology, University of Innsbruck, Austria
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15
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LeVasseur JG, Kennard CD, Finley EM, Muse RK. Dermatologic electrosurgery in patients with implantable cardioverter-defibrillators and pacemakers. Dermatol Surg 1998; 24:233-40. [PMID: 9491118 DOI: 10.1111/j.1524-4725.1998.tb04142.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Electrosurgery is frequently employed in the treatment of skin cancer and other dermatologic conditions in the elderly. Implantable cardioverter-defibrillators (ICDs) and pacemakers are most commonly seen in this older population. Potentially hazardous electrosurgical interference exists with the function of ICDs and pacemakers in this setting. OBJECTIVE Our goal is to review the potential hazards of electrosurgery in patients with ICDs and pacemakers and to suggest a perioperative management plan. METHODS Review of the medical literature on electrosurgical interference with ICDs and pacemakers was accomplished in addition to a case report of ventricular tachycardia during Mohs surgery on a patient with an ICD. RESULTS Multiple case reports and reviews from the nonder-matologic literature demonstrate that a real hazard exists. CONCLUSION Knowledge of the potential electrosurgical interference with ICDs and pacemakers is required to perform these procedures safely. A perioperative management plan is suggested.
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Affiliation(s)
- J G LeVasseur
- Department of Dermatology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas, USA
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16
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Abstract
The increased number of patients with implantable cardiac devices presents a unique challenge to physicians performing office-based electrosurgical procedures. Electrosurgery can be performed safely if the electrosurgical techniques and potential risks from these devices are understood. We present an overview of the most common types of implantable cardiac devices, potential complications associated with them, and recommendations for preoperative evaluation, intraoperative monitoring, and postoperative follow-up.
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Affiliation(s)
- A T Riordan
- Department of Dermatology, St. Louis University Health Science Center, USA
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17
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Abstract
The electrical defibrillator has been proven to be a life-saving device in the treatment of cardiac arrest due to ventricular tachycardia or ventricular fibrillation. An understanding of the physiology and technology behind this device is useful for providers of emergency care. In this article, we review the current concepts in electrical defibrillation and briefly discuss the developmental history. The physiology and the technical considerations will make up the bulk of the discussion. The latest developments in electrical defibrillation also will be reviewed.
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Affiliation(s)
- J H Truong
- Department of Emergency Medicine, University of California San Diego Medical Center 92103-8676, USA
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18
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Rubin JM, Miller ED. Intraoperative Pacemaker Malfunction During Total Hip Arthroplasty. Anesth Analg 1995. [DOI: 10.1213/00000539-199502000-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Rubin JM, Miller ED. Intraoperative pacemaker malfunction during total hip arthroplasty. Anesth Analg 1995; 80:410-2. [PMID: 7818133 DOI: 10.1097/00000539-199502000-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- J M Rubin
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York
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20
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Altamura G, Bianconi L, Lo Bianco F, Toscano S, Ammirati F, Pandozi C, Castro A, Cardinale M, Mennuni M, Santini M. Transthoracic DC shock may represent a serious hazard in pacemaker dependent patients. Pacing Clin Electrophysiol 1995; 18:194-8. [PMID: 7724398 DOI: 10.1111/j.1540-8159.1995.tb02503.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
External defibrillation is widely used for the termination of various atrial and ventricular tachyarrhythmias, including pacemaker patients. Our study was intended to evaluate the effects of DC shocks in 36 patients with unipolar pacemakers implanted in the right pectoral region (25 DDD, 10 VVI, 3 AAI). The shocks were delivered with paddles on the anterior surface of the thorax, as far as possible away from the pacemaker. The pacing output was programmed at 0.5 msec and 5 V (25 patients), 4 V (1 patient), and 2.5 V (10 patients). Transient loss of capture occurred in 18 patients (50%). These patients, compared with those without capture failure, received higher peak and cumulative shock energies, respectively, 216 +/- 99 versus 123 +/- 50 joules (P < 0.002) and 352 +/- 62 versus 147 +/- 98 joules (P < 0.004) and had a lower pacemaker pulse amplitude (4.0 +/- 1.2 vs 4.6 +/- 1.0 V, P = 0.11). Failure to capture lasted from 5 seconds to 30 minutes (mean 157 sec). In 15 patients the ventricular stimulation threshold was measured before and serially after cardioversion. A six-fold threshold increase was observed 3 minutes after the shock (P < 0.004) with gradual recovery to nearly baseline values at 24 hours. Transient sensing failure occurred in 7 of the 17 patients in whom it could be evaluated (41%). Furthermore, three cases of shock induced pacemaker malfunctions were observed requiring replacement of the stimulator in two patients. In conclusion, the incidence of loss of capture in pacemaker patients subjected to electrical cardioversion/defibrillation is high.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Altamura
