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

Abstract

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.

Pacemaker Failure to Capture Caused by Electrocautery: A Rare Pacemaker Pulse Generator Change Complication

“…Transient suppression of PM by EC is not uncommon, but prolonged failure to capture, as in our case, has been reported earlier but is a rare finding [4,13,14]. Mangar et al described the case of a 15-year-old female undergoing surgery who had her PM (ventricular demand pacing (VVI)) switched to asynchronous mode but experienced asystole with the application of unipolar EC, which caused decreased device voltage and failure [13].…”

“…This issue was circumvented when they used cutting EC. Modulated signals are used for cutting EC using bursts of energy versus coagulation EC where unmodulated signals heat the tissue [14]. Nagarakanti et al described two cases.…”

Emergency Neurosurgery in a Patient With Pacemaker: The Double Trouble

“…Electromagnetic interference during the use of cautery can trigger the anti-tachyarrhythmia function and lead to bradycardia or even asystole in a patient who is pacemaker-dependent. In a previous case report, electromagnetic interference-induced asystole was reported in a 74-year-old male patient undergoing spine surgery with DDDR (dual-chamber paced, dual-chamber sensed, dual response to sensing, and rate modulated) pacemaker in-situ [ 8 ]. Continuous ECG monitoring plays an important role in such cases for the detection and treatment of intraoperative arrhythmias.…”

Perioperative Management of Patients with Cardiac Implantable Electronic Devices and Utility of Magnet Application

“…In pacing-dependent patients, EMI may lead to oversensing and inappropriate pacing inhibition with the risk of asystole [23,24]. In ICD patients, EMI may induce inappropriate anti-tachycardia pacing or defibrillation [25,26] which may cause sudden patient movement, possibly at a critical moment during surgery or may even induce a ventricular arrhythmia [27] with possible fatal outcome in extreme scenarios [28].…”