This case highlights the risk of asystole during pacemaker generator changes due to electrocautery-induced mode switching to unipolar pacing when the generator is removed from the pocket.
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Alerts to asystole risk in generator changes; leaves open optimal electrocautery protocols pending prospective data.
A 42-year-old pacemaker-dependent patient presented for pacemaker generator change. During the procedure, electromagnetic interference from electrocautery caused the pacemaker to switch from bipolar to asynchronous unipolar pacing. Subsequent removal of the generator from the pocket and thus removing the anode from the "unipolar" pacing configuration led to asystole-which was promptly identified. The pacemaker was reinserted into the device pocket immediately, restoring pacer function. This case demonstrates the need for vigilance and rapid response during cardiac implantable electronic device (CIED) generator changes and highlights how knowledge of CIED functions can help avoid electrocautery-related complications.
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Olszewski et al. (2025) studied this question.
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