Cardiac Equipment and Transplants [51]
6.7
Cardiac Equipment and Transplants [51]
- For stent management, see page 69
Implantable Cardioverter‐Defibrillator (Figure 6.20) (ICD)
Figure 6.20
- Indications
- Prevention of sudden cardiac death due to VT/VF
- Primary Concerns
- Electromagnetic interference
- Device could misinterpret as tachyarrhythmia and deliver shock
- Electrosurgery units
- Monopolar more likely to interfere than bipolar
- Coagulation setting more likely to interfere than cutting setting
- Peripheral nerve stimulators
- Dental equipment generally considered safe [52]
- Evaluation
- Pulse generator will most likely be in a left prepectoral, subcutaneous position
- Placed on right side for left‐handed patients
- History
- Cardiac history
- Cardiac procedures
- Interrogation by cardiac care team within three to six months of procedure to reveal:
- Manufacturer
- Model number
- Function
- Magnet response of device (Figure 6.21)
- Battery life
- Significant events
- Treatments delivered
- Underlying rhythm
- Anesthesia Management
- Consider treating in hospital setting
- Cardiology consultation
- Obtain recent baseline ECG
- In coordination with cardiac care team, devices may be disabled or reprogrammed to suspend anti‐tachyarrhythmia mode
- Attach defibrillator pads before induction as there is a reason the patient has an ICD
- In the event of an arrhythmia, if a magnet has been placed, remove magnet to allow for reactivation of anti‐tachyarrhythmia function of ICD
- Limit epinephrine in local anesthetic to 40 μg
- External defibrillator with transcutaneous pacing capability readily available
- Reactivate or reprogram prior to discharge
Figure 6.21
Permanent Pacemaker (PPM)
- Most modern devices are a pacemaker and ICD
- If an ICD has pacing capability, magnet will suspend anti‐tachyarrhythmia therapy but will not affect pacing mode
- Pacemakers have a specific code to understand their functionality (Figure 6.22)
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