Deactivation of a Demand Pacemaker by Transurethral Electrocautery

Wajszczuk, Waldemar J.; Mowry, Frank M.; Dugan, Norbert L

doi:10.1056/nejm196901022800108

Cited by 66 publications

(18 citation statements)

References 6 publications

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“…Almost all the previously reported cases of EMI occurred with the cutting mode[4–6] and not with the coagulation mode of surgical electrocautery in patients with cardiac pacemakers. These reports could be explained by the fact that the cutting mode is generally utilized in settings of higher power than those in the coagulation mode; and because of its function, it is applied for a longer period of time for tissue cutting compared to a very brief burst of energy to coagulate a bleeding vessel.…”

Section: Discussionmentioning

confidence: 99%

“…[3] Moreover, EMI can cause serious intraoperative hemodynamic sequelae. This type of interference has almost always been reported in association with the cutting mode of monopolar electrocautery[4–6] but rarely in association with the coagulation mode. We report a case of EMI resulting in asystole caused by monopolar surgical electrocautery in the coagulation mode, which did not occur during the use of the cutting mode.…”

Section: Introductionmentioning

confidence: 99%

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Electromagnetic interference in a cardiac pacemaker during cauterization with the coagulating, not cutting mode

Abdelmalak

Jagannathan

Arain

et al. 2011

J Anaesthesiol Clin Pharmacol

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Electromagnetic interference in pacemakers has almost always been reported in association with the cutting mode of monopolar electrocautery and rarely in association with the coagulation mode. We report a case of electrocautery-induced electromagnetic interference with a DDDR pacemaker (dual-chamber paced, dual-chamber sensed, dual response to sensing, and rate modulated) in the coagulating and not cutting mode during a spine procedure. We also discuss the factors affecting intraoperative electromagnetic interference. A 74-year-old man experienced intraoperative electromagnetic interference that resulted in asystole caused by surgical electrocautery in the coagulation mode while the electrodispersive pad was placed at different locations and distances from the operating site (This electromagnetic interference did not occur during the use of the cutting mode). However, because of careful management, the outcome was favorable. Clinicians should be aware that the coagulation mode of electrocautery can cause electromagnetic interference and hemodynamic instability. Heightened vigilance and preparedness can ensure a favorable outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Electromagnetic interference in a cardiac pacemaker during cauterization with the coagulating, not cutting mode

Abdelmalak

Jagannathan

Arain

et al. 2011

J Anaesthesiol Clin Pharmacol

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“…Pacemaker function may be affected in a variety of ways [2]. Most commonly, electrical interference set up by the diathermy circuit can be misinterpreted by the pacemaker as spontaneous cardiac electrical activity and lead to inhibition of the pulse generator and cessation of ventricular contraction [3]. If diathermy is performed close to the pulse generator its internal circuitry may be damaged [4] or the pacemaker may be reprogrammed because the interference produced mimics the programming device [5].…”

Section: Discussionmentioning

confidence: 99%

Pacemaker failure during transurethral resection of the prostate

Kellow

1993

Anaesthesia

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SummaryA case is described of the intra-operative failure of an implanted pacemaker during transurethral prostatic resection caused by a diathermy-related increase in capture threshold which coincided with massive haemorrhage from the operative site. Key wordsEquipment; pacemakers, diathermy. Complications; pacemaker failure. Surgery; prostatectomy. Haemorrhage.There are more than 25000 patients in the United Kingdom with an implanted permanent pacemaker [I]. It is likely that this number will steadily increase, so that pacemaker-dependent patients will present for surgery more frequently. Although it is generally assumed that modern pacemakers are immune from the effects of surgical diathermy, problems may still occur. This report describes a patient in whom the use of unipolar diathermy for transurethral resection of the prostate (TURP) was associated with pacemaker failure. Case historyA 70-year-old man with a history of benign prostatic hypertrophy was admitted for elective transurethral prostatic resection. Three years prior to surgery he had developed complete heart block resulting in syncopal episodes for which a Biotronik Diplos 05 pacemaker had been implanted. This is a modern programmable device designed for atrial and ventricular pacing and it was programmed accordingly in the D D D mode (dual chamber sensing and pacing). It had been checked 6 months before surgery when it had been noticed that the ventricular capture threshold was higher than the lower output setting of the pulse generator (2.5 volts) so that, in order to achieve ventricular stimulation, the device had to be set on its maximum output of 5.0 volts. The threshold of the atrial lead was not elevated.The patient was taking enalapril 5 mg once daily for hypertension and was otherwise well. He was seen preoperatively by the cardiologists, who changed his pacemaker from D D D mode to VVI (on-demand ventricular pacing). His pre-operative electrocardiogram (ECG) showed pacemaker-generated potentials before each ventricular complex, implying that ventricular contractions were pacemaker-dependent. Two years previously he had undergone an uneventful T U R P under spinal anaesthesia with the existing pacemaker in place and he was keen to have the same anaesthetic technique on this occasion.He was premedicated with temazepam 10 mg and on arrival in the anaesthetic room a 14-G cannula was inserted under local anaesthesia, after which his circulation was volume preloaded with 1 I of Ringer lactate solution. He was monitored with continuous ECG, pulse oximetry and automatic noninvasive sphygmomanometry. A 26-G spinal needle was inserted into the L,, interspace, after infiltration with local anaesthetic, and isobaric 0.5% bupivacaine 3.5 ml was injected into the subarachnoid space. This produced a dense sensory and motor block to T, in 10 min and a decrease in blood pressure from 110/70 mmHg to 98/65 mmHg. He was then moved into the operating theatre where he was given oxygen 5 1.min-I by face mask and sedated with midazolam 2.5 mg, which produced no ...

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“…Die Neutralelektrode (Kauterplatte) sollte möglichst weit vom SM-System platziert und eine Kauteranwendung im Umkreis von weniger als 15 cm vom SM-Generator vermieden werden [75,76]. Prinzipiell kann es durch Hochfrequenzchirurgie zu Hemmung und/oder Triggerung des SM-Systems, aber auch zu Änderungen des Stimulationsmodus kommen [8,9,19,24,26,50,56,60,65,70,74,84,90,100,103,105]. Eine kontinuierliche Anwendung verursacht normalerweise ein Umschalten des SM in den asynchronen "noise interference mode", während intermittierendes Kautern zu jeweils vorüberge-hender Hemmung führen kann und ungünstigstenfalls längere Pausen bis hin zur Asystolie möglich sind [86].…”

Section: Quellen Elektromagnetischer Interferenzunclassified

Perioperative management of patients with implanted pacemakers or cardioverter/defibrillators

Gombotz

Monti²,

Leitgeb³

et al. 2009

Anaesthesist

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The perioperative risk for patients with pacemakers or implanted cardioverter/defibrillators (ICD) is mainly dependent on the underlying disease. However, severe to life-threatening complications of the implanted system can occur due to electromagnetic interference in the environment of the operation. These complications can be prevented or adequately treated by taking special precautions and measures. Even though the currently available data on the optimal perioperative management to pacemakers and ICDs is still unsatisfactory, the increasing clinical relevance of this topic was the reason for the formulation of recommendations by an interdisciplinary working group in Austria.

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Deactivation of a Demand Pacemaker by Transurethral Electrocautery

Cited by 66 publications

References 6 publications

Electromagnetic interference in a cardiac pacemaker during cauterization with the coagulating, not cutting mode

Electromagnetic interference in a cardiac pacemaker during cauterization with the coagulating, not cutting mode

Pacemaker failure during transurethral resection of the prostate

Perioperative management of patients with implanted pacemakers or cardioverter/defibrillators

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