Inappropriate Implantable Cardioverter-Defibrillator Therapy During Total Hip Arthroplasty

Area of Science:

• Cardiology
• Medical Devices
• Surgical Electrophysiology

Background:

• Electromagnetic interference (EMI) poses a risk for inappropriate therapy from implantable cardioverter-defibrillators (ICDs).
• Current guidelines suggest infraumbilical surgeries using monopolar electrocautery are low risk for EMI, often not requiring routine magnet application.
• Patient history and surgical factors can influence EMI susceptibility.

Observation:

• A 71-year-old woman with an ICD for non-ischemic cardiomyopathy underwent a left total hip arthroplasty.
• Monopolar electrocautery was utilized for the infraumbilical surgery.
• The patient experienced nine episodes of inappropriate ICD therapy during the procedure.

Findings:

• Despite infraumbilical surgery, significant EMI occurred, leading to multiple inappropriate ICD therapies.
• The placement of the electrocautery dispersion pad is hypothesized to be a contributing factor.
• No long-term sequelae were observed in the patient.

Implications:

• The location of electrocautery dispersion pads should be carefully considered during infraumbilical surgeries in patients with ICDs.
• Suspending anti-tachycardia functions intraoperatively may be necessary even when guidelines do not mandate it.
• This case highlights the need for individualized risk assessment regarding EMI and ICDs.