Key result
General anesthesia with specific CRT-D reprogramming allowed for successful hip arthroplasty without adverse events or electrosurgical interference in an 83-year-old male with severe left ventricular dysfunction.
Why the study?
There is limited literature regarding the anesthesia management of geriatric patients with advanced HFrEF implanted with cardiac resynchronization therapy devices presenting for surgery.
Case Report (n=1)
No
Careful perioperative planning, multidisciplinary communication, and appropriate device reprogramming allow for safe general anesthesia and surgery in elderly patients with severe LV dysfunction and CRT-D devices.
May guide individualized CRT-D management in high-risk surgical patients; leaves open need for prospective validation before broader adoption.
Cardiac resynchronization therapy has emerged as a key component in management of advanced heart failure with reduced ejection fraction in selected subset of geriatric patients. The burgeoning burden of comorbidities, complexity of these devices and aging population presenting for surgeries necessitates peri-operative physicians to be cognizant and confident to handle these challenging cases. Limited literature about anesthesia management of patients implanted with these devices add to the situational challenge. We present a case of elderly gentleman with ischemic cardiomyopathy and cardiac resynchronization therapy-defibrillator device who underwent hip replacement under general anesthesia. Understanding the disease and the device are the crucial and definitive exigencies to manage such cases.
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Ashish Bangaar (2022) conducted a case report in Severe Left Ventricular Dysfunction and Cardiac Resynchronization Therapy-Defibrillator Device requiring Hip Arthroplasty (n=1). General anesthesia with CRT-D reprogramming (DOO mode, defibrillator deactivated) was evaluated on Successful completion of surgery without adverse events or CRT-D interactions. General anesthesia with specific CRT-D reprogramming allowed for successful hip arthroplasty without adverse events or electrosurgical interference in an 83-year-old male with severe left ventricular dysfunction.
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