Inadvertent Intraoperative Defibrillation Secondary to Electrocautery Grounding Pad Placement

Area of Science:

• Cardiovascular medicine
• Medical device technology
• Surgical safety

Background:

• Electrocautery use during surgery poses a rare risk of intraoperative defibrillation for patients with cardiovascular implantable electronic devices (CIEDs).
• Below-the-umbilicus electrocautery use is considered to have a near-zero risk of causing inadvertent defibrillation.
• Defibrillation linked to electrodispersive pad (EDP) radiofrequency dispersion has been purely theoretical until now.

Observation:

• A 67-year-old male with an automatic implantable cardioverter defibrillator (AICD) underwent robotic-assisted left anterior total hip arthroplasty.
• The patient experienced inadvertent intraoperative defibrillation during electrocautery use.
• Defibrillation episodes ceased after repositioning the contralateral electrodispersive pad and placing a donut magnet over the AICD.

Findings:

• This case report details the first documented instance of intraoperative defibrillation caused by electrocautery in a patient with an AICD.
• The findings suggest a potential interaction between electrocautery, EDPs, and AICD function.
• The successful management involved repositioning the EDP and applying a magnet to the AICD.

Implications:

• This case highlights the importance of considering CIEDs when using electrocautery, even below the umbilicus.
• It suggests a need for revised surgical protocols and device management strategies during procedures involving CIEDs and electrocautery.
• Further research is warranted to understand the mechanisms and mitigate the risks of intraoperative defibrillation associated with electrocautery and CIEDs.