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Anesthesia > Pace maker and ICD > Flashcards

Pace maker and ICD Flashcards

1
Q

What is the first step in managing a preop pt with implanted cardiac rhythm devices

A

If available, review ECG/rhythm strip, CXR, CPAP ICD/pacemaker information form, interrogation report, and/or cardiology note. Use these to determine underlying heart rhythm, device type, magnet behavior, and other applicable information.

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2
Q

If the device has no defibrillator and no electromagnetic interference (EMI) anticipated with procedure, can procedure be proceeded?

A

Yes

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3
Q
  1. no defibrillator

2. EMI will NOT be of significant duration & EMI pathway NOT be near device or leads (<15cm)

A

Proceed with magnet available but usually better if not used. Consider verifying magnet response

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4
Q
  1. no defibrillator
  2. EMI will be of significant duration & EMI pathway be near device or leads (<15cm)
  3. but pt is NOT pacemaker dependant
A

Proceed with magnet available but usually better if not used. Consider verifying magnet response

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5
Q
  1. no defibrillator
  2. EMI will be of significant duration & EMI pathway be near device or leads (<15cm)
  3. pt is pacemaker dependant
  4. magnet use is feasible
A

Verify pacing response to magnet and consider impact of asynchronous pacing. Apply magnet prophylactically or if any evidence of problematic bradycardia.

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6
Q
  1. no defibrillator
  2. EMI will be of significant duration & EMI pathway be near device or leads (<15cm)
  3. pt is pacemaker dependant
  4. magnet use is NOT feasible
A

Contact EP RN to reprogram pacemaker

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7
Q
  1. The device has defibrillator

2. NOT anticipate EMI with procedure

A

Proceed with procedure. Consider having magnet and cutaneous defibrillation pads available. Remember, magnet will not affect pacing behavior

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8
Q
  1. The device has defibrillator
  2. Anticipate EMI with procedure
  3. EMI will unlikely be of significant duration & EMI pathway NOT be near device or leads (<15cm)
  4. magnet use is feasible
A

Apply magnet to disable defibrillator. Consider verifying magnet response (and if Guidant/Boston Scientific see page 4). 1 Monitor rhythm for pacemaker inhibition. Ensure external defibrillation equipment available and consider applying cutaneous defibrillation pads. If VT/VF occurs, remove magnet to enable ICD and prepare for backup external defibrillation.

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9
Q
  1. The device has defibrillator
  2. Anticipate EMI with procedure
  3. EMI will unlikely be of significant duration & EMI pathway NOT be near device or leads (
A

Contact EP RN to reprogram device to disable defibrillation therapy. Ensure external defibrillation equipment available. Apply cutaneous defibrillation pads, if possible.

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10
Q
  1. The device has defibrillator
  2. Anticipate EMI with procedure
  3. EMI will likely be of significant duration & EMI pathway NOT be near device or leads (
A

Consider magnet application if feasible2 and verify magnet response (and if Guidant/Boston Scientific see page 4). 1 Otherwise contact EP RN to reprogram and disable defibrillation therapy. Ensure external defibrillation equipment available.
Apply cutaneous defibrillation pads if possible, especially if defibrillation turned off.

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11
Q
  1. The device has defibrillator
  2. Anticipate EMI with procedure
  3. EMI will likely be of significant duration & EMI pathway NOT be near device or leads (
A

Contact EP RN to reprogram device to adjust pacemaker and disable defibrillator. Ensure external defibrillation equipment available and apply cutaneous defibrillation pads if possible.

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12
Q

General

A

Monitor for undesired rate responsive pacing functions or disable if indicated. After procedure, call for post-procedure device interrogation if indicated

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13
Q

How to verify magnet response?

A
  1. CPAP ICD/PPM form
  2. d/w company representative
  3. interrogation report
  4. magnet on–>EKG (12 lead), hemodynamic changes, symptoms, etc.
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14
Q

Does magnet affect pacing behavior if the device has a defibrillator?

A

NO, it only affect defibrillator function

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15
Q

Magnet use feasible means?

A

A magnet can be maintained securely in position over the device during the procedure and manipulated if needed.

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16
Q

How to determine pacemaker dependence?

A
  1. A &/or V pacing on ECG–>stop or lowering pacing rate–>intrinsic rhythm & conduction
  2. know reason for needing PM
  3. estimate perioperative stress
17
Q

Asynchronous pacing modes

A
  1. by programming or by magnet
  2. VOO or DOO: unaffected by underlying cardiac activity
  3. AOO rarely used
  4. deterioration: asynchrony/A-V competition or R on T phenomenon
18
Q

VOO

A
  1. detrimental to CO except in Af

2. may be tolerated by healthier pt for short case

19
Q

rate-responsive features

A
  1. sensor–>automatically adjust rates
  2. generally time-limited
  3. not disabled by magnet
  4. consider disabling it prior surgery if acceleration of HR is detrimental
20
Q

WHEN TO INTERROGATE POST-OPERATIVELY?

A
  1. programming change preoperatively
  2. external defibrillation used
  3. possible device damage or dysfunction
  4. clinically indicated
  5. if likely not resuming pre-magnet setting if magnet used
21
Q

Electrocautery considerations?

A
  1. grouding pad –>EMI pathway far away from device
  2. short, non-sustained burst of monopolar electrocautery
  3. bipolar electrocautery
22
Q

How to determine device manufacturer?

A
  1. CPAP form, implant report, Pt
  2. CXR: code letters
  3. manufacturer’s hotline: name, DOB
  4. Asynchronous pacing rate
23
Q

Contact phone numbers

A 
EP nurse (Mon-Fri):	(314) 424-0487
EP Fellow (after hours):	(314) 424-4680
Guidant/Boston Scientific	(800) 227-3422
Medtronic	(800) 878-5616
St. Jude	(800) 722-3423
24
Q

CRT-Ds

A

Cardiac Resynchronization Therapy Defibrillators (CRT-Ds).

25
Q

Boston Scientific ICDs & CRT-Ds

A
  1. If programmed to respond to magnet–>can use magnet to inhibit tachy therapy
  2. small subset need to contact technical services

Anesthesia (11 decks)

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