Pacemakers and implantable cardioverter defibrillators - general and anesthetic considerations

Amy G. Rapsang; Prithwis Bhattacharyya

doi:10.1016/j.bjane.2013.02.005

Review Article

Pacemakers and implantable cardioverter defibrillators - general and anesthetic considerations

Marcapassos e cardioversores desfibriladores implantáveis - considerações gerais e anestésicas

Amy G. Rapsang; Prithwis Bhattacharyya

http://dx.doi.org/10.1016/j.bjane.2013.02.005 Braz J Anesthesiol, vol.64, n3, p.205-214, 2014

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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.

Keywords

Pacemakers, Implantable cardioverter defibrillators, Anesthesia for device patients

Resumo

Marcapasso (MP) é um sistema que consiste em um gerador de impulso e eletrodo ou eletrodos que conduzem o impulso elétrico para o coração do paciente. Códigos de MP e cardioversor desfibrilador implantável (CDI) foram criados para descrever o tipo de MP ou CDI implantado. Indicações para a implantação de MP e CDI foram descritas pelo Colégio Americano de Cardiologistas. Alguns MPs têm interruptores de circuitos magneticamente operados incorporados, porém a aplicação magnética pode causar efeitos adversos graves; portanto, os dispositivos devem ser considerados programáveis, salvo conhecimento em contrário. Quando um paciente portador de dispositivo é submetido a qualquer procedimento (com ou sem anestesia), precauções especiais devem ser tomadas, incluindo história/exame físico focados; perguntas sobre o MP antes e após o procedimento, uso de medicamentos de emergência/estimulação e desfibrilação temporárias; reprogramação do MP e desabilitação de certas funções, caso necessário; monitoração dos distúrbios metabólicos e eletrolíticos e evitar certos medicamentos e equipamentos que podem interferir na função do MP. Se houver previsão de interações com o dispositivo, considerar a suspensão do procedimento até que a fonte de interferência tenha sido eliminada ou controlada e todas as medidas corretivas devem ser tomadas para garantir o funcionamento adequado do MP. Após o procedimento, frequência e ritmo cardíacos devem ser monitorados continuamente, medicamentos e equipamentos de emergência devem ser mantidos de prontidão e pode ser necessário consultar um cardiologista ou serviço de MP-CDI.

Palavras-chave

Marcapassos, Cardioversores desfibriladores implantáveis, Anestesia para portadores de dispositivos

References

Rozner MA. Implantable cardiac pulse generators: pacemakers and cardioverter-defibrillators. Miller's anesthesia. :1402-1388.

Bernstein AD, Daubert JC, Fletcher RD. The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group.. Pacing Clin Electrophysiol. ;25:260-264.

ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. J Am Coll Cardiol. ;51:1-62.

Banker R, Mitchell R, Badhwar N. Pacemakers and implantable cardioverter-defibrillator emergencies. Cardiac intensive care. :334-310.

Sethuran S, Toff WD, Vuylsteke A. Implanted cardiac pacemakers and defibrillators in anaesthetic practice. Br J Anaesth. ;88:631-627.

Practice Advisory for the Perioperative Management of Patients with Cardiac Rhythm Management Devices: Pacemakers and Implantable Cardioverter-Defibrillators. A Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Rhythm Management Devices.. Anesthesiology. ;103:186-198.

Kleinman B, Hamilton J, Hariman R. Apparent failure of a precordial magnet and pacemaker programmer to convert a DDD pacemaker to VOO mode during the use of the electrosurgical unit. Anesthesiology. ;86:247-250.

Rastogi S, Goel S, Tempe DK. Anaesthetic management of patients with cardiac pacemakers and defibrillators for noncardiac surgery. Ann Cardiac Anaesth. ;8:32-21.

Chien WW, Foster E, Phillips B. Pacemaker syndrome in a patient with DDD pacemaker for long QT syndrome. Pacing Clin Electrophysiol. ;14:1212-1209.

Brode SE, Schwartzman D, Callans DJ. ICD-antiarrhythmic drug and ICD-pacemaker interactions. J Cardiovasc Electrophysiol. ;8:830-842.

Kalin R, Stanton MS. Current clinical issues for MRI scanning of pacemaker and defibrillator patients. PACE. ;28:328-326.

Levine GN, Gomes AS, Arai AE. Safety of magnetic resonance imaging in patients with cardiovascular devices: an American Heart Association scientific statement from the Committee on Diagnostic and Interventional Cardiac Catheterization. Circulation. ;116:2878-2891.

