The patient with a pacemaker or related device

Patients with implanted pacemakers and ICDs can be safely managed for surgery and anaesthesia. Anaesthetic management of such patients should be planned first according to the patient's underlying medical status with particular emphasis on ventricular function and electrolyte balance. The anaesthetist must understand the various modes of pacemakers and ICDs available in the patient population. These devices are safe and well shielded form most electromagnetic interference in the operating room. Some precautions are nevertheless necessary. A magnet should not be placed routinely over a programmable pacemaker or ICD in the operating room, especially in the presence of electrocautery. Rate-responsive pacemakers should have rate adaptive modes disabled before surgery whenever possible. The mechanism of rate response should be known, so that inappropriate changes in heart rate can be avoided in the perioperative period if the rate responsive mode cannot for some reason be disabled. Antitachycardia pacemakers, should have the antitachycardia function disabled preoperatively. Methods for the provision of alternate emergency pacing should be available when dealing with patients at risk of bradyarrhythmias or pacemaker failure in the operating room. The anaesthetist should have a safe, practical plan of action that suites his/her experience and capabilities. ICDs should have automatic cardioverter-defibrillator functions disabled for surgery and external modes of cardioversion/defibrillation should be available.