- Department of Heart Disease, San Filippo Neri Hospital, Rome, Italy
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21
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Cox JN. Pathology of cardiac pacemakers and central catheters. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1994; 86:199-271. [PMID: 8162711 DOI: 10.1007/978-3-642-76846-0_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J N Cox
- Department of Pathology, CMU, Geneva, Switzerland
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22
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Abstract
Electromagnetic signals coming from the pacemaker programmer can permanently damage multiprogrammable pacemakers. At a follow-up of a sixfold programmable VVI pacemaker (Phoenix 251-6, Pacesetter), the emergency VVI button was activated on the programmer after the programming of the pacing impulse had induced a loss of capture. The next telemetrical interrogation revealed an alteration to a threefold programmable Programmalith III. The inadvertent programming of the model number occurred, because the programming head was removed at one very specific time in the programming sequence of the emergency VVI command.
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Affiliation(s)
- A Schuchert
- Department of Cardiology, University-Hospital Eppendorf, Hamburg, Germany
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23
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Calkins H, Brinker J, Veltri EP, Guarnieri T, Levine JH. Clinical interactions between pacemakers and automatic implantable cardioverter-defibrillators. J Am Coll Cardiol 1990; 16:666-73. [PMID: 2387940 DOI: 10.1016/0735-1097(90)90358-v] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Concomitant use of a pacemaker and an automatic implantable cardioverter-defibrillator (AICD) is common. Seventeen percent of patients receiving an AICD at The Johns Hopkins Hospital also had a permanent pacemaker implanted before (16 patients), at the same time as (2 patients) or after (12 patients) AICD implantation. Four types of interactions were noted: 1) transient failure to sense or capture immediately after AICD discharge (seven patients); 2) oversensing of the pacemaker stimulus by the AICD, leading to double counting (one patient); 3) AICD failure to sense ventricular fibrillation resulting from pacemaker stimulus oversensing (three patients, one only at high asynchronous output); and 4) pacemaker reprogramming caused by AICD discharge (three patients). No clinical sequelae of these interactions were noted during follow-up study. Thus, potentially adverse clinical interactions are common and routine screening is recommended. With proper attention to lead placements and programming of the devices, clinical consequences of these interactions can be avoided.
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Affiliation(s)
- H Calkins
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
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Abstract
The reciprocal effects of resuscitation and permanent, ventricular-inhibited pacemakers were examined in four, well-documented cases of witnessed out-of-hospital arrest. The resulting observations provide useful insight in the treatment of cardiac arrest in the large number of patients with permanent pacemakers. Transient sensing malfunctions occurred in the two patients in whom direct current countershocks were not required and were probably related to the severely deranged state of the myocardium. In spite of periods of asynchronous pacing in this critically unstable setting, no arrhythmias were precipitated. In the two patients who required defibrillation, transient malfunctions of pacing, capture and sensing occurred in spite of protective electronics in the pacing system, the left-sided location of the generator and, in one patient, the bipolar configuration. The pacemaker appeared to intermittently sense coarse ventricular fibrillatory waves. The malfunctions in the two latter cases were probably the result of the combined effects of the countershock and the abnormal state of the myocardium. All four patients succumbed, three in the emergency room and one on the eighth hospital day. Outcome was predominantly determined by the patient's response to therapeutic interventions. The observed pacemaker malfunctions, although potentially life-threatening, had no obvious, adverse effect on outcome in these four cases, mainly because of the transient nature of the abnormalities. Indeed, in one case, the presence of pacemaker activity was pivotal in identifying the native rhythm, illustrating the diagnostic potential of this analytical approach.
