Guidelines for the peri-operative management of people with cardiac implantable electronic devices: Guidelines from the British Heart Rhythm Society

Abstract

This document provides practical guidance for the management of people with cardiac implantable electronic devices who are undergoing surgical intervention. Increasing numbers of people have cardiac device implants including pacemakers, implantable defibrillators and cardiac resynchronisation devices. During surgical procedures, exposure to electromagnetic interference may lead to inappropriate device function including withholding of pacing function or shock therapies. The guideline summarises key aspects of pre-operative assessment protocols to ensure that all people have their device clearly identified and have had appropriate device follow-up pre-operatively. It outlines general measures which can minimise the risk of potentially problematic electromagnetic interference in the surgical environment. It also includes detailed guidance according to the type of device, whether individuals are dependent on the pacing function of the device and the nature of the procedure they are undergoing. People identified as being at significant risk of harmful procedure-related inappropriate device function may require temporary alteration to the device programming. This may be carried out by a trained cardiac physiologist using a device programmer or, in some cases, can be achieved by clinical magnet application. Guidance on the safe use of magnets and emergency situations is included. Common diagnostic procedures and dental interventions are covered. The guidance aims to provide specific and pragmatic advice which can be applied to provide safe and streamlined care for people with cardiac implantable devices.