[Cardiac implantable electronic devices : Electromagnetic interference from electrocauterization, lithotripsy and...

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Device Management

Background:

• Cardiac implantable electronic devices (CIEDs) present management challenges due to electromagnetic interference (EMI) risks in medical settings.
• Existing guidelines for perioperative CIED management often lack robust evidence and can be contradictory.
• Increasing complexity of modern CIEDs necessitates updated management strategies.

Purpose of the Study:

• To review and update perioperative management protocols for patients with CIEDs.
• To address the safety of procedures involving potential EMI, such as electrocauterization, extracorporeal shock wave lithotripsy, and physiotherapy.
• To provide a pragmatic approach to CIED management based on recent clinical observations and findings.

Main Methods:

• Review of recent studies and clinical observations regarding EMI in CIED patients.
• Analysis of the impact of specific procedures (electrocauterization, ESWL, physiotherapy) on CIED function.
• Development and presentation of an adapted perioperative CIED management protocol.

Main Results:

• Despite potential for EMI, most procedures, including intraoperative electrocauterization and extracorporeal shock wave lithotripsy, can be safely performed in patients with modern CIEDs.
• Older recommendations regarding severe interference risks are often not supported by current clinical data.
• Physiotherapy devices can pose EMI risks, necessitating coordination with CIED specialists.

Conclusions:

• Perioperative management of CIED patients can be pragmatically adapted based on current evidence, moving beyond outdated recommendations.
• Modern CIEDs are generally robust, allowing for safe execution of a wide range of medical procedures.
• Close collaboration between medical teams and CIED specialists is crucial for ensuring patient safety during procedures with potential EMI exposure.