Implantable cardioverter defibrillator during laser transurethral resection of the prostate

Implantable cardioverter defibrillators have been instrumental in the health and safety of patients who are at increased risk of sudden death by ventricular tachycardia or fibrillation. Consensus on the perioperative management of cardiovascular implantable electronic devices has suggested that certain surgical interventions (including transurethral resection of the prostate) may interfere with the sensing capability of the device, thereby resulting in unforeseen adverse outcomes. However, improvements in the implantable cardioverter defibrillators have made it less susceptible to surgical interference. In addition, current guidelines recommend deactivation of the implantable cardioverter defibrillators to an asynchronous mode prior to most surgical interventions. We present the first two case reports in which implantable cardioverter defibrillators were not deactivated prior to GreenLight 180-W XPS laser-guided transurethral resection of the prostate. We left the implantable cardioverter defibrillators activated to allow them to detect and treat lethal arrhythmias by direct rather than extrinsic cardioversion. There was no cardiac arrhythmia incident in these two cases. Laser technology is not a documented source of electromagnetic interference in patients with implantable cardioverter defibrillators. There is no current evidence that links lasers to implantable cardioverter defibrillators malfunction. With increasing numbers of patients with implantable cardioverter defibrillators undergoing many different laser surgical procedures, further studies are warranted to analyze in depth the effects of laser therapy on implantable cardioverter defibrillators function and update in current guidelines.