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Current Perioperative Management of the Patient With a Cardiac Rhythm Management Device

Department of Anesthesiology, Mount Sinai School of Medicine, marc.stone{at}mountsinai.org

Andrey Apinis, MD

Department of Anesthesiology, Mount Sinai Medical Center New York

The safe and effective perioperative management of the patient with a cardiac rhythm management device (ie, pacemaker and/or implantable cardioverter defibrillator) is based entirely on the avoidance of adverse outcomes, including damage to the device, the leads, or the site of lead implantation that might prevent the device from functioning as intended. An important management principle is the potential reprogramming of such a device in the perioperative period to avoid transient interruption of device function or the delivery of inappropriate electrophysiological therapy (eg, unnecessary defibrillation or pacing). Given the large numbers of patients worldwide currently implanted with these devices, the anesthesia practitioner should become electively familiar with the current technology. This article describes the current status of cardiac rhythm management devices and discusses recommended perioperative management.

Key Words: cardiac rhythm management device • pacemaker • implantable cardioverter defibrillator • ICD • heart failure • perioperative management • anesthesia • sudden cardiac death • ventricular fibrillation

This version was published on March 1, 2009

Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 13, No. 1, 31-43 (2009)
DOI: 10.1177/1089253209332211


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