Endoscopic Electrosurgery in Patients with Cardiac Implantable Electronic Devices

Abstract

Background/Aims:Patients with cardiac implantable electronic devices (CIEDs) undergoing endoscopic electrosurgery (EE) are at a risk of electromagnetic interference (EMI). We aimed to analyze the effects of EE in CIED patients.Methods:Patients with CIED who underwent EE procedures such as snare polypectomy, endoscopic submucosal dissection (ESD), and endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) were retrospectively analyzed. Postprocedural symptoms as well as demographic and outpatient follow-up data were reviewed through medical records. Electrical data, including preprocedural and postprocedural arrhythmia records, were reviewed through pacemaker interrogation, 24-hour Holter monitoring, or electrocardiogram.Results:Fifty-nine procedures in 49 patients were analyzed. Fifty procedures were performed in 43 patients with a pacemaker, and nine were performed in six patients with an implantable cardioverter-defibrillator. There were one gastric and 44 colon snare polypectomies, five gastric and one colon ESDs, and eight ERCPs with EST. Fifty-five cases of electrical follow-up were noted, with two postprocedural changes not caused by EE. Thirty-one pacemaker interrogations had procedure recordings, with two cases of asymptomatic tachycardia. All patients were asymptomatic with no adverse events.Conclusions:Our study reports no adverse events from EE in patients with CIED, suggesting that this procedure is safe. However, because of the possibility of EMI, recommendations on EE should be followed.

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

“…Consequently, the indifferent return pad should be placed as far away from the CIED as possible, keeping the surgical site between the CIED and the return electrode (Figure 15). [494][495][496][497] In patients with implantable loop recorders (especially those not undergoing remote monitoring and regular downloads of the CIED memory), the device memory download is to be considered…”

Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter–Defibrillators 2020

“…Observational studies report that electromagnetic interference may occur during monopolar electrosurgery, [11][12][13][14][15] radiofrequency ablation, [16][17][18][19][20][21] magnetic resonance imaging, [22][23][24][25][26][27][28][29][30][31][32][33][34][35] and radiation therapy [36][37][38][39][40][41][42] (Category B3-H evidence). Case reports also indicate the occurrence of electromagnetic interference during monopolar electrosurgery, [43][44][45][46][47][48][49][50] bipolar electrosurgery, 51 radiofrequency ablation, [52][53][54] magnetic resonance imaging, [6][7][8][9]…”

A Review of Capacitive Return Electrodes in Electrosurgery

“…Patients with cardiac implanted electronic devices (CIED) are at risk of experiencing electromagnetic interference (EMI) when monopolar electrosurgery is used in a surgical procedure. [10] EMI events can be serious and may lead to patient injury. Rozner et al [11] presented a case series of 3 patients with implantable cardioverter-defibrillator (ICDs) that were treated with electrosurgery, but not per the current guidelines as described by the American Society of Anesthesiologists (ASA) or Heart Rhythm Society (HRS).…”