|Year : 2019 | Volume
| Issue : 3 | Page : 76-78
Safety and outcomes of noncardiac surgery in patients with cardiac implantable electronic devices
Bahman Akhondi1, Mohammadmostafa Ansari-Ramandi2, Mona Heidarali1, Farzad Kamali1, Majid Haghjoo1
1 Department of Cardiac Electrophysiology; Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
2 Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
|Date of Submission||22-Jul-2019|
|Date of Acceptance||26-Jul-2019|
|Date of Web Publication||08-Nov-2019|
Dr. Majid Haghjoo
Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Vali E Asr St., Ayatollah Rafsanjani Blvd, Tehran 1995614331
Source of Support: None, Conflict of Interest: None
Background: Electromagnetic interference can cause damage to cardiac implantable electronic devices (CIEDs). The current guidelines recommend the interrogation of all pacemakers and defibrillators before and after surgery. The objective of the study was to evaluate the safety and outcomes of noncardiac surgeries in patients with CIEDs. Methods: Between January 2014 and January 2019, all patients with CIEDs who underwent noncardiac surgery were included. The patient's baseline characteristics and data regarding their procedure and postsurgical complications and mortality were extracted from their medical records. The device analysis 6 months after the procedure was also seen. Results: Of the 54 patients, 16 had permanent pacemaker, 25 implantable cardioverter defibrillator, and 13 cardiac resynchronization therapy device. Most common indication for surgery was inguinal or abdominal hernia (n = 46); three patients underwent surgery for cholecystitis and five for other reasons. Supraventricular tachycardia was reported in one patient during surgery and in another one after surgery. Only one patient experienced intraoperative ventricular tachycardia. There was no device malfunction during and after surgery. During 6-month follow-up, 5.6% mortality rate was reported. Conclusions: With recommended device programming before surgery, noncardiac surgery is well tolerated in the majority of the patients with CIEDs without significant interference in the device function.
Keywords: Implantable cardiac devices, malfunction, noncardiac surgery, safety
|How to cite this article:|
Akhondi B, Ansari-Ramandi M, Heidarali M, Kamali F, Haghjoo M. Safety and outcomes of noncardiac surgery in patients with cardiac implantable electronic devices. Res Cardiovasc Med 2019;8:76-8
|How to cite this URL:|
Akhondi B, Ansari-Ramandi M, Heidarali M, Kamali F, Haghjoo M. Safety and outcomes of noncardiac surgery in patients with cardiac implantable electronic devices. Res Cardiovasc Med [serial online] 2019 [cited 2019 Nov 14];8:76-8. Available from: http://www.rcvmonline.com/text.asp?2019/8/3/76/270586
| Introduction|| |
With increasing indications for cardiac implantable electronic devices (CIEDs), the number of patients having them has increased considerably. Electromagnetic interference (EMI) which is faced during noncardiac surgeries is common and can cause damage to permanent pacemakers (PPMs) and implantable cardioverter defibrillators (ICDs). The problems reported are failure to pace, inappropriate reprogramming, and total malfunction of the system. Because of the EMI, the current guidelines recommend the interrogation of all PPMs and ICDs before and after surgery. In this study, we try to evaluate the safety and outcome of noncardiac surgeries in patients with cardiac devices.
| Methods|| |
Our local ethical committee reviewed and approved the protocol of the study. The investigation was performed retrospectively using the medical records of patients with CIEDs who underwent surgery from January 2014 to January 2019 at our center.
All patients had gone interrogation of their devices before and after the surgery and 6 months after the surgery. The patient's demographic data, device type, indication for device implantation, and baseline disease were collected. The patient's medical records were checked for any hypotension, supraventricular tachycardia, ventricular tachycardia, or fibrillation or any other complication reported during or after surgery. Records were checked for device malfunction and any other medical condition happening during and after surgery. The device analysis 6 months after surgery was also seen for any malfunction.