Roguin A, Goldsher D. Magnetic resonance imaging in individuals with cardiovascular implantable electronic devices. Europace. ;10:346-336.

Schwartzenburg CF, Wass CT, Strickland RA. Rate-adaptive cardiac pacing: implications of environmental noise during craniotomy. Anesthesiology. ;87:1254-1252.

Hayes DL, Holmes DR, Gray JE. Effect of 1.5 Tesla nuclear magnetic resonance imaging scanner on implanted permanent pacemakers.. J Am Coll Cardiol. ;10:786-782.

Sommer T, Vahlhaus C, Lauck G. MR imaging and cardiac pacemakers: in-vitro evaluation and in-vivo studies in 51 patients at 0.5 T.. Radiology. ;215:869-879.

Gimbel JR, Johnson D, Levine PA. Safe performance of magnetic resonance imaging on five patients with permanent cardiac pacemakers. Pacing Clin Electrophysiol. ;19:919-913.

Nazarian S, Roguin A, Zviman MM. Clinical utility and safety of a protocol for noncardiac and cardiac magnetic resonance imaging of patients with permanent pacemakers and implantable-cardioverter defibrillators at 1.5 Tesla.. Circulation. ;114:1284-1277.

Kanal E, Barkovich AJ, Bell C. ACR guidance document for safe MR practices. Am J Roentgenol. ;188:1-27.

Martin TE, Coman JA, Shellock FG. Magnetic resonance imaging and cardiac pacemaker safety at 1.5- Tesla.. J Am Coll Cardiol. ;43:1315-1324.

Loewy J, Loewy A, Kendall EJ. Reconsideration of pacemakers and MR imaging. Radiographics. ;24:1257-1268.

Domino KB, Smith TC. Electrocautery-induced reprogramming of a pacemaker using a precordial magnet. Anesth Analg. ;62:612-609.

Belott PH, Sands S, Warren J. Resetting of DDD pacemakers due to EMI. Pacing Clin Electrophysiol. ;7:169-172.

Van Hemel NM, Hamerlijnck RP, Pronk KJ. Upper limit ventricular stimulation in respiratory rate responsive pacing due to electrocautery. Pacing Clin Electrophysiol. ;12:1723-1720.

Chauvin M, Crenner F, Brechenmacher C. Interaction between permanent cardiac pacing and electrocautery: the significance of electrode position. Pacing Clin Electrophysiol. ;15:2033-2028.

Levine PA, Balady GJ, Lazar HL. Electrocautery and pacemakers: management of the paced patient subject to electrocautery. Ann Thorac Surg. ;41:313-317.

Erdman S, Levinsky L, Servadio C. Safety precautions in the management of patients with pacemakers when electrocautery operations are performed. Surg Gynecol Obstet. ;167:311-314.

Alexopoulos GS, Frances RJ. ECT and cardiac patients with pacemakers. Am J Psychiatry. ;137:1111-1112.

Rozner MA. Intrathoracic gadgets: update on pacemakers and implantable cardioverter-defibrillators. :212.

Salukhe TV, Dob D, Sutton R. Pacemakers and defibrillators: anaesthetic implications. Br J Anaesth. ;93:95-104.

Philbin DM, Marieb MA, Aithal KH. Inappropriate shocks delivered by an ICD as a result of sensed potentials from a transcutaneous electronic nerve stimulation unit. Pacing Clin Electrophysiol. ;21:2011-2010.

Raitt MH, Stelzer KJ, Laramore GE. Runaway pacemaker during high-energy neutron radiation therapy. Chest. ;106:955-957.

Souliman SK, Christie J. Pacemaker failure induced by radiotherapy. Pacing Clin Electrophysiol. ;17:270-273.

Muller- Runkel R, Orsolini G, Kalokhe UP. Monitoring the radiation dose to a multiprogrammable pacemaker during radical radiation therapy: a case report. Pacing Clin Electrophysiol. ;13:1470-1466.

Langberg J, Abber J, Thuroff JW. The effects of extracorporeal shock wave lithotripsy on pacemaker function. Pacing Clin Electrophysiol. ;10:1142-1146.

Cooper D, Wilkoff B, Masterson M. Effects of extracorporeal shock wave lithotripsy on cardiac pacemakers and its safety in patients with implanted cardiac pacemakers. Pacing Clin Electrophysiol. ;11:1386-1387.

Albers DD, Lybrand FE, Axton JC. Shockwave lithotripsy and pacemakers: experience with 20 cases. J Endourol. ;9:301-303.

Ganem JP, Carson CC. Cardiac arrhythmias with external fixed rate signal generators in shock wave lithotripsy with the Medstone lithotripter. Urology. ;51:548-552.

Ito S, Shibata H, Okahisa T. Endoscopic therapy using monopolar and bipolar snare with a high-frequency current in patients with a pacemaker. Endoscopy. ;26:270.

Aylward P, Blood R, Tonkin A. Complications of defibrillation with permanent pacemaker in situ. Pacing Clin Electrophysiol. ;2:464-462.

Waller C, Callies F, Langenfeld H. Adverse effects of direct current cardioversion on cardiac pacemakers and electrodes: is external cardioversion contraindicated in patients with permanent pacing systems?. Europace. ;6:165-168.

Das G, Eaton J. Pacemaker malfunction following transthoracic countershock. Pacing Clin Electrophysiol. ;4:487-490.

Levine PA, Barold SS, Fletcher RD. Adverse acute and chronic effects of electrical defibrillation and cardioversion on implanted unipolar cardiac pacing systems. J Am Coll Cardiol. ;1:1422-1413.

Gould L, Patel S, Gomes GI. Pacemaker failure following external defibrillation. Pacing Clin Electrophysiol. ;4:577-575.

Calkins H, Brinker J, Veltri EP. Clinical interactions between pacemaker and automated implantable cardioverter defibrillators. J Am Coll Cardiol. ;16:666-673.

Yee R, Jones DL, Klein GJ. Pacing threshold changes after transvenous catheter countershock. Am J Cardiol. ;53:507-503.

Lau FY, Bilitch M, Wintroub HJ. Protection of implanted pacemakers from excessive electrical energy of DC shock. Am J Cardiol. ;23:244-249.

Mehta Y, Swaminathan M, Juneja R. Noncardiac surgery and pacemaker cardioverter-defibrillator management. J Cardiothorac Vasc Anesth. ;12:224-221.

Mangar D, Atlas GM, Kane PB. Electrocautery-induced pacemaker malfunction during surgery. Can J Anaesth. ;38:618-616.

Heymsfield SB, Wang Z, Visser M. Techniques used in the measurement of body composition: an overview with emphasis on bioelectrical impedance analysis. Am J Clin Nutr. ;64:478S-484S.

Leeab SY, Gallagherc D. Assessment methods in human body composition. Curr Opin Clin Nutr Metab Care. ;11:572-566.

Rienzo VD, Minelli M, Sambugaro R. Applicability of extra- cellular electrical impedance tomography in monitoring respiratory tract inflammation. J Investig Allergol Clin Immunol. ;17:38-34.

Dohrmann ML, Goldschlager NF. Myocardial stimulation threshold in patients with cardiac pacemakers: effect of physiologic variables, pharmacologic agents, and lead electrodes. Cardiol Clin. ;3:537-527.

Saxon LA, Stevenson WG, Middlekauff HR. Increased risk of progressive hemodynamic deterioration in advanced heart failure patients requiring permanent pacemakers. Am Heart J. ;125:1306-1310.

Fleisher LA, Beckman JA, Brown KA. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. .

Simon AB. Perioperative management of the pacemaker patient. Anesthesiology. 1977;46:127-31; Simon AB. Perioperative management of the pacemaker patient. Circulation. ;116:1976-1971.

Zaidan JR. Pacemakers. Anesthesiology. ;60:334-319.

Kemnitz J, Peters J. Cardiac pacemakers and implantable cardioverter defibrillators in the perioperative phase. Anasthesiol Intensivmed Notfallmed Schmerzther. ;28:212-199.

Finfer SR. Pacemaker failure on induction of anaesthesia. Br J Anaesth. ;66:512-509.

Atlee JL, Bernstein AD. Cardiac rhythm management devices, perioperative management. Anesthesiology. ;95:1492-1506.

Lamas GA, Rebecca GS, Braunwald NS. Pacemaker malfunction after nitrous oxide anesthesia. Am J Cardiol. ;56:995-996.

Thiagarajah S, Azar I, Agres M. Pacemaker malfunction associated with positive pressure ventilation. Anesthesiology. ;58:565-566.

Pacemakers and implantable cardioverter defibrillators - general and anesthetic considerations

Marcapassos e cardioversores desfibriladores implantáveis - considerações gerais e anestésicas

Amy G. Rapsang; Prithwis Bhattacharyya

Abstract

Keywords

Resumo

Palavras-chave

References

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