Key result
In patients with implanted CRT devices undergoing non-cardiac surgery, there were no intraoperative adverse device effects, and routine prophylactic device reprogramming to asynchronous pacing appears inessential.
Why the study?
Data on the perioperative management and outcomes of CRT device carriers undergoing surgery unrelated to the device were scarce.
Does non-cardiac surgery increase the risk of adverse device effects in patients with implanted CRT devices?
Observational (n=198)
Yes
Does non-cardiac surgery increase the risk of adverse device effects in patients with implanted CRT devices?
Routine prophylactic device reprogramming to asynchronous pacing or sensor deactivation is generally not required for CRT patients undergoing non-cardiac surgery, though comprehensive pre- and post-operative interrogation remains mandatory.
BACKGROUND: ICDs and pacemakers for cardiac resynchronization therapy (CRT) are complex devices with different sensors and automatic algorithms implanted in patients with advanced cardiac diseases. Data on the perioperative management and outcome of CRT carriers undergoing surgery unrelated to the device are scarce. METHODS: Data from 198 CRT device carriers (100 with active rate responsive sensor) were evaluated regarding perioperative adverse (device-related) events (A(D)E) and lead parameter changes. RESULTS: Thirty-nine adverse observations were documented in 180 patients during preoperative interrogation, which were most often related to the left-ventricular lead and requiring intervention/reprogramming in 22 cases (12%). Anesthesia-related events occurred in 69 patients. There was no ADE for non-cardiac surgery and in pacemaker-dependent patients not programmed to an asynchronous pacing mode. Post-operative device interrogation showed significant lead parameter changes in 64/179 patients (36%) requiring reprogramming in 29 cases (16%). CONCLUSION: The left-ventricular pacing lead represents the most vulnerable system component. Comprehensive pre and post-interventional device interrogation is mandatory to ensure proper system function. The type of ICD function suspension has no impact on each patient's outcome. Precautionary activity sensor deactivation is not required for non-cardiac interventions. Routine prophylactic device reprogramming to asynchronous pacing appears inessential. Most of the CRT pacemakers do not require surgery-related reprogramming.
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Niedermeier et al. (2021) conducted an observational in Patients with implanted CRT devices undergoing non-device associated surgery (n=198). Non-device-related surgery or catheter interventions was evaluated on Number and type of perioperative adverse device effects (ADE). In patients with implanted CRT devices undergoing non-cardiac surgery, there were no intraoperative adverse device effects, and routine prophylactic device reprogramming to asynchronous pacing appears inessential.
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