Data were analyzed using t-test and Mann–Whitney test and reported as mean ± standard deviation or percentages. A P < 0.05 was considered statistically significant.
| Results|| |
Of the 54 included patients, 16 had PPM, 25 had ICD, and 13 had cardiac resynchronization therapy device (CRT-D). The other patient characteristics are shown in [Table 1].
Forty-six patients had done herniorrhaphy, three underwent surgery for cholecystitis, while five others for other reasons. The electrocardiographic characteristics of the patients are shown in [Table 2].
Regarding complications happening intraoperatively, only one episode of supraventricular tachycardia was reported. There was no bradycardia, hypotension or mortality reported during the surgery.
The surgical data and postoperative complications are summarized in [Table 3]. There was postoperative mortality of 5.55% of noncardiac cause, which led to the evaluation of just 51 patients at 6-month follow-up.
There was correlation between postoperative hypotension and mortality (P < 0.005). The postoperative interrogation of all devices showed that there was no malfunction or changes in the programming of the devices after the surgery and at 6-month follow-up.
| Discussion|| |
The present study showed that noncardiac surgeries are well tolerated in patients with CIED. Device malfunction secondary to EMI is rare.
There was no significant mortality or morbidity after surgery in patients with CIED, and the mortality in these patients was of noncardiac cause which was correlated to the postoperative hypotension in these patients. There was only one case of VT after surgery which was managed appropriately by the ICD.
There have been some studies done in this field focusing more on the endoscopic procedures with less focus on other procedures.,, In a study both patients undergoing endoscopic procedure and other surgeries were evaluated, which of those 79 patients underwent surgeries other than endoscopic procedure. The results of the study were in favor of device safety in most patients and they proposed a decision tree for the management of patients with CIEDs in periprocedual setting.
The results of our study also concluded that noncardiac surgeries are safe in patient with CIEDs, and there is no significant interference and effect on the device programming. With the advancement of new devices, there is more hope that procedures can be done safely without any great concern for device malfunction during surgeries. Still, more prospective studies are needed to evaluate the effects of different surgeries on CIEDs functioning in patients.
| Conclusion|| |
With recommended device programming before surgery, non-cardiac surgery is well tolerated in the majority of the patients with CIEDs without significant interference in the device function. Therefore in the resent study the safety and outcome of non-cardiac surgeries in patients with cardiac devices have been evaluated.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Boehmer JP. Device therapy for heart failure. Am J Cardiol 2003;91:53D-59D.
Mond HG, Proclemer A. The 11th
world survey of cardiac pacing and implantable cardioverter-defibrillators: Calendar year 2009 – A World Society of Arrhythmia's Project. Pacing Clin Electrophysiol 2011;34:1013-27.
Madigan JD, Choudhri AF, Chen J, Spotnitz HM, Oz MC, Edwards N. Surgical management of the patient with an implanted cardiac device: Implications of electromagnetic interference. Ann Surg 1999;230:639-47.
Cheng A, Nazarian S, Spragg DD, Bilchick K, Tandri H, Mark L, et al.
Effects of surgical and endoscopic electrocautery on modern-day permanent pacemaker and implantable cardioverter-defibrillator systems. Pacing Clin Electrophysiol 2008;31:344-50.
Baeg MK, Kim SW, Ko SH, Lee YB, Hwang S, Lee BW, et al.
Endoscopic electrosurgery in patients with cardiac implantable electronic devices. Clin Endosc 2016;49:176-81.
Guertin D, Faheem O, Ling T, Pelletier G, McComas D, Yarlagadda RK, et al.
Electromagnetic interference (EMI) and arrhythmic events in ICD patients undergoing gastrointestinal procedures. Pacing Clin Electrophysiol 2007;30:734-9.
Parekh PJ, Buerlein RC, Shams R, Herre J, Johnson DA. An update on the management of implanted cardiac devices during electrosurgical procedures. Gastrointest Endosc 2013;78:836-41.
[Table 1], [Table 2], [Table 3]