Key result
Educated anesthesia teams safely manage most CIED patients with magnets alone, improving workflows over formal interrogation.
Why the study?
Recent technological and philosophical advances have changed the perioperative management of patients with cardiac implantable electronic devices.
Can educated anesthesia teams independently manage CIED patients perioperatively with magnet application alone?
Can educated anesthesia teams independently manage CIED patients perioperatively with magnet application alone?
Educated anesthesia teams can safely manage most CIED patients perioperatively using magnet application alone, improving workflows without requiring formal device interrogation for every patient.
May support magnet-only management by trained anesthesia teams for most CIED patients; leaves open prospective validation before practice change.
PURPOSE OF REVIEW: There have been both technological and philosophical advances over the last decade regarding pacemakers and implanted cardioverter defibrillators (ICDs). Collectively, these devices are currently referred to as cardiac implantable electronic devices (CIEDs). Technological advances include the introduction of leadless pacemakers, subcutaneous defibrillators and cardiac event recorders, enhancements regarding compatibility of CIEDs for MRI scanning, the ability to interrogate devices remotely, and improved programming modes that preserve battery life. Philosophical advances have been mainly in the area of perioperative management of CIED patients. RECENT FINDINGS: Current practice recommendations now acknowledge that not every patient requires a formal interrogation of their CIED before and after surgery (as was previously recommended). The response to magnet application is standardized across manufacturer's platforms, and it is known that sources of electromagnetic interference remote from the CIED and its leads do not usually cause any interference with device function. SUMMARY: Educated anesthesia teams can independently manage the vast majority of CIED patients perioperatively with magnet application alone. Furthermore, this portends enhanced patient safety and improved workflows in the perioperative period.
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Feldman et al. (2020) conducted a review in Patients with cardiac implantable electronic devices (CIEDs) in the perioperative period. Perioperative management of CIEDs by anesthesia teams was evaluated. Educated anesthesia teams can independently manage the vast majority of CIED patients perioperatively with magnet application alone, enhancing patient safety and improving workflows.
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