Perioperative management of patients with pacemakers and implantable cardioverter defibrillators

An increasing number of patients scheduled for surgery have an implanted cardiac pacemakers or cardioverter defibrillator to. treat symptomatic bradycardia, malignant tachycardia or congestive heart failure. Numerous iatrogenic factors may impact on the function of these advanced devices and cause malfunction with adverse consequences for the patient. The perioperative management of a patient provided with an antiarrhythmia device requires a knowledge of the underlying rhythm disorder as well as the programmed pacing modality, which must be modified whenever necessary. Electromagnetic interference, the most common concern of a pacemaker patient, must be identified and, wherever possible, avoided. Intra-operative monitoring of the pacemaker/defibrillator mode is essential, as also is the immediate availability of a temporary external pacemaker and/or defibrillator.