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Affiliation(s)
- M A Zullo
- Department of Medicine, New York Hospital-Cornell Medical Center, NY 10021
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25
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Abstract
The automatic implantable cardioverter defibrillator is an effective device for prevention of sudden cardiac death. Patients who require the implantation of the device often require permanent pacing for symptomatic bradyarrhythmias and may require antiarrhythmic drug therapy. Antiarrhythmic drugs may alter the defibrillation thresholds, arrhythmia cycle length and frequency, pacing thresholds and postshock excitability. Interactions between the defibrillator and the pacemaker may result in sensing problems, leading to multiple counting and inappropriate shocks, or ventricular fibrillation nondetection, sensing or capture failure post defibrillation and pacemaker reprogramming induced by defibrillator discharge. The potential for interactions will increase as the new generation of programmable defibrillators become clinically available, combining features of permanent pacemakers, antitachycardia pacemakers and defibrillators.
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Affiliation(s)
- I Singer
- Cardiovascular Division, University of Louisville, KY 40202
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Guarnieri T, Datorre SD, Bondke H, Brinker J, Myers S, Levine JH. Increased pacing threshold after an automatic defibrillator shock in dogs: effects of class I and class II antiarrhythmic drugs. Pacing Clin Electrophysiol 1988; 11:1324-30. [PMID: 2460838 DOI: 10.1111/j.1540-8159.1988.tb03995.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A high energy shock delivered by an automatic defibrillator may interfere with pacemaker function. To provide insight into the changes that occur in the threshold for ventricular pacing after the shock from an automatic defibrillator, we measured the time to capture during asynchronous ventricular pacing in dogs from endocardial or epicardial sites, after a 30 joule shock was delivered via conventional automatic defibrillator (AICD) patch electrodes. After a 30 joule shock, there was a transient loss of ventricular capture. The duration of capture loss was related to current strength. During endocardial pacing at threshold current, the time to capture was 4.9 +/- 1.2 s, whereas at current values twice threshold the time to capture from endocardial pacing was 2.2 +/- 0.9 s. No difference was found between endocardial and epicardial pacing sites in the time to capture. To ascertain the mechanism of capture loss we: (1) examined the effects of converting the pacing catheter to a current sink (transiently shunting to ground); (2) altered excitability by an infusion of flecainide; (3) blocked sympathetic input (propranolol). No change in time to capture was noted by shunting the pacer to ground. After an infusion of flecainide the time to capture from endocardial pacing was significantly prolonged to 14.9 +/- 2.2 s at the threshold value (P less than .01) and 5.6 +/- 2.1 s at twice threshold (P less than .05). Conversely, intravenous propranolol had no effect on the time to capture after shock from endocardial pacing. These data indicate that there is a transient increase in pacing threshold after the shock from an automatic defibrillator.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T Guarnieri
- Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
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Keung EC, Sudduth B. Arrhythmias in Single-Chamber Pacemakers. Cardiol Clin 1985. [DOI: 10.1016/s0733-8651(18)30652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ventriglia WJ, Hamilton GC. Electrical Interventions in Cardiopulmonary Resuscitation: Defibrillation. Emerg Med Clin North Am 1983. [DOI: 10.1016/s0733-8627(20)30808-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
There are two basic types of cardiac pacemakers: (1) Fixed-rate pacemakers stimulate the heart at a regular rate independent of the intrinsic heart rate. (2) Demand pacemakers sense the heart's spontaneous rhythm. They are more commonly used because they are noncompetitive with the heart. There are two varieties of demand pacemakers: ventricular-inhibited and ventricular-triggered. Their responses to electrical interference are quite different. Potential pacemaker interference is a consideration with high-frequency electrosurgery. The problems with electrosurgical interference have occurred primarily with early pacemaker models. Recent improvements in electrical shielding and filtering systems have made pacemakers very resistant to outside electrical influence. Simple electrodesiccation of small lesions on relatively healthy pacemaker patients poses negligible risks. Caution is advised for marginal patients undergoing extensive electrosurgical procedures. The potential risks are further minimized by proper attention to patient history, monitoring, proper grounding, the avoidance of cutting current, and the use of proper technic.
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Alferness CA. Pacemaker damage due to external countershock in patients with implanted cardiac pacemakers. Pacing Clin Electrophysiol 1982; 5:457-8. [PMID: 6179065 DOI: 10.1111/j.1540-8159.1982.tb02254.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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