Anesthetic Consideration in Patients with Cardiac Implantable Electronic Devices (CIED)

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Kanlayanee Yongyukantorn


Nowadays, the number of patients who have the cardiac implantable electronic devices is increasing. Anesthesiologists should have knowledge of and understanding about these devices, for example indication of implantation, principles of function, working program, and the factors that may be interfere with the device’s operation. Also, the anesthesiologist must be able to appropriately evaluate and manage problems that may occur with patients during the pre-, intra- and post-operation phases.

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Review articles


1.Rapsang AG, Bhattacharyya P. Pacemakers and implantable cardioverter defibrillators-general and anesthetic considerations. Rev Bras Anesthesiol 2014;64(3):205-14.

2. Greenspon AJ, Patel JD, Lau E, et al. Trends in permanent pacemaker implantation in the United States from 1993 to
2009: increasing complexity of patients and procedures. J Am Coll Cardiol 2012;60(16):1540-45.

3. Bernstein AD, Daubert JC, Fletcher RD, et al. The revised NASPE/BPEG generic code for antibradycardia, adaptiverate, and multisite pacing. North American Society of pacing and electrophysiology/British pacing and electrophysiology group. Pacing Clin Electrophysiol 2002;25(2):260-4.

4. Epstein AE, DiMarco JP, Ellenbogen KA, et al. 2012 ACCF/ AHA/HRS focused update incorporated into the ACCF/AHA/ HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task
Force on practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2013;61(3):e6-e75.

5. 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.

6. Stone ME, Salter B, Fischer A. Perioperative management of patients with cardiac implantable electronic devices. Br J Anaesth 2011;107:i16-26.

7. Crossley GH, Poole JE, Rozner MA, Asirvatham SJ, Cheng A, Chung MK. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) expert consensus statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management. Heart Rhythm 2011;8(7):1114-54.

8. Grant JD, Jensen GL, Tang C, Pollard JM, Kry SF, Krishnan S. Radiotherapy-induced malfunction in contemporary cardiovascular implantable electronic devices: clinical incidence and predictors. JAMA Oncol 2015;1(5):624-32.

9. Zaremba T, Jakobsen AR, Søgaard M, Thøgersen AM, Riahi S. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review. Europace 2016 ื18(4):479-91.
10. Pervez R. Pacemakers & implantable cardioverterdefibrillators (ICDs) Part 2 - Anaesthesia [Internet]. 2013[cited 2015 Dec 14]. Available from: node/2097

11. Epstein MR, Mayer JE, Duncan BW. Use of an ultrasonic scalpel as an alternative to electrocautery in patients with pacemaker. Ann Thorac Surg 1998;65:1802-4.

12. Ozeren M, Dogan OV, Duzgun C, Yucel E. Use of an ultrasonic scalpel in the open-heart reoperation of a patient with pacemaker. Eur J Cardiothorac Surg 2002;21:761-2.

13. 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 2004;6(2):165-8.

14. Manegold JC, Israel CW, Ehrlich JR, Duray G, Pajitnev D, Wegener FT. External cardioversion of atrial fibrillation in patients with implanted pacemaker or cardioverter-defibrillator systems: a randomized comparison of monophasic and biphasic shock energy application. Eur Heart J 2007;28(14):

15. Lakkireddy D, Patel D, Ryschon K, Bhateja R, Bhakru M, Thal S. Safety and efficacy of radiofrequency energy catheter ablation of atrial fibrillation in patients with pacemakers and implantable cardiac defibrillators. Heart Rhythm 2005;

16. Ellenbogen KA, Wood MA, Stambler BS. Acute effects of radiofrequency ablation of atrial arrhythmias on implanted permanent pacing systems. Pacing Clin Electrophysiol 1996;19(9):1287-95.

17. McCollough CH, Zhang J, Primak AN, Clement WJ, Buysman JR. Effects of CT irradiation on implantable cardiac rhythm management devices. Radiology 2007;243(3):766-74.

18. Yamaji S, Imai S, Saito F, Yagi H, Kushiro T, Uchiyama T. Does high-power computed tomography scanning equipment affect the operation of pacemakers? Circ J 2006;70(2):190-7.

19. Brooks C, Mutter M. Pacemaker failure associated with therapeutic radiation. Am J Emerg Med 1988;6(6):591-3.

20. Adamec R, Haefliger JM, Killisch JP, Niederer J, Jaquet P. Damaging effect of therapeutic radiation on programmable pacemakers. Pacing Clin Electrophysiol 1982;5(2):146-50.

21. Baikoussis NG, Apostolakis E, Papakonstantinou NA, Sarantitis I, Dougenis D. Safety of magnetic resonance imaging in patients with implanted cardiac prostheses and metallic cardiovascular electronic devices. Ann Thorac Surg 2011;91(6):2006-11.