External Defibrillation/Cardioversion Protocol in Patients With an Implanted Cardioverter Defibrillator or Pacemaker: Systematic Review and Meta-Analysis

Abstract

Introduction: The use of cardiac implantable electronic devices (CIED) is increasing, and implanted patients require more often interventional procedures such as external defibrillation (ED) and electrical cardioversion (ECV). The creation of periprocedural care algorithms for patients with CIED is complex: the different programming capabilities of currently manufactured devices, confusion regarding the differences between pacemakers (PM) and implanted cardiac defibrillator (ICD), the use of old devices in some patients and lastly the continuous evolution in CIED technology with the introduction of leadless PM and subcutaneous implanted cardioverter defibrillators (S-ICD). Procedural advisories have been developed by professional societies, but the recommendations of these societies differ regarding to ED and ECV use. Methods: We performed a systematic database search of studies published between January 2000 and October 2021 assessing ED and ECV by the selection process (PRISMA) and identified 5 prospective eligible articles. Two meta-analyses assessed the proportion of patients with complications and the proportion of patients with no clinicallly relevant parameter modifications, respectively. Results: The final population for the meta-analysis included 2077 patients. The meta-analysis showed a weighted random pooled effect size of 0.55% (95% CI = 0.04% − 1.06 %) for complications, and of 22.4% (95% CI = 2.03% – 42.7%) for no clinically relevant modification parameters. Conclusions: Our review indicates that few dysfunctions are detectable in patients with chest implanted CIED treated with ECV or ED. When an impanted patient undergoes ECV or ED procedures, caution is needed including CIED interrogation before and after the procedure.