Cardiology MCQ 56

Q. Which of the following is not true regarding perioperative management of a patient with implanted intracardiac device undergoing non-cardiac surgery?

A. Pacemaker should be reprogrammed to asynchronous mode (VOO mode)

B. Tachyarrhythmic therapy should be terminated in ICD

C. Routine preoperative and postoperative interrogation of the device is not required

D. Bipolar electrocautery should be preferably used

Answer: C. Routine preoperative and postoperative interrogation of the device is not required

Explanation: 

Patients with Implantable cardioverter defibrillators (ICD) and pacemakers undergoing surgery:

Electrocautery may interfere with devices, leading to:

• Device reset to default mode (Power on Reset events) which can cause asynchronous to inhibited pacing and it may be life threatening to the patient if he is pacemaker dependent
• Inhibition of pacemaker output
• False sensing with increased pacemaker rate
• ICD firing
• Myocardial injury with lead failure

Recommendations

• All devices should be evaluated/interrogated preoperatively and postoperatively.
• Pacemakers should be reprogrammed to asynchronous mode or a magnet should be placed over the device during surgery to create VOO mode.
• For ICD’s, tachyarrhythmia algorithms should be deactivated during surgery, with reactivation postoperatively
• Bipolar electrocautery should be used and its use minimized.
• The distance between electrocautery and implanted device should be maximized.