[Update on the perioperative management of cardiac implantable electronic devices]

The discipline of cardiac implantable electronic devices (CIED) has undergone numerous technical innovations in recent years. Leadless pacemaker systems are increasingly being implanted, biventricular cardiac resynchronization therapy (CRT) is firmly established and subcutaneous or extravascular implantable cardioverter defibrillators (S-ICD, EV-ICD) have become available. Moreover, advances such as direct stimulation of the cardiac conduction system with conduction system pacing systems and loop recorders with dimensions smaller than a USB stick illustrate the remarkable pace of technological innovation. For anesthesiology personnel these innovations have particular clinical relevance. The rising prevalence of patients with CIED undergoing noncardiac surgery underscores the need for a thorough understanding of device functionality, perioperative management strategies and potential interactions with anesthetic techniques. This article provides an overview of the most significant technological advances in the field of CIED and outlines practical recommendations to support the safe and effective integration into daily anesthesiological practice.