Key result
Magnet-assisted asynchronous pacing enables safe spinal anaesthesia in a patient with a permanent pacemaker.
Why the study?
Patients with CIEDs frequently require non-cardiac surgery, necessitating careful perioperative planning, and regional anaesthesia may offer advantages over general anaesthesia in selected cases.
Case Report (n=1)
No
Low-dose spinal anaesthesia combined with magnet-assisted asynchronous pacing is a safe and effective strategy for selected patients with permanent pacemakers undergoing lower abdominal surgery.
May support individualized CIED management under spinal anesthesia; hypothesis-generating and leaves open need for prospective validation.
Patients with cardiac implantable electronic devices (CIEDs) are increasingly presenting for non-cardiac surgery, requiring careful perioperative planning to avoid electromagnetic interference, device malfunction, and haemodynamic instability. Although general anaesthesia is frequently used in such patients, regional anaesthesia may offer several advantages when appropriately selected. We report the successful perioperative management of a 75-year-old man with coronary artery disease and a VVIR permanent pacemaker who underwent elective Lichtenstein hernioplasty under spinal anaesthesia. Following a multidisciplinary evaluation, the pacemaker was temporarily converted to asynchronous VOO pacing using magnet application. Continuous electrocardiographic monitoring, avoidance of monopolar electrocautery, availability of external defibrillation, and perioperative cardiology support ensured a safe perioperative period. The intraoperative and postoperative periods were uneventful. This case highlights the importance of structured CIED assessment, individualised pacemaker management, and careful haemodynamic monitoring when neuraxial anaesthesia is considered in patients with permanent pacemakers.
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Kumar et al. (2026) conducted a case report in Inguinal hernia in a patient with a permanent pacemaker (n=1). Spinal anaesthesia with magnet application for asynchronous pacing was evaluated on Perioperative safety and haemodynamic stability. Spinal anaesthesia combined with temporary magnet-assisted asynchronous pacing allowed for safe and haemodynamically stable perioperative management of a patient with a permanent pacemaker.
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