[Surgical and interventional use of radiofrequency current: is there interference with implantable...

During surgical and interventional procedures, interactions between implantable cardioverter defibrillators (ICD) and electrical cautery, respectively, application of radiofrequency (RF) energy may occur. Induction of inadequate shock therapies or device malfunction may result and represent a potential perioperative hazard for the patient.

Hence, we analyzed the intraoperative interactions in 23 consecutive ICD patients with regard to different surgical and interventional procedures. Sixteen surgical operations (general surgery n = 7, urologic n = 5, abdominal n = 2, gynecological n = 1, thoracic n = 1) and 7 interventional therapies (RF catheter ablation n = 5, endoscopic papillotomy n = 2) were performed. The ICD devices were all located in the left pectoral position and consisted of 15 single and 8 dual chamber defibrillators. During the procedure tachyarrhythmia detection (VF 295 +/- 21 ms, VT 370 +/- 55 ms) of the devices was maintained active (monitoring mode); only ICD therapies were inactivated. The indifferent electrode of the electrical cauter/RF generator was placed in standard positions (right mid femoral position n = 18, thoracic spine area n = 5). After the procedure, the ICD memory was checked for detections, respectively, for changes of the programming.

There was no misdetection or reprogramming of the ICD caused by electrical cautery or RF energy.

Despite the lack of undesired interactions ICDs should be inactivated preoperatively to assure maximum patient safety. However, should inactivation be ineffective or not manageable, electromagnetic interference is highly unlikely.