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Endoscopic diathermy in patients with cardiac pacemakers
1Digestive Diseases Research Centre, St Bartholomew's and the Royal London School of Medicine and Dentistry, UK. A.M.Veitch@mds.mqw.ac.uk
Background And Study Aims:
Malfunction of cardiac pacemakers related to diathermy in surgical procedures has been reported, but the risks of endoscopic diathermy in pacemaker patients is unknown. The aim of this study was to investigate current practice amongst British gastroenterologists regarding endoscopy in cardiac pacemaker patients.
Methods:
An anonymous postal questionnaire survey of 634 members of the Endoscopy section of the British Society of Gastroenterology was conducted.
Results:
410/634 (65%) replied. Respondents conducted 59270 endoscopic retrograde cholangiopancreatography procedures (ERCPs) and 88544 colonoscopies per year. 77.3% of respondents were aware of the possibility of adverse interactions between diathermy and pacemakers. 74.2% enquired whether a pacemaker was present prior to endoscopy. In cases where patients were known to have pacemakers fitted, 23.9% recorded an electrocardiogram (ECG) prior to endoscopic diathermy, 36.2% conducted ECG monitoring during the procedure, 35.9% consulted a cardiologist or pacemaker technician and 13.4% carried out specific preventative measures. 4.1% of all respondents were aware of instances of pacemaker malfunction having occurred during endoscopic diathermy.
Conclusion:
Most gastroenterologists surveyed were aware of the possibility of adverse interactions between diathermy and cardiac pacemakers, but few undertook measures to detect or prevent pacemaker malfunction. Endoscopic diathermy in cardiac pacemaker patients, however, appears generally safe, although the endoscopist should be aware of the small chance of an adverse interaction.