5.4 ICDs Flashcards
Q4 — Implantable cardiac devices
a) List any four possible indications for the insertion of a cardiac implantable permanent pacemaker.
● Sick sinus syndrome.
● Recurrent symptomatic bradycardia.
● Third-degree heart block.
● Advanced second-degree heart block.
● Heart rate less than 40.
● Ventricular pauses greater than 5 seconds.
● Periods of asystole more than 3 seconds.
● Trifascicular block.
● Biventricular pacing in patients with cardiac failure
b) List any four possible indications for the insertion of a cardiac
implantable cardioverter defibrillator (ICD).
● VF/VT cardiac arrest.
● Symptomatic recurrent VT.
● Recurrent haemodynamically unstable SVT.
● Structural heart disease.
● Cardiomyopathy
(ischaemic, dilated).
● Conduction disorders.
● Acquired or inherited spontaneous
arrhythmogenic conditions.
c) What factors would you check/consider preoperatively in a patient with these types of devices?
● History, examination and optimisation
(of fluids, electrolytes and medications).
● Check device information —
device type (pacemaker vs. ICD;
pacemaker patient identification card).
● Time since last check of the device
(6 months ICD; 12 months PPM).
● Battery life.
● ECG —
to check the function and the patient’s
dependency on their pacemaker.
● CXR.
● Physiologist advice on the device.
● Determine the device behaviour with a magnet.
● Turn off advanced rate response function.
● The defibrillator function of an ICD should be deactivated immediately before any surgery where electromagnetic interference is deemed likely.
d) Outline the main features of intraoperative and postoperative management of patients with these types of devices having elective surgery under general anaesthetic
● Monitor ECG continuously.
● Consider invasive blood pressure
monitoring to check mechanical capture
(especially if poor ventricular function).
● Bipolar diathermy.
● If unipolar diathermy is used, minimise the effects.
● Defibrillation pads applied.
● Defibrillator pad placement to
avoid/reduce electrical flow
through intracardiac leads.
● Defibrillator capable of pacing readily available.
● Drugs for cardiopulmonary resuscitation
immediately available.
● Stable induction and maintenance of anaesthesia.
● Consider avoiding succinylcholine.
● Back-up pacing and defibrillation
facilities readily available in recovery.
● Postoperative device check and
reprogramming if needed.
● Follow the ALS® algorithms to
treat bradyarrhythmias and tachyarrhythmias.
