A Shocking Pause: Interplay Between Pacemaker Safety Mode-Switching and Generator Manipulation Leading to Asystole
Robert F Olszewski1, Sean J Dikdan2, Dhruv Vasant1
1From the Department of Anesthesiology, Temple University Hospital, Philadelphia, Pennsylvania.
A&A Practice
|June 6, 2025
Summary
Electrocautery during pacemaker generator replacement can cause dangerous pacing changes. Prompt identification and device repositioning quickly resolved asystole, highlighting the need for vigilance during cardiac implantable electronic device procedures.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Pacemaker generator changes are common procedures.
- Electromagnetic interference (EMI) from electrocautery can affect cardiac implantable electronic devices (CIEDs).
Purpose of the Study:
- To report a case of asystole during a pacemaker generator change due to EMI.
- To emphasize the importance of understanding CIED function during procedures.
Main Methods:
- A 42-year-old pacemaker-dependent patient underwent generator change.
- Electrocautery use led to a pacemaker mode switch.
- Device repositioning was performed to restore pacing.
Main Results:
- Electromagnetic interference caused the pacemaker to switch from bipolar to asynchronous unipolar pacing.
- Removing the generator from the pocket resulted in asystole.
- Reinserting the pacemaker immediately restored normal function.
Conclusions:
- Vigilance and rapid response are crucial during CIED generator changes.
- Knowledge of CIED programming and function is essential to prevent electrocautery-related complications.
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