Perioperative Management of Cardiac Implantable Electronic Devices

As the demographic profile of surgical patients evolves, an increasing proportion present with cardiac implantable electronic devices (CIEDs) such as pacemakers, implantable cardioverter-defibrillators and cardiac resynchronisation therapy systems. Effective perioperative management seeks to prevent device malfunction, electromagnetic interference and arrhythmias, while maintaining necessary pacing or defibrillation support. Preoperative assessment includes identification of device type, manufacturer-specific magnet responses and patient pacing dependency to determine whether reprogramming to an asynchronous mode or temporary suspension of tachycardia therapies is indicated. Intraoperatively, strategies such as optimised electrocautery settings, strategic positioning of grounding pads and continuous electrocardiographic monitoring serve to minimise electromagnetic interference. Postoperative interrogation verifies lead integrity, battery status and restoration of baseline programming. Multidisciplinary coordination among anaesthetists, cardiologists, electrophysiologists and specialised nursing teams, underpinned by clear organisational protocols, enhances safety and efficiency. Emerging approaches leverage remote device monitoring, automated alerts and standardised checklists to accommodate evolving device algorithms and surgical technologies. Globally, dedicated CIED services aim to reduce perioperative complications, streamline workflows and deliver cost-effective care.

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Perioperative Management of Cardiac Implantable Electronic Devices publication trend

The graph below shows the total number of articles in perioperative management of cardiac implantable electronic devices across all publications each year (not limited to Nature Index journals).

Technical terms

Cardiac implantable electronic device (CIED): An umbrella term for implanted pacemakers, defibrillators and resynchronisation devices that provide electrical therapy to the heart.

Asynchronous pacing: A mode in which a pacemaker delivers impulses at a fixed rate, irrespective of intrinsic cardiac activity, to prevent oversensing in environments with electromagnetic interference.

Electromagnetic interference (EMI): Disturbance caused by external electrical sources, such as electrocautery, that can inhibit device sensing or trigger inappropriate therapies.

Electrocautery: A surgical technique that uses high-frequency electrical current for cutting or coagulating tissue, which can produce EMI affecting CIEDs.

Magnet application: Placement of a clinical magnet over a CIED to temporarily alter its operating mode—commonly used to enforce asynchronous pacing or suspend tachycardia detection.

References

1. Perioperative Management of Patients with Cardiac Implantable Electronic Devices and Utility of Magnet Application. Journal of Clinical Medicine (2022).
2. Pacemaker Failure to Capture Caused by Electrocautery: A Rare Pacemaker Pulse Generator Change Complication. Cureus (2022).
3. Economic Evaluation of Anesthesiology-Led Cardiac Implantable Electronic Device Service. Healthcare (2023).
4. Inadvertent Intraoperative Defibrillation Secondary to Electrocautery Grounding Pad Placement. Cureus (2022).