Randomized controlled trial of perioperative ICD management: magnet application versus reprogramming

Area of Science:

• Cardiology
• Medical Devices
• Surgical Procedures

Background:

• Limited data exists for perioperative implantable cardioverter-defibrillator (ICD) management during electrocautery.
• Electrocautery use in patients with ICDs requires careful management to prevent device malfunction.

Purpose of the Study:

• To compare the efficacy of a magnet protocol versus programming ICDs off for perioperative management during electrocautery.
• To evaluate ICD off-time, caregiver handoffs, and electromagnetic interference (EMI).

Main Methods:

• A multicenter randomized controlled trial involving 80 patients with pectoral ICDs undergoing surgery with monopolar electrocautery.
• Patients were randomized to an "Off" group (ICD therapy programmed off) or a "Magnet" group (ICD therapy suspended with a magnet).
• A registry tracked ICD patients with procedures within 6 inches of the ICD.

Main Results:

• The "Magnet" group experienced significantly less "excess" ICD off-time (28 minutes) compared to the "Off" group (115 minutes).
• The "Off" group had more caregiver handoffs (6.6 vs 5.5).
• No electromagnetic interference (EMI), arrhythmic events, or device resets were observed in either group.

Conclusions:

• A magnet protocol simplifies perioperative ICD management for electrocautery procedures over 6 inches from the ICD.
• This approach leads to shorter ICD downtime, fewer provider handoffs, and no risk of inadvertent discharge with deactivated therapy.
• The magnet protocol ensures device integrity without compromising patient safety.