Designed and created by Guideline Central in participation with the American Society of Anesthesiologists
Perioperative Management of Patients with Cardiac Implantable Electronic Devices
Patient Guideline Summary
Publication Date: February 1, 2020
Last Updated: March 3, 2023
Objective
Objective
This patient summary means to discuss key recommendations from the American Society of Anesthesiologists for the perioperative management of patients with cardiac implantable electronic devices. It is limited to adults 18 years of age and older and should not be used as a reference for children.
Overview
Overview
- There are several types of Cardiac Implantable Electronic Devices (CIEDs).
- These electronic and magnetic tools used in surgery can interfere with CIEDs:
- Electric scalpels
- X-ray, computed tomography (CT), and magnetic resonance imaging (MRI)
- Lithotripsy (to break up kidney stones)
- External heart defibrillators and rhythm normalizers
- Electroconvulsive therapy equipment
- These electronic and magnetic tools used in surgery can interfere with CIEDs:
- Anesthesiologists are responsible for managing CIEDs during surgery.
- We will use the abbreviation CIED throughout this summary to refer to cardiac implantable electronic devices.
- This patient summary focuses on managing problems that can occur when surgical tools interfere with CIEDs.
Diagnosis
Diagnosis
- If you have a CIED, your anesthesiologist will determine its type and the possible tools that can interfere with its operation.
- Continuous monitoring of your blood oxygen, heart rhythm, and electrical activity will occur before, after, and throughout the surgery.
Treatment
Treatment
- Options available to avoid interference:
- Use tools that do not interfere with the CIED – e.g., ultrasound scalpels.
- Minimize or redirect the electromagnetic energy.
- Disable the CIED functions that can be affected and can be managed by the anesthesiologist.
- Emergency external defibrillation and cardioversion equipment will be available in the surgical suite.
- Your CIED will be tested before, during, and after surgery to make sure it is functioning normally.
Abbreviations
- CIED: Cardiac Implantable Electronic Device
- CT: Computed Tomography
- MRI: Magnetic Resonance Imaging
Source Citation
Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter–Defibrillators 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices*. Anesthesiology 2020;132(2):225-252. doi: https://doi.org/10.1097/ALN.0000000000002821.
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.