Effects of surgical and endoscopic electrocautery on modern-day permanent pacemaker and implantable cardioverter-defibrillator systems

Background: Current guidelines recommend that all implanted pacemakers (PPM) and defibrillators (ICD) be interrogated before and after every invasive procedure. The ability of newer devices to withstand system malfunction or failure during surgery/endoscopy remains unknown. Objective: To determine the frequency of PPM or ICD malfunction from periprocedural electrocautery. Methods: Ninety-two consecutive individuals referred for evaluation of a PPM or ICD system prior to noncardiac surgery/endoscopy were enrolled. Devices were preoperatively programmed to a monitor only zone to allow for detection of electromagnetic interferences (EMIs). Pacing parameters were maintained without disabling rate responsiveness. The devices were fully interrogated again after surgery. Correlations of inappropriate EMI sensing were made with reference to the distance from the site of electrocautery application to the device system. Results: All devices withstood periprocedural EMI exposure without malfunction or changes in programming. Minor changes in lead parameters were noted. Three device systems demonstrated brief atrial mode switching episodes, one of which was likely secondary to inappropriate sensing of atrial noise. Two pacemaker devices demonstrated inappropriate sensing of ventricular noise, both of which occurred when the application of electrocautery was within close proximity to the pacemaker generator (< 8 cm). No ventricular sensed events were noted in any ICD system. Conclusions: EMIs during noncardiac surgical/endoscopic procedures pose little threat to current device systems. Rare occasions of inappropriate sensing by devices can be seen in situations where the application of unipolar electrocautery is in close proximity of the system. Routine postsurgical interrogation of PPM or ICDs may not be necessary.