Electromagnetic interference in a cardiac pacemaker during cauterization with the coagulating, not cutting mode

Area of Science:

• Cardiology
• Biomedical Engineering
• Neurosurgery

Background:

• Monopolar electrocautery is commonly used in surgery, with electromagnetic interference (EMI) typically associated with its cutting mode.
• Dual-chamber, rate-modulated pacemakers (DDDR) are susceptible to EMI, potentially causing hemodynamic instability.
• Understanding EMI risks is vital for patient safety during procedures involving electronic implants.

Observation:

• A case of a 74-year-old male patient with a DDDR pacemaker experiencing intraoperative EMI during a spine procedure.
• The EMI occurred specifically during the coagulation mode of monopolar electrocautery, not the cutting mode.
• The electrodispersive pad placement varied, but EMI persisted during coagulation, leading to asystole.

Findings:

• Electrocautery in the coagulation mode can induce significant EMI in DDDR pacemakers.
• This interference can lead to life-threatening events such as asystole.
• The location of the electrodispersive pad did not prevent EMI during coagulation mode.

Implications:

• Clinicians must be aware that the coagulation mode poses a risk for pacemaker EMI and hemodynamic compromise.
• Heightened vigilance and preparedness are essential for managing patients with pacemakers during electrosurgery.
• Implementing strategies to mitigate EMI risk can ensure favorable patient outcomes in neurosurgical and other procedures.