Copenhagen, Denmark – 3 April 2022: Recommendations on the prevention and management of interference caused by medical procedures in patients with implanted electronic cardiac devices is published today in EP Europace,1 a journal of the European Society of Cardiology (ESC) and presented at EHRA 2022,2 a scientific congress of the ESC.
“Interference is frequently caused by numerous medical interventions, but rare consequences are largely avoidable if preventive actions are taken,” said lead author Professor Markus Stühlinger of the Medical University of Innsbruck, Austria. “The document outlines what medical staff should do before and during different types of medical procedures. Patients can also contribute by carrying their device card which specifies the type, model and manufacturer.”
The paper covers pacemakers, which keep the heart beating regularly and not too slowly; defibrillators, which stop potentially fatal heart rhythms by delivering a shock; and loop recorders, used to detect and diagnose arrhythmias.
Interference that may affect the functioning of these devices can occur during medical procedures due to electromagnetic fields (for example during surgery), a magnetic field (i.e. magnetic resonance imaging; MRI), radiation (e.g. cancer treatment), or acoustic waves (e.g. lithotripsy to destroy kidney stones). The result is that the electronic cardiac device may stop working temporarily or permanently, or deliver an unneeded shock.
Modern surgery typically uses electrocautery, where an electrical current is delivered via a scalpel. “If the procedure is close to the generator of a pacemaker or defibrillator, the device may recognise the signal and respond to it inappropriately,” explained Professor Stühlinger. “This can cause inhibition of pacing, leading to a drop in heart rate, or an unnecessary shock because the device erroneously detects a dangerous arrhythmia.”
The authors outline the steps that should be taken to prevent device malfunctioning due to interference. For surgery, the first step is to check how reliant the patient is on the device – for example, does he or she need constant pacing or not? In addition, medical staff should check that the device and its battery are working properly. The second step is to test how the device responds to having a magnet placed next to it. If the device reacts as expected, then surgery can proceed normally, and the ECG and pulse should be monitored. If the device behaviour is abnormal, a magnet can be placed near the device during surgery to inhibit interference from electrocautery.
It is estimated that 50% to 75% of patients with implanted cardiac devices will need an MRI scan during the lifetime of their device. The document states that MRI should only be performed in patients with these devices in centres with appropriate teams, protocols, and equipment. “Collaborative relationships between radiologists, physicists, cardiologists, and allied health staff members are essential for safe outcomes,” state the authors. They recommend reprogramming the cardiac device before and after a scan and provide detailed instructions.
For radiation, there is a small risk that cardiac devices will not function properly after therapy. Professor Stühlinger said: “Pacemakers and implanted defibrillators should be checked regularly during radiation treatment, either with remote monitoring or a weekly in-person appointment.
He concluded: “This is a comprehensive report describing the preventive measures that should be employed to ensure that patients with implanted cardiac devices can undergo medical procedures safely.”
The international consensus statement was developed by the European Heart Rhythm Association (EHRA), a branch of the ESC; the Heart Rhythm Society (HRS); the Asia Pacific Heart Rhythm Society (APHRS); and the Latin American Heart Rhythm Society (LAHRS). It is also published in Heart Rhythm, the official journal of the HRS, Journal of Arrhythmia, the official journal of the APHRS, and Journal of Interventional Cardiac Electrophysiology, the official journal of the LAHRS.
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Notes to editor
Disclosures: Please see the paper.
References and notes
1Stühlinger M, Haran Burri H, Vernooy K, et al. EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices (CIED). EP Europace. 2022.
2The paper will be presented during the session “EHRA scientific documents 2022” on 3 April at 08:20 to 09:20 CEST.
The European Heart Rhythm Association (EHRA) is a branch of the European Society of Cardiology (ESC). Its aim is to improve patients’ quality of life and reduce sudden cardiac death by limiting the impact of heart rhythm disturbances.
About the EHRA Congress #EHRA2022
EHRA 2022 is the annual congress of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC).
The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.
About the Heart Rhythm Society
The Heart Rhythm Society (HRS) is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards. Incorporated in 1979 and based in Washington, DC, it has a membership of more than 7,000 heart rhythm professionals in more than 90 countries around the world. For more information, visit www.HRSonline.org.
About the Asia Pacific Heart Rhythm Society
The Asia Pacific Heart Rhythm Society (APHRS) is the international organisation specialising in science and education for cardiac arrhythmia professionals. For members, the society regularly offers various educational programmes at the state-of-the-art laboratories with excellent lectures. For more information, visit www.aphrs.org.
About the Latin American Heart Rhythm Society
The Latin American Heart Rhythm Society (LAHRS) was founded in 2017 with the aim of continuing the mission started by Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE) more than twenty years ago, promoting the improvement of the quality of life and reducing mortality related to cardiac arrhythmias in the Latin American population. For more information, visit http://www.lahrs.org.
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