Programming pacemakers and implantable cardioverterdefibrillators

The worldwide 2009 survey documents placement of more than one million Cardiac Pacing and Implantable Cardioverter-Defibrillators in 61 countries. At that time, the United States was the largest implanter of cardiac implantable electronic devices (CIED), adding nearly 33,000 new implantable cardioverter defibrillators (ICD) and 60,000 new pacemakers (PM) each year. The indications and utilization of cardiac implantable electronic devices (CIED) increase annually. Concomitantly, the concerns surrounding the safety risks and procedural outcomes also increase with the implantation of these devices [1]. There is an increasing number of patients with Cardiac Implantable Electronic Devices (CIED) undergoing various medical and surgical procedures often requiring care provided by an anesthetic team. This obligates anesthesia providers to have some basic knowledge of these devices and the impact that the surrounding equipment and the environment can have on the function of these devices. In order to provide safe care during an Electrophysiology Procedure, principles from the Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) expert consensus statement on the perioperative management of the patients with CIEDs apply. The primary recommendation is that the peri-procedural management of CIEDs must be individualized to the patient, CIED, and the procedure being performed and that there should be communication between the procedural team and anesthesia providers. The step-wise approach should include 1) identifying the type of CIED, 2) identifying the CIED function, 3) identifying pacing dependency, 4) determining the type and extent of Electro Magnetic Interference (EMI), 5) determining the need of reprogramming, 5) determining the need for post-procedure reinterrogation/reprogramming.