Perioperative Management of Cardiac Implantable Electronic Devices: A Single-Center Report of 469 Interrogations

An Unexpected Magnet Response of a Biotronik Pacemaker in Automatic Mode: A Case Report

“…[5][6][7] In 1 report, 6 of 38 Biotronik pacemakers that were interrogated at a single center were in the AUTO mode. 8 It is important for anesthesiologists to identify patients presenting for surgery with Biotronik pacemakers with AUTO as the magnet response mode who require asynchronous pacing. The interrogation report may state that the magnet response is AUTO and include headings labeled "magnet cycle 1-10" with an asynchronous pacing mode, such as DOO, and "magnet cycle 11…" with the original pacing mode.…”

“…1,3,6,7,12 Biotronik has 3 modes of magnet response: AUTO, SYNC, and ASYNC. [5][6][7][8][9] The magnet response with the AUTO mode directs a pacemaker to asynchronously pace (ie, DOO) at a rate of 90 bpm for 10 beats, after which the pacemaker reverts to the original pacing mode. 3,5,8 The AUTO mode can be used to obtain 10-beat electrocardiograms with pacing to assess device function with certain features disabled, such as the event counter, and may be more comfortable for patients while these assessments are made according to Biotronik.…”

“…[5][6][7][8][9] The magnet response with the AUTO mode directs a pacemaker to asynchronously pace (ie, DOO) at a rate of 90 bpm for 10 beats, after which the pacemaker reverts to the original pacing mode. 3,5,8 The AUTO mode can be used to obtain 10-beat electrocardiograms with pacing to assess device function with certain features disabled, such as the event counter, and may be more comfortable for patients while these assessments are made according to Biotronik. 5,6 A Biotronik pacemaker in the SYNC mode will not respond to magnet application with asynchronous pacing, but will continue with the original pacing settings.…”

“…3,4 Furthermore, some CIED experts may be less familiar with Biotronik pacemakers or find changing the magnet mode to be more technically challenging, and prefer reprogramming to asynchronous pacing. 8 Before patients leave the postanesthesia care unit, it is important to restore reprogrammed Biotronik pacemakers to the original pacing settings and ensure that the pacemaker has not entered an emergency backup mode. [1][2][3][4] If the pacemaker magnet mode is changed from the AUTO mode to the ASYNC mode, consider discussing with a CIED expert whether to leave the patient's pacemaker in the ASYNC mode, so a magnet can be used for sustained asynchronous pacing in the future.…”

“…The AUTO mode is the manufacturer's default magnet response mode. [5][6][7][8][9] Anesthesiologists should be aware of the characteristics of the Biotronik pacemaker magnet modes, have strategies to identify each magnet response, and, when needed, contact a cardiovascular implantable electronic device (CIED) expert to adjust pacemaker settings for surgery. The patient provided Health Insurance Portability and Accountability Act of 1996 written authorization for the publication of this case report.…”