Practical Guide on the Perioperative Management in Patients with CIEDs

Abstract

Patients with cardiovascular implantable electronic devices (CIEDs), which consist of permanent pacemaker, implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT), should be carefully taken care of regarding perioperative management. The type of CIEDs and the location of surgery should be considered when it comes to a surgery. In addition, CIEDs interrogation should be performed before the surgery. If patients were pacemaker-dependent, the device mode must be changed to asynchronous mode and disabled rate-adaptive mode. If patients have ICD, the ICD therapy must be disabled. During the operation, surgeons should be recommended whether they should use bipolar electrocautery or ultrasonic scalpel with short burst within 5 seconds as the preferred method. After the surgery, the CIEDs mode should be changed to the previous settings before the surgery, for example, enabling ICD therapy, enabling rate-adaptive sensors, and changing asynchronous mode to previous mode before the surgery.