The patient with a cardiac pacemaker or implanted defibrillator and management during anaesthesia

Worldwide, nearly 3 million patients have cardiac pacemakers and more than 300,000 have implantable cardioverter-defibrillators. Many factors cause confusion regarding perioperative care of these patients, since conventional wisdom, case reports, textbooks, and literature reviews have either not kept pace with technologic developments or contain incorrect statements. Additionally, recalls or alert notices have prompted programming changes that might not be understood or recognized.

The complexity of the devices, as well as features designed to improve both the quality of life and the survival of the patient, can masquerade as pacing malfunction. Additionally, algorithms designed to detect heart rate, ST segment behavior, and arrhythmias in electrocardiographic monitors may lead to inappropriate behavior on the part of the perioperative team.

Appropriate education of perioperative practitioners, as well as preoperative interrogation of a pacemaker or implantable cardioverter-defibrillator, may prevent perioperative delays, cancellations, and deaths. Additionally, evidence suggests that postoperative re-interrogation of any cardiac generator is warranted if an operative event includes the use of monopolar electrosurgery ('Bovie') or significant fluid or blood component administration.