Cardiac Devices and Electromagnetic Interference Revisited: New Radiofrequency Technologies and Implications for Dermatologic Surgery

Abstract

BACKGROUND AND OBJECTIVE. As the number of patients with implantable cardiac devices escalates, inadvertent electromagnetic interference (EMI) by electrosurgery carries increasing concern for patient safety. Given the trend for dermatologic care delivery by nonphysician providers, supervising physicians must carefully consider the adequacy of perioperative evaluation in elective or cosmetic settings. Rapidly evolving technology also calls into question potential EMI of new therapeutic modalities (radiofrequency resurfacing, electrochemotherapy, and endovenous ablation). The most recently published recommendations (1998) for care of dermatologic patients with cardiac devices do not differ significantly from guidelines proposed in 1975. These recommendations, based on complications experienced during

Error Avoidance in Dermatologic Surgery

“…This can lead to permanent damage of the pacemaker and cause arrhythmias, inappropriate sensing, and rapid pacing [49,46]. The risk of interference is dependent on multiple factors but it is most common when monopolar cautery is used for sustained periods (>5 s) [50]. If electrosurgery cannot be avoided in patients with pacemakers, then bipolar forceps and true thermal cautery should be used [50].…”

Investigation of Hyfrecators and Their In Vitro Interference with Implantable Cardiac Devices

“…Advances in CRM devices have decreased the potential for EMI. In approximately 2004, the device input protection capabilities increased because of industry improvements in the technology and miniaturization of certain components (Medtronics personal communication), including improvements in filter feed‐through and signal‐processing algorithms that can squelch signals outside of cardiac depolarization frequencies of 10 to 50 Hz …”

“…In approximately 2004, the device input protection capabilities increased because of industry improvements in the technology and miniaturization of certain components (Medtronics personal communication), including improvements in filter feed-through and signalprocessing algorithms that can squelch signals outside of cardiac depolarization frequencies of 10 to 50 Hz. 1,3 A hyfrecator works by emitting low-power highfrequency alternating current electrical pulses through an electrode mounted on a hand piece. The electrode can be monoterminal, with the current passing to the patient, or biterminal, with the current passing through the patient and returning to a second electrode.…”

“…T here have been previous reports in the dermatologic literature reviewing the electromagnetic interference (EMI) potential of electrosurgical devices in patients with cardiac devices. [1][2][3] They give excellent reviews of the cardiac devices and provided recommended precautionary measures to take when performing surgery on these patients in an office-based setting, but these precautions are not based on safety guidelines specific to hyfrecators. Additionally, our literature search did not reveal any studies specifically addressing the electromagnetic interference of hyfrecators with cardiac devices.…”

Electrosurgery and Implantable Electronic Devices: Review and Implications for Office-Based Procedures

“…The latest models are demand pacemakers that sense the heart's intrinsic rhythm and inhibit pacing in the same chamber or trigger pacing in another cardiac chamber. 5,6 These devices also have sophisticated timing features to optimize heart rates and even treat some atrial arrhythmias.…”