Which organizations have released guidelines for the perioperative management of permanent pacemakers (PPMs) and automatic implantable cardioverter-defibrillators (AICDs)?

Updated: Oct 29, 2018
  • Author: Albert H Tsai, MD; Chief Editor: Sheela Pai Cole, MD  more...
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Advances in the development of CIEDs over the past two decades have led to growing acceptance of the use of these devices in increasingly complex patient populations. Indeed, an analysis of PPM trends from 1993 to 2009 revealed a 56% increase in the implantation rate despite concurrent increases in patient age and comorbidities. [2]

The increase in implantation notwithstanding, a 2011 survey of American Society of Anesthesiologists (ASA) members revealed substantial disagreement regarding various perioperative CIED management practices, suggesting an opportunity for improving awareness regarding the implications of CIEDs for surgical patients. [3]  To that end, with reference to the 2011 ASA practice advisory for perioperative management of patients with CIEDs, [3]  this article outlines a practical approach to evaluating and managing patients with PPMs and AICDs who present in the perioperative period.

The 2011 Heart Rhythm Society (HRS)/ASA expert consensus statement on perioperative management of CIEDs also recommended that the procedural team ask the patient’s CIED team for advice in order to mitigate perioperative risks. [4] The Department of Anesthesiology and Pain Medicine and the Division of Cardiology at the University of Washington described their development of a training program for a small group of anesthesiologists to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary. [5]

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