Pacemakers in Noncardiac Surgery

Mohs Micrographic Surgery in a Patient with a Deep Brain Stimulator: A Review of the Literature on Implantable Electrical Devices

“…Bipolar leads reduce the susceptibility to electrosurgical interference because the short distance between the electrodes lessens the “antenna effect” and makes the system less vulnerable to stray current 46,47,54 . Indications for permanent cardiac pacing include third‐degree AV block, Mobitz II second‐degree heart block, sick sinus syndrome, atrial fibrillation and flutter with slow ventricular response, and symptomatic intraventricular conduction disturbances including a bifasicular or trifasicular block 52,55 …”

“…It is important to ensure that current between the surgical site and indifferent electrode passes as far from the generator as possible. Some authors recommend maintaining a distance of at least 15 cm between the surgical instrument and the pulse generator to minimize damage to the circuitry, especially with a unipolar pacemaker with a large “antenna effect.” 55,77 Application of current directly over a generator may destroy it and lead to direct passage of current to the heart 47,99 If possible, deactivate an implantable cardioverter‐defibrillator before the procedure to minimize inadvertent sensing of electromagnetic interference resulting in the delivery of an inappropriate shock.…”

“…46,47,54 Indications for permanent cardiac pacing include third-degree AV block, Mobitz II second-degree heart block, sick sinus syndrome, atrial fibrillation and flutter with slow ventricular response, and symptomatic intraventricular conduction disturbances including a bifasicular or trifasicular block. 52,55 Dermatologic surgeons should also be aware of the several different types of pacemaker generators that also exist. The simplest, but less frequently used, type is the asynchronous or ''fixed-rate'' generator.…”

Dertnatologic Electrosurgery in Patients with Implantable Cardioverter-Defibrillators and Pacemakers

“…We are not aware of any reported cases of ICD or pacemaker malfunction in patients treated with electrosurgery by dermatologists. Several articles describe strategies to reduce electromagnetic interference for pacemakers, 14,16,17,24–27 but no guidelines are suggested for ICDs. Manufacturers of pacemakers and ICDs (Medtronic, Minneapolis, MN; Cardiac Pacemakers Inc. [CPI], St. Paul, MN; Intermedics, Angleton, TX) suggest that since many variables are unknown the most conservative approach should be followed (Personal communications with technical support divisions, 16 Aug 1996).…”

“…The goal is to minimize the potential effect of electrosurgery on the implanted device by ensuring current between the surgical site and the return electrode passes as far away from the generator and heart as possible. Some authors have recommended the active tip of the electrosurgical instrument should not be used within 15 cm of the generator to prevent damage to the circuitry 26 . Direct application of electrocoagulation over a generator will likely destroy it and may result in direct passage of current to the heart 60 …”