How does the type of pacer used affect perioperative management of permanent pacemakers (PPMs) and automatic implantable cardioverter-defibrillators (AICDs)?

Updated: Oct 29, 2018
  • Author: Albert H Tsai, MD; Chief Editor: Sheela Pai Cole, MD  more...
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Answer

Answer

With the myriad of CIED brands and models currently available, it is imperative to understand how each specific device responds to perioperative interventions.

The most important initial distinction to make is between PPMs and AICDs. PPMs sense and pace the atrium, the ventricle, or both, whereas AICDs have the additional function of cardioversion and defibrillation when clinically appropriate. A major reason why making this distinction perioperatively is important is that EMI and magnet placement affect the two device types differently (see below). For example, EMI can lead to inappropriate sensing in PPMs, but it can also result in inappropriate cardioversion or defibrillation in AICDs.

Various methods may be employed to identify the type of CIED present. A detailed history from a reliable historian often yields the answer quickly and should be the first step taken. Many patients have retained their device ID card, which contains the brand name, implant date, and serial/model numbers. A phone call to the brand representative or an online search of the serial number may yield the needed device information, as may office or procedural notes from the patient’s cardiologist and interrogation reports of the device. Finally, radiography or computed tomography (CT) of the chest can be used to identify the device type and brand.  [6]


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