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. 2018 Jun;57(2):383-390.
doi: 10.20471/acc.2018.57.02.22.

Recommendations for Perioperative Management of Patients with Cardiac Implantable Electronic Devices

Nikola Pavlović  1 , Šime Manola  1 , Hrvoje Vražić  2 , Marinko Vučić  3 , Sandro Brusich  4 , Vjekoslav Radeljić  1 , Ivan Zeljković  1 , Richard Matasić  5 , Ante Anić  6 , Ivica Benko  1 , Željka Gavranović  3 , Milana Zlatić Glogoški  3
Affiliations

Recommendations for Perioperative Management of Patients with Cardiac Implantable Electronic Devices

Nikola Pavlović et al. Acta Clin Croat. 2018 Jun.

Abstract

Four thousand cardiac implantable electronic devices (CIED) are implanted yearly in Croatia with constant increase. General anesthesia and surgery carry some specific risk for the patients with implanted CIEDs. Since most of the surgical procedures are performed in institutions without reprogramming devices available, or in the periods when they are unavailable, these guidelines aim to standardize the protocol for perioperative management of these patients. With this protocol, most of the procedures can be performed easily and, more importantly, safely in the majority of surgical patients.

Keywords: Anesthesia, General; Cardiac Resynchronization Therapy Devices; Croatia; Guideline; Perioperative Care.

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Figures

Fig. 1
Fig. 1
Identification card of a patient with a pacemaker (left) and cardioverter defibrillator (right). Data on the manufacturer, device and programming are shown.
Fig. 2
Fig. 2
Postero-anterior chest x-ray: (A) pacemaker can be recognized by the generator in the left pectoral region and two ‘thin’ electrodes in the right atrial appendage and right ventricular apex (arrows). In this case, double-chamber (DDD) pacemaker is shown (options with one lead in the ventricle or very rarely only in the atrium are possible); (B) cardioverter defibrillator can be recognized by coils on the leads, which deliver high-energy shocks (arrows). Options with one, two or three leads are possible (three leads if it is a CRT-D device); (C) cardiac resynchronization therapy (CRT-P) device. This device can be recognized by the presence of additional lead in the coronary sinus – left ventricle (arrow). Options without atrial lead or with ICD leads are possible; (D) implantable loop recorder (ILR), which is implanted left parasternally and has no leads in or outside the heart.
Fig. 3
Fig. 3
Algorithm for perioperative management of patients with pacemakers and ICDs.
See this image and copyright information in PMC

References

    1. Raatikainen MJ, Arnar DO, Zeppenfeld K, Merino JL, Kuck KH, Hindricks G. Current trends in the use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology member countries: 2015 report from the European Heart Rhythm Association. Europace. 2015; Suppl 4:iv1–72. 10.1093/europace/euv265 - DOI - PubMed
    1. Sticherling C, Menafoglio A, Burri H, et al. Recommendations for the perioperative management of patients with cardiac implantable electronic devices. Cardiovasc Med. 2016;19:13–8. 10.4414/cvm.2016.00378 - DOI
    1. Healey JS, Merchant R, Simpson C, et al. Canadian Cardiovascular Society/Canadian Anesthesiologists Society/Canadian Heart Rhythm Society joint position statement on the perioperative management of patients with implanted pacemakers, defibrillators, and neurostimulating devices. Can J Cardiol. 2012;28:141–51. 10.1016/j.cjca.2011.08.121 - DOI - PubMed
    1. Pinski SL, Trohman RG. Interference in implanted cardiac devices, part II. Pacing Clin Electrophysiol. 2002;25:1496–509. 10.1046/j.1460-9592.2002.01496.x - DOI - PubMed
    1. Jacob S, Panaich SS, Maheshwari R, Haddad JW, Padanilam BJ, John SK. Clinical applications of magnets on cardiac rhythm management devices. Europace. 2011;13:1222–30. 10.1093/europace/eur137 - DOI - PubMed

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