Electromagnetic interference of an external temporary pacemaker during maxillofacial and neck surgery

Area of Science:

• Cardiovascular Medicine
• Surgical Technology
• Biomedical Engineering

Background:

• Patients with pre-existing cardiac conditions like atrioventricular block and bundle-branch block may require temporary pacemakers.
• Electrocautery is a common surgical tool used to control bleeding during procedures.
• Electromagnetic interference (EMI) from electrocautery can potentially affect pacemaker function.

Observation:

• A patient undergoing hemimaxillectomy and radical neck dissection required a temporary transvenous demand pacemaker.
• Despite implementing standard precautions against EMI, the patient experienced pacemaker inhibition during electrocautery use.
• The pacing failure was attributed to current dispersion from the active electrocautery electrode.

Findings:

• Indirect inhibition of an external temporary pacemaker by electrocautery was observed.
• Electrocautery-induced current dispersion poses a risk to temporary pacemaker function.
• Standard EMI precautions were insufficient to prevent pacing failure in this case.

Implications:

• Neck surgery in patients with temporary pacemakers necessitates careful consideration of electrocautery use.
• Occipital placement of the electrocautery ground plate is a potential strategy to mitigate EMI risk.
• This case highlights the importance of monitoring pacemaker function during electrocautery in high-risk patients.