Surgical management of the patient with an implanted cardiac device

Implications of electromagnetic interference

John D. Madigan, Asim Choudhri, Jonathan Chen, Henry M. Spotnitz, Mehmet C. Oz, Niloo Edwards

Research output: Contribution to journalReview article

77 Citations (Scopus)

Abstract

Objective: To identify the sources of electromagnetic interference (EMI) that may alter the performance of implanted cardiac devices and develop strategies to minimize their effects on patient hemodynamic status. Summary Background Data: Since the development of the sensing demand pacemaker, EMI in the clinical setting has concerned physicians treating patients with such devices. Implanted cardiovertor defibrillators (ICDs) and ventricular assist devices (VADs) can also be affected by EMI. Methods: All known sources of interference to pacemakers, ICDs, and VADs were evaluated and preventative strategies were devised. Results: All devices should be thoroughly evaluated before and after surgery to make sure that its function has not been permanently damaged or changed. If electrocautery is to be used, pacemakers should be placed in a triggered or asynchronous mode; ICDs should have arrhythmia detection suspended before surgery. If defibrillation is to be used, the current flow between the paddles should be kept as far away from and perpendicular to the lead system as possible. Both pacemakers and ICDs should be properly shielded if magnetic resonance imaging, positron emission tomography, or radiation therapy is to be used. The effect of EMI on VADs depends on the model. Magnetic resonance imaging adversely affects all VADs except the Abiomed VAD, and therefore its use should be avoided in this population of patients. Conclusions: The patient with an implanted cardiac device can safely undergo surgery as long as certain precautions are taken.

Original languageEnglish (US)
Pages (from-to)639-647
Number of pages9
JournalAnnals of surgery
Volume230
Issue number5
DOIs
StatePublished - Nov 1 1999

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Heart-Assist Devices
Electromagnetic Phenomena
Defibrillators
Equipment and Supplies
Magnetic Resonance Imaging
Electrocoagulation
Positron-Emission Tomography
Cardiac Arrhythmias
Radiotherapy
Hemodynamics
Physicians
Population

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Surgical management of the patient with an implanted cardiac device : Implications of electromagnetic interference. / Madigan, John D.; Choudhri, Asim; Chen, Jonathan; Spotnitz, Henry M.; Oz, Mehmet C.; Edwards, Niloo.

In: Annals of surgery, Vol. 230, No. 5, 01.11.1999, p. 639-647.

Research output: Contribution to journalReview article

Madigan, John D. ; Choudhri, Asim ; Chen, Jonathan ; Spotnitz, Henry M. ; Oz, Mehmet C. ; Edwards, Niloo. / Surgical management of the patient with an implanted cardiac device : Implications of electromagnetic interference. In: Annals of surgery. 1999 ; Vol. 230, No. 5. pp. 639-647.
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