Key result
Monopolar electrocautery during hip surgery triggers inappropriate ICD shocks via electromagnetic interference.
Why the study?
The use of underbody dispersive electrodes placed on the operating table for monopolar electrosurgery is increasing, but little is known about the risk of electromagnetic interference in patients with a CIED.
Case Report (n=1)
No
Umbilical-level underbody electrodes risk inappropriate ICD shocks in hip surgery; extends EMI concerns beyond traditional high-risk sites and warrants prospective evaluation.
During surgery, cardiac implantable electronic device (CIED) function may be disrupted by electromagnetic interference (EMI) from monopolar electrosurgery and cause adverse sequelae. Monopolar electrosurgery requires a dispersive electrode. While a conventional electrode is affixed to the patient, use of "underbody" electrodes placed on the operating table is increasing. We present a case in which an underbody electrode was used, and EMI occurred even though the surgical site was inferior to the umbilicus. Since little is known about EMI risk with underbody electrodes, practitioners should be wary of their use in CIED patients undergoing surgery until more information is available.
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Tully et al. (2020) conducted a case report in Non-ischemic cardiomyopathy with an implantable cardioverter-defibrillator undergoing left total hip arthroplasty (n=1). Monopolar electrocautery with a dispersive return electrode placed on the back at the level of the umbilicus was evaluated on Inappropriate ICD therapy due to electromagnetic interference (EMI). Monopolar electrocautery with an umbilical-level return electrode caused electromagnetic interference triggering 9 inappropriate 30 J ICD shocks and 4 anti-tachycardia pacing events during hip surgery